Are You Getting These Nutrients? - Part 6

Iron is extremely important to our health, for without it our cells cannot get oxygen. And yet, especially for women of childbearing age, it's a fairly common mineral deficiency, and people on low-carb diets tend to eat less of it. Women of childbearing age need to get 18 mg per day in their diets, while others only need about 8 mg.

Low-Carb Sources of Iron

Chicken Liver, 3 oz - 11 mg iron

Beef Liver, 3 oz - 5.2 mg iron

Soybeans, cooked, 1/2 cup 4.4 mg iron, 3 gm net carb

Spinach, cooked, 1/2 cup - 3.2 mg iron, 2 gm net carb

Roast Beef, 3 oz 3.1 mg iron

Asparagus, 6 spears - 2 mg iron, 2 gm net carb

Iron is an essential mineral that is required for human life. Iron is found in the body's red blood cells, which carry oxygen-rich blood to every cell in the body. Iron is also involved in producing adenosine triphosphate (ATP), the body's energy source. Extra iron is stored in the liver, bone marrow, spleen, and muscles.

Not having enough iron can lead to anemia. The most common symptoms of anemia are weakness and fatigue. One reason people who are iron deficient get tired easily is because their cells do not get enough oxygen. Pregnant women, young women during their reproductive years, and children tend to be at highest risk of iron deficiency. Iron deficiency anemia in children is associated with poor neurodevelopment. Anemia may be mild, moderate, or severe. It can be caused by blood loss, such as that from a bleeding ulcer, menstruation, severe trauma, surgery, or a malignant tumor. It can also be caused by an iron-poor diet, not absorbing enough dietary iron, pregnancy, and the rapid growth that takes place during infancy, early childhood, and adolescence.

On the other hand, too much iron in the body can lead to a condition known as hemochromatosis, which can cause diabetes, liver damage, and discoloration of the skin. Unlike other nutrients, excess iron cannot be excreted by the human body. For that reason, you should not take iron supplements without asking your doctor if you need extra iron.

According to the World Health Organization (WHO), iron deficiency is the number one nutritional disorder in the world. Up to 80% of the world's population may be iron deficient, and 30% may have iron deficiency anemia.

Ferrous sulfate is the most common type of iron supplement. Other available forms include ferrous fumarate, ferrous succinate, ferrous gluconate, ferrous lactate, ferrous glutamate, ferric ammonium citrate, and ferrous glycine.

In severe cases of anemia from low levels of iron, or if there is rapid blood loss leading to iron deficiency, iron and blood are administered intravenously (IV) in hospitals.

Recommendations for iron are provided in the Dietary Reference Intakes (DRIs), developed by the Institute of Medicine of the National Academy of Sciences.

Adult

Eat a well-balanced diet, and only use iron supplements under the direction of a physician.

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a doctor.

The most common side effect from iron supplements is stomach upset, including discomfort, nausea, diarrhea, constipation, and heartburn. Taking iron supplements will often darken stool color.

Although the evidence is not clear, there may be an association between high iron stores and the risks of heart disease, cancer (such as breast cancer), and Alzheimer disease. In people with inflammatory bowel disease (Crohn's disease and ulcerative colitis), the parts of the intestine that are inflamed appear to have higher amounts of iron.

Iron overload disease is usually due to an inherited condition called hemochromatosis. But it may occur in people who take large amounts of iron over a long period of time. Symptoms include skin discoloration, diabetes, and liver damage, among other potential complications. According to the U.S. Food and Drug Administration (FDA), taking up to 45 mg of iron per day is safe. Whether taking more than that over a long period of time is safe is unknown. Severe iron overdose occurs with amounts of iron 50 to 100 times greater than the recommended dietary dose. Such iron toxicity can destroy cells in the gastrointestinal tract, which can cause vomiting, bloody diarrhea, and even death. Iron poisoning is the most common accidental poisoning in children. Keep iron supplements in childproof bottles and out of reach of children.

