Caveman Doctor listened to his last conventional wisdom talk from a nutritionist this week. He thought this one might be different, as it was titled “Low Carbohydrate, High Protein Diets.” Using his sense of smell fine-tuned by years of hunting for prey, he could smell the conventional “wisdom” pouring out of this talk and into the ears of its unwitting victims. Caveman Doctor tried several times to discuss actual scientific data with the nutritionist and engage in debate, but each time the speaker could not address his questions. He got so upset, he let out a big roar and crept off to his cave, i.e. office, to vent. Then he started writing this on his computer (whatever a computer is).
This ancient Greek aphorism’s simple yet profound message remains relevant in our modern era. It is self-empowering, and leads to independent thought and action. However, some groups, such as the modern conventional diet “experts”, often seem to have a different motto:
“We know you better than you do, just take our word for it and do what we tell you.”
Hearing dieticians tell people who have trouble with keeping off weight to cut calories, but to continue to eat high amounts of carbohydrates, is unfortunately a common occurrence. Knowing that this advice does not work, but rather sets people up for failure, anxiety, and even self-loathing, makes it painful to watch it being propagated. Pushers of conventional wisdom do not refer to data or nutritional studies (if they even know them) but rather fall back on the recommendations. Such behaviors cause the blood pressure of those of us that review the scientific literature to rise quicker than the blood sugar of someone following our government’s dietary recommendations.
This is Your Brain on Grains and Sugar
Carbohydrates, especially sugar and grains, raise insulin. Insulin causes several subsequent biological responses, and ultimately, raises your appetite. With repeated exposure, insulin has such a stimulatory effect on appetite that it is used as a treatment for anorexia.1,2 It stimulates a part of the brain (the hypothalamus) that causes drastic increases in appetite3, the same area that causes uncontrollable hunger and obesity in children with Prader-Willi syndrome.4 If insulin will cause appetite stimulation in anorexic patients, what will it do to a room of people who struggle with eating issues?
Taking it a step further, a recent study gave rats the option of indulging in cocaine versus sweet saccharin. Ninety-four percent of the time,5 the rats chose the sweet reward over what is considered one of the most addictive drugs in our society. You read that right, sweet foods may be more addictive than cocaine.
Would we tell a drug addict only do a little bit of cocaine? Yet we are taking people addicted to a substance possibly more addictive than cocaine, and telling them to only eat a little in moderation. And let’s not forget that unlike cocaine, which is taboo and hard to find, carbs are ubiquitous in our society and even promoted as being healthy. Is it any surprise that our dietary advice fails? Carbohydrates, especially sugar and grains, are like addictive drugs to our brain stimulating appetite and stimulating the need for more carbohydrates6.
Eating them is the ultimate test of willpower.
Maybe worst of all, studies show that when women are sad or depressed, they turn to foods with greater than a 6:1 ratio of carbohydrates to protein.7 Like a beleaguered spouse returning to an abusive relationship, the cycle of overeating only gets amplified after failed attempts at moderation with carbohydrates leads to further consumption of carbohydrates to lessen the anxiety and sadness that follow. The discussion of low-fat versus low-carb takes on a different form when appetite suppression versus stimulation is considered. Regardless of any discussion of a metabolic advantage of low-carb dieting, it has been shown repeatedly that when dieters are placed on a low-carb regimen, they spontaneously reduce their overall food intake.8 The goal here is to empower people to make changes, not provide them with advice that has been shown to be ineffective and places the emphasis on controlling physiologic urges that are often uncontrollable.
Do people want to eat too much?
Do people want to overdo it on food?
Do people want to be obese?
Why can’t they just eat a little ice cream, bread, or candy?
Everything in moderation has failed.
So let’s stop telling people to do it.
Think about the saying “like a kid in a candy shop”. The modern diet is essentially a modified candy shop, with carbs (i.e., sugar and grains) composing a large portion of every meal and snack. Let’s break ourselves out of this constantly tempting, draining candy shop and instead eat wholesome foods.
Would a cocaine addict try to beat his addiction by only engaging in moderate drug usage? Of course not, yet once again, there I sat watching the onus placed back on the dieter, not the recommendations. A member of the audience had it right from the beginning. Carbs are addictive and many people are addicted. A more successful approach may be to avoid those addictive foods from the start and instead enjoy filling, nutrient-dense foods that leave you satiated, and not begging for more. It doesn’t take a degree in medicine or nutrition to see this. It does, however, take some courage and perseverance to go against the faulty teachings of conventional wisdom.
Maybe reduced-carbohydrate dieting isn’t the only solution for some rare groups, but it is likely a great solution for the majority. As a practitioner of medicine or dietitian, ignoring and withholding this dietary option is unfair for your patients and limits their ability to succeed.
I was addicted to carbs and am not afraid to admit it. I now know that I am only capable of eating carbohydrate sources in the form of leafy green and colorful vegetables, sweet potatoes, and berries with rare exception. I admitted my addiction a long time ago, removed it, watched my health soar, and moved on. Unfortunately, while I moved on, the conventional dietary advice has not – it remains heavily carb-biased. Let’s try to empower people to admit their addiction and move on, instead of advising them to only do smaller amounts of their drug.
If you are able to eat that single piece of bread and pass on the rest of the basket, congratulations – you are unique. However, if you are like most of us addicts, the best way to handle your carbohydrate intolerance and addiction may be to avoid that bread in the first place, or consume it very infrequently. Oh, and don’t feel bad if you can’t handle these carbs in moderation. You’re just like the rest of us.
In a battle that can’t be won, identify your enemies and avoid them. Know Thyself.
1. Dally P, Sargant W: Treatment and outcome of anorexia nervosa. BMJ 2:793-795, 1966,
2. Munoz MT, Argente J: Anorexia nervosa in female adolescents: endocrine and bone mineral density disturbances. Eur J Endocrinol 147:275-86, 2002, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12213663
3. Cincotta AH, Luo S, Liang Y: Hyperinsulinemia increases norepinephrine metabolism in the ventromedial hypothalamus of rats. Neuroreport 11:383-7, 2000, http://www.ncbi.nlm.nih.gov/pubmed/10674491
4. Swaab DF: Prader-Willi syndrome and the hypothalamus. Acta paediatrica 423:50-4, 1997, http://www.ncbi.nlm.nih.gov/pubmed/9401539
5. Lenoir M, Serre F, Cantin L, et al: Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2:e698, 2007, http://dx.plos.org/10.1371/journal.pone.0000698
6. Geiselman PJ, Novin D: The role of carbohydrates in appetite, hunger and obesity. Appetite;Appetite 3:203-223, 1982,
7. Spring B, Schneider K, Smith M, et al: Abuse potential of carbohydrates for overweight carbohydrate cravers. Psychopharmacology 197:637-647, 2008, http://dx.doi.org/10.1007/s00213-008-1085-z
8. Hite AH, Berkowitz VG, Berkowitz K: Low-carbohydrate diet review: shifting the paradigm. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 26:300-8, 2011, http://www.ncbi.nlm.nih.gov/pubmed/21586415
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