Intravenous (IV) iron, given in hospitals to treat severe anemia, can lead to headache, fever, swollen lymph nodes, painful joints, hives, and worsening of rheumatoid arthritis. In rare instances, it can cause anaphylaxis, a life-threatening allergic reaction.

Are You Getting These Nutrients? - Part 5

Magnesium is a mineral that many people do not eat enough of - some estimate that 30-50% of Americans don't reach the 400 mg recommended by the FDA. Unfortunately, people on low-carb diets may fare even worse - in one study, 70% of those 8 weeks into the Atkins diet were not eating sufficient magnesium. Worse, people with diabetes who respond to low-carb diets may need magnesium even more than others, since it is important in glucose metabolism and blood sugar control. Other functions of magnesium include participating in protein synthesis, bone development and maintenance, DNA synthesis, and cell function.

Low-Carb Sources of Magnesium

Pumpkin Seeds - 1 oz kernels, roasted - 156 mg magnesium, 2 gm net carb 

Spinach (also chard), 1/2 cup cooked - 78 mg magnesium, 2 gm net carb

Soybeans (try black soybeans), 1/2 cup cooked - 74 mg magnesium, 3 gm net carb

Almonds, 1 oz - 77 mg magnesium, 3 gm net carb

Peanuts, 1 oz - 52 mg magnesium, 4 gm net carb

Flax seed, 1 tablespoon - 40 mg magnesium, scant carb

Also: legumes, fish, green vegetables, and yogurt

Every organ in the body, especially the heart, muscles, and kidneys, needs magnesium. This mineral also contributes to the makeup of teeth and bones. Magnesium activates enzymes, contributes to energy production, and helps regulate levels of calcium, copper, zinc, potassium, vitamin D, and other important nutrients in the body.

You can get magnesium from many foods. However, most people in the U.S. probably do not get as much magnesium as they should from their diet. Foods rich in magnesium include whole grains, nuts, and green vegetables. Green leafy vegetables are particularly good sources of magnesium.

Although you may not get enough magnesium from your diet, it is rare to be deficient in magnesium. However, certain medical conditions can upset the body's magnesium balance. For example, an intestinal virus that causes vomiting or diarrhea can cause a temporary magnesium deficiency. Some health conditions can lead to deficiencies, including - gastrointestinal diseases, such as irritable bowel syndrome (IBS) and ulcerative colitis, diabetes, pancreatitis, hyperthyroidism (high thyroid hormone levels), kidney disease, and taking diuretics

Other factors that can lower magnesium levels include - drinking too much coffee, soda, or alcohol, eating too much sodium (salt), heavy menstrual periods, excessive sweating, and prolonged stress.

Symptoms of magnesium deficiency may include - agitation and anxiety, restless leg syndrome (RLS), sleep disorders, irritability, nausea and vomiting, abnormal heart rhythms, low blood pressure, confusion, muscle spasm and weakness, hyperventilation, insomnia, poor nail growth, and seizures

Many herbs, spices, and seaweeds supply magnesium, such as - agar seaweed, coriander, dill weed, celery seed, sage, dried mustard, basil, fennel seed, savory, cumin seed, tarragon, marjoram, and poppy seed.

Magnesium is available in many forms. Recommended forms include magnesium citrate, magnesium gluconate, and magnesium lactate, all of which are more easily absorbed into the body than other forms. Time-release preparations may improve absorption. Ask your doctor.

Other familiar sources are magnesium hydroxide (often used as a laxative or antacid) and magnesium sulfate (generally used orally as a laxative or in multivitamins, or added to a bath). Some magnesium, such as Epsom salts, can be absorbed through the skin. Preliminary research suggests Epsom salts can relieve swelling, inflammation, and ease muscle aches and pains.

Be sure to check with your health care provider before taking magnesium supplements and before giving them to a child. Under certain circumstances, such as certain heart arrhythmias or preeclampsia, a doctor will give magnesium by IV in the hospital.

It is a good idea to take a B-vitamin complex, or a multivitamin containing B vitamins, because the level of vitamin B6 in the body determines how much magnesium will be absorbed into the cells.

Dosages are based on the dietary reference intakes (DRIs) issued from the Food and Nutrition Board of the United States Government's Office of Dietary Supplements, part of the National Institutes of Health (NIH).

Adult

• Males, 19 to 30 years of age: 400 mg daily
• Females, 19 to 30 years of age: 310 mg daily
• Males, 31 years of age and over: 420 mg daily
• Females, 31 years of age and over: 320 mg daily
• Pregnant females, 19 to 30 years of age: 350 mg daily
• Pregnant females, 31 and over: 360 mg daily
• Breastfeeding females, 19 to 30 years of age: 310 mg daily
• Breastfeeding females, 31 years of age and over: 320 mg daily

A person's need for magnesium increases during pregnancy, recovery from surgery and illnesses, and athletic training. Speak with your doctor.

Because of the potential for side effects and interactions with medications, you should only take dietary supplements under the supervision of a doctor.

Since magnesium is excreted by the kidneys, people with heart or kidney disease should not take magnesium supplements except under their doctors' supervision.

It is very rare to overdose on magnesium from food. However, people who ingest large amounts of milk of magnesia (as a laxative or antacid), Epsom salts (as a laxative or tonic), or magnesium supplements may overdose, especially if they have kidney problems. Too much magnesium can cause serious health problems, including – nausea, vomiting, severely lowered blood pressure, confusion, slowed heart rate, respiratory paralysis, deficiencies of other minerals, coma, cardiac arrhythmias, cardiac arrest, and death.

More common side effects from magnesium include upset stomach and diarrhea.

Magnesium competes with calcium for absorption and can cause a calcium deficiency if calcium levels are already low. Some medications may lower magnesium levels in the body. These include - chemotherapy drugs, diuretics, digoxin (Lanoxin), steroids, and certain antibiotics.

Are You Getting These Nutrients? - Part 4

Probably the most well known vitamin, vitamin C performs many functions in our bodies, from helping to make neurotransmitters in our brains to protecting our cells from damage, to building connective tissue. Vitamin C is easily degraded during storage and cooking. Keep your produce cool, and don't overcook it. Aim for at least 90 mg daily for adult males, 75 mg for females.

Low-Carb Sources of Vitamin C

Red Bell Pepper, 1/2 cup raw - 95 mg vitamin C, 3 grams net carb

Green Bell Pepper, 1/2 cup raw - 60 mg vitamin C,

Brussels sprouts, 1/2 cup cooked - 48 mg vitamin C, 3 grams net carb

Broccoli, 1/2 cup cooked - 51 mg vitamin C, 3 grams net carb

Strawberries, 1/2 cup sliced - 49 mg vitamin C, 4 grams net carb

Cauliflower, 1/2 cup cooked - 44 mg vitamin C, 2 grams net carb

Grapefruit, 1/2 medium - 44 mg vitamin C, 9 grams net carb

Cabbage, 1 cup, raw, chopped - 33 mg vitamin C, 3 grams net carb

Also: kale and other greens, raspberries, green beans, cantaloupe are good sources of vitamin C. Almost all fruits and vegetables have some vitamin C. Do not consume grapefruit if you take medications for cholesterol, blood pressure, and heart problems as it can cause some of these medications to become toxic. Talk to your doctor if you like grapefruit as sometimes medications can be changed to avoid this problem.

Vitamin C is a water-soluble vitamin, meaning that your body doesn't store it. You have to get what you need from food, including citrus fruits, broccoli, and tomatoes.

You need vitamin C for the growth and repair of tissues in all parts of your body. It helps the body make collagen, an important protein used to make skin, cartilage, tendons, ligaments, and blood vessels. Vitamin C is needed for healing wounds, and for repairing and maintaining bones and teeth. It also helps the body absorb iron from nonheme sources.

Vitamin C is an antioxidant, along with vitamin E, beta-carotene, and many other plant-based nutrients. Antioxidants block some of the damage caused by free radicals, substances that damage DNA. The build up of free radicals over time may contribute to the aging process and the development of health conditions such as cancer, heart disease, and arthritis.

It’s rare to be seriously deficient in vitamin C, although evidence suggests that many people may have low levels of vitamin C. Smoking cigarettes lowers the amount of vitamin C in the body, so smokers are at a higher risk of deficiency.

Signs of vitamin deficiency include dry and splitting hair; gingivitis (inflammation of the gums) and bleeding gums; rough, dry, scaly skin; decreased wound-healing rate, easy bruising; nosebleeds; and a decreased ability to ward off infection. A severe form of vitamin C deficiency is known as scurvy.

Low levels of vitamin C have been associated with a number of conditions, including high blood pressure, gallbladder disease, stroke, some cancers, and atherosclerosis, the build up of plaque in blood vessels that can lead to heart attack and stroke. Getting enough vitamin C from your diet, by eating lots of fruit and vegetables, may help reduce the risk of developing some of these conditions. There is no conclusive evidence that taking vitamin C supplements will help or prevent any of these conditions.

Excellent sources of vitamin C include oranges, green peppers, watermelon, papaya, grapefruit, cantaloupe, strawberries, kiwi, mango, broccoli, tomatoes, Brussels sprouts, cauliflower, cabbage, and citrus juices or juices fortified with vitamin C. Raw and cooked leafy greens (turnip greens, spinach), red and green peppers, canned and fresh tomatoes, winter squash, raspberries, blueberries, cranberries, and pineapple are also rich sources of vitamin C. Vitamin C is sensitive to light, air, and heat, so you'll get the most vitamin C if you eat fruits and vegetables raw or lightly cooked.

You can purchase either natural or synthetic vitamin C, also called ascorbic acid, in a variety of forms. Tablets, capsules, and chewables are probably the most popular forms, but vitamin C also comes in powdered crystalline, effervescent, and liquid forms. Vitamin C comes in doses ranging from 25 - 1,000 mg.

"Buffered" vitamin C is also available if you find that regular ascorbic acid upsets your stomach. An esterified form of vitamin C is also available, which may be easier on the stomach for those who are prone to heartburn.

The best way to take vitamin C supplements is 2 or 3 times per day, with meals, depending on the dosage. Some studies suggest that adults should take 250 - 500 mg twice a day for any benefit. Talk to your doctor before taking more than 1,000 mg of vitamin C on a daily basis and before giving vitamin C to a child.

Daily intake of dietary vitamin C (according to the National Academy of Sciences) is listed below.

Adult

• Men over 18 years: 90 mg
• Women over 18 years: 75 mg
• Pregnant women 14 - 18 years: 80 mg
• Pregnant women over 18 years: 85 mg
• Breastfeeding women 14 - 18 years: 115 mg
• Breastfeeding women over 18 years: 120 mg

Because smoking depletes vitamin C, people who smoke may need an additional 35 mg per day.

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable doctor. Vitamin C supplements have a diuretic effect, meaning the help the body get rid of excess fluid. Be sure to drink plenty of fluids when taking them.

Most commercial vitamin C is made from corn. People sensitive to corn should look for alternative sources, such as sago palm.

Vitamin C increases the amount of iron absorbed from foods. People with hemochromatosis, an inherited condition where too much iron builds up in the body, should not take vitamin C supplements.

Vitamin C is generally considered safe because your body gets rid of what it does not use. But at high doses (more than 2,000 mg daily) it can cause diarrhea, gas, or stomach upset. If you experience these side effects, lower the dose of vitamin C.

People with kidney problems should talk to their doctor before taking vitamin C.

People who smoke or use nicotine patches may need more vitamin C because nicotine makes vitamin C less effective in the body.

Are You Getting These Nutrients? - Part 3

The nutrient for this discussion is folate (vitamin B9), which is found in whole foods. Folic acid is found in supplements and fortified foods. Folic acid is more bioavailable to be used by the body, so the recommended amounts are a little complicated, but basically the recommended daily allowance is 400 mcg (also called DFE) for adults.

Folate is best known for preventing a type of birth defect called a neural tube defect. It is used in many chemical reactions in the body, and its functions include cell formation, especially red blood cells.

Low-Carb Sources of Folate

Basically liver and anything green will give you lots of folate.

Chicken Livers - 3.5 oz. - 578 mcg folate - 1 gram carbohydrate

Asparagus - 6 spears - 134 mcg folate

Spinach - 1/2 cup cooked - 131 mcg folate

Brussels sprouts, 1/2 cup cooked - 78 mcg folate

Avocado - 1/2 cup sliced - 59 mcg folate

Romaine Lettuce - 1 cup - 64 mcg - half a gram net carb

Broccoli - 1/2 cup chopped - 52 mcg folate

Also: salmon, crab, lamb, and most green vegetables

Vitamin B9, also called folate or folic acid, is one of 8 B vitamins. All B vitamins help the body convert food (carbohydrates) into fuel (glucose), which is used to produce energy. These B vitamins, often referred to as B-complex vitamins, also help the body use fats and protein. B-complex vitamins are needed for a healthy liver, and healthy skin, hair, and eyes. They also help the nervous system function properly. Folic acid is the synthetic form of B9, found in supplements and fortified foods, while folate occurs naturally in foods.

All the B vitamins are water-soluble, meaning the body does not store them.

Folic acid is crucial for proper brain function and plays an important role in mental and emotional health. It aids in the production of DNA and RNA, the body's genetic material, and is especially important when cells and tissues are growing rapidly, such as in infancy, adolescence, and pregnancy. Folic acid also works closely with vitamin B12 to help make red blood cells and help iron work properly in the body.

Vitamin B9 works with vitamins B6 and B12 and other nutrients to control blood levels of the amino acid homocysteine. High levels of homocysteine are associated with heart disease, however researchers are not sure whether homocysteine is a cause of heart disease or just a marker that indicates someone may have heart disease.

It is fairly common to have low levels of folic acid. Alcoholism, inflammatory bowel disease (IBD), and celiac disease can cause folic acid deficiency. Also, certain medications may lower levels of folic acid in the body. Folic acid deficiency can cause - poor growth, tongue inflammation, gingivitis, loss of appetite, shortness of breath, diarrhea, irritability, forgetfulness, and mental sluggishness.

Daily recommendations for dietary folic acid are:

Adult

• Men and women, 19 years and older: 400 mcg (RDA)
• Pregnant women: 600 mcg (RDA)
• Breastfeeding women: 500 mcg (RDA)

Most people (except pregnant women) should be able to get enough folic acid from their diets. Check with a knowledgeable doctor before taking folic acid supplements or giving them to children.

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable doctor.

Folic acid comes in tablets. It usually is taken once a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take folic acid exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you are taking folic acid to treat a deficiency, you probably will feel better quickly, often within 24 hours. However, do not stop taking this drug until your doctor tells you to do so.

Are You Getting These Nutrients? - Part 2

The first nutrient thiamin (vitamin B1) is important for the body's energy production, the brain, and the nervous system function. Because it works in concert with the other B vitamins, a deficit of one can cause the others to not function as well. Thiamin is prone to destruction in food processing, storage, and cooking.

Low-Carb Sources of Thiamin

Pork - 4 oz. (before cooking) - almost 1 mg thiamin

Macadamia Nuts - 1 oz. - .34 mg thiamin, 1.5 grams net carb

Chicken Livers - 3.5 oz. - .31 mg thiamin, 1 gram carb

Pecans - 1 oz. - .19 mg thiamin - 1 gram net carb

Peanuts - 1 oz. - .18 mg thiamin - 2 grams net carb

Flaxseed - 1 Tablespoon - .17 mg thiamin, almost zero net carb

Asparagus - 6 medium spears - .14 mg thiamin, 2 grams net carb

Daily recommendations for dietary vitamin B1, according to the National Academy of Sciences, are as follows:

Adult

• Men, 19 years and older: 1.2 mg (RDA)
• Women, 19 years and older: 1.1 mg (RDA)
• Pregnant or breastfeeding women: 1.4 mg (RDA)

Most foods contain small amounts of thiamine. Large amounts can be found in: pork, beef, poultry, and organ meat.

As with all medications and supplements, check with your doctor before giving vitamin B1 supplements to a child.

Low plasma concentrations and high renal clearance of thiamin have been observed in diabetic patients compared to healthy subjects, suggesting that individuals with type 1 or type 2 diabetes mellitus are at increased risk for thiamin deficiency. Two thiamin transporters, thiamin transporter-1 (THTR-1) and THTR-2, are involved in thiamin uptake by enterocytes in the small intestine and re-uptake in the proximal tubules of the kidneys. A recent study suggested that hyperglycemia in diabetic patients could affect thiamin re-uptake by decreasing the expression of thiamin transporters in the kidneys. Conversely, thiamin deficiency appears to impair the normal endocrine function of the pancreas and exacerbate hyperglycemia.

In a randomized, double-blind pilot study, high-dose thiamin supplements (300 mg/day) were given for six weeks to hyperglycemic individuals (either glucose intolerant or newly diagnosed with type 2 diabetes). Thiamin supplementation prevented any further increase in fasting glucose and insulin levels compared with placebo treatment but did not reduce the hyperglycemia. However, one study suggested that thiamin supplementation might improve fasting glucose levels in type 2 diabetics in early stages of the disease (i.e., pre-diabetes or early diabetes).

Thiamine comes in tablets to take by mouth. It is usually taken three times a day with meals. If you have a thiamine deficiency, your doctor may prescribe thiamine for 1 month or more. Follow the directions on your prescription label or package label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take thiamine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Thiamine should be taken with meals. If you are taking an extended-release (long-acting) product, do not chew or crush the tablet. Some tablets can be crushed and mixed with food.

Are You Getting These Nutrients? - Part 1

Tim called me the other day and asked if I had read this by Laura Dolson. I said I had and was working on a blog about it. He asked me how far I had gotten in my writing. I said I had started and been sidetracked by statins and was still reading about statins. He asked if he could stop by and I invited him.

After he arrived, he asked me to open my file, as he wanted to cover some of the points. After I had it opened, he asked me to scroll down to see the foods under each nutrient. Then he asked me to scroll to the bottom and asked my why vitamin B12 received so little attention. I said this is because this is for healthy people and not for people with diabetes and other chronic diseases that require addition of other nutrients.

This caused him to stop and think for some time. He finally agreed and asked if I was concerned about this. I said very concerned and had planned to try covering this in my writing. I don't know if I can make the case strong enough, but I planned on trying. He asked if I could send him a copy before it was published. I said yes, if he would send me any information he located that he felt was important enough. He said he would and he asked how many blogs I would have on this topic. I said that it looked like seven or more at present and if he found a lot more, then it could be even more.

We talked some more and he asked if I would accept information from others. I said I always have and if it was important enough, I would blog about it separately or combine it with other material I had on the topic. He asked if he could see some of the other topics I was considering writing about and had on my list. When I showed him, he was surprised and said he agreed, as there had been many topics of interest recently. I agreed and said it would be easier if my cataracts were not getting worse. This surprised him and he asked when this might happen. I said as soon as the eye surgeon felt comfortable that my eyelid was healed and would not cause possible infection that could compromise the surgery.

Then I had the thought of pulling some information from this source and this source plus some from here. Tim said he would pull together some of the material he was looking for and would email me copies. I told him not to make everything important and I would need some limits. He assured me that he would prioritize what he sent me on each nutrient.

Back to the topic as this is important for those of us eating low carb high fat. When we change our way of eating, we should be concerned about the nutrients we might be missing. Our support group is fortunate that we have two nutritionists that work with the way of eating we like. They check our foods and are looking for shortages that we may have. Other people need to either know nutrition or learn on their own.

As Tim said, vitamin B12 is often not given the attention it deserves and this is especially important for people with diabetes (PWD) on metformin and among the elderly. The elderly and PWD are especially vulnerable because as they age, many lose the ability to convert vitamin B12 from animal foods. Vitamin B12 is only found in liver, sardines, salmon, kidney, eggs, beef, and pork. There are no vegetable sources.

In the next blogs, I will cover Thiamin (vitamin B1), Folate (vitamin B9), Vitamin C, Magnesium, Iron, Vitamin D, Vitamin E, Calcium, Choline, Niacin, Vitamin A, and Zinc.

The first five nutrients above are nutrients to watch when you reduce carbohydrates, and the next three are ones that many people are often short of in what they eat. The last four are nutrients that people with chronic diseases are often short or deficient in their bodies, and vitamin B12 needs special consideration.

It is worth noting for vegetarians and vegan low-carbers, they are limiting their diets more and must be very conscious of the nutrients that may be omitting. This is especially true for vitamin B12, choline, niacin, vitamin A, and zinc.

Have Your Doctor Read This about LCHF

Keith Runyan, MD, is a retired physician, with type 1 diabetes, who graduated from Emory University School of Medicine in 1986. A vast majority of physicians he has encountered during his career have the patient’s best interest in mind and want to improve their health.

So if you learn about the benefits of a low carbohydrate lifestyle from books, articles published in medical journals, or God forbid, the INTERNET, you might wonder why your doctor is either not supportive or even cautions you against it.

His description of what doctors do not know is funny. He says the answer is simpler than you might think. It is not that your doctor does not want you to experience the benefits. It is most likely that your doctor was not educated about the effect of diet on disease. To understand this, let me give you some background about medical education.

In order to get into medical school in the first place, you have to be an excellent student. In our current education system, being an excellent student means being able to learn and retain lots of information in a short period of time and accurately recall that information on a test or later in medical training with their patients. It does not require that they be creative thinkers or innovators, or question what they are being taught. Once a student enters medical school, the amount and pace of learning is accelerated further. There is literally no time to question the validity of the material.

Most medical students have heard from their wise professors the phrase, “half of what you just learned is wrong, but we don’t know which half. However, that is a difficult concept to accept given the time and effort spent learning all that material. In essence, the overwhelming feeling at the end of medical school is, I know I don’t know everything, but at least I know what matters the most.”

The next piece to this puzzle is to know that nutrition is barely discussed in most (not all) medical schools. At Emory, in 1982, we had about 2 weeks of education in “nutrition.” But, what was covered was how the body metabolizes protein, carbohydrate, and fat, nutritional deficiency diseases, and the nutritional requirements to prevent those diseases. The fact that many chronic diseases like cancer, heart disease, diabetes, and digestive diseases were rare prior the adoption of the Western diet was not covered. He states that, “I did not learn this until 2011 when I read Good Calories, Bad Calories by Gary Taubes.”

Some physicians will be familiar with the low carbohydrate diet already and others may be willing to learn about it and support you especially when they see your condition is improving as a result. However, other physicians may immediately recognize it is not part of their armamentarium, therefore it must be either not effective, or possibly dangerous, especially if the word “ketosis” or “ketones” is mentioned. Although doctors should know the difference between “nutritional ketosis” and “ketoacidosis,” the term “nutritional ketosis” is only mentioned in the context of a low carbohydrate ketogenic diet and therefore is not discussed in medical school. So the only context in which most doctors know about “ketosis” is one of the following: starvation ketosis, diabetic ketoacidosis, or alcoholic ketoacidosis, none of which are good.

Dr. Runyan says, “For reasons that are beyond the scope of this article, it is best to have your physician on board with your low carbohydrate lifestyle. It will affect the need for or lack thereof of many of your medications. There can be side effects that are easily corrected with knowledge of how the diet works.”

I would advise reading the complete blog as this only covers part of it. Dr. Runyan covers a lot in his blog.