way of eating
I love getting on the latest bandwagon. I'm a pretty early adopter of trendy stuff like when everyone started counting their steps I had a fitbit strapped on. I whitened my teeth the first time a Crest commercial told me I should, about 15 years ago. I took yoga classes in the 90s before there were even yoga clothes. My latest trend? Low carb, high fat eating.
I started to hear a buzz about it on a female physician's Facebook group about 6 months ago. Physicians on the group started posting some interesting evidence how a low-carb high fat diet could improve many diseases like diabetes, Alzheimer's, heart disease, autism, etc. Antedotically women were also saying how great they felt cutting out/down carbs and increasing fat consumption. So, I ordered a couple of books, searched the research literature, started listening to podcasts and watched a few documentaries on the topic.
I'm becoming more and more convinced there is something to this "diet." [Side bar: it's called a "way of eating", not a diet, as it's not necessarily for weight loss - it is meant to be a permanent change in eating.] I've even followed it for a while at variable carb levels and I can see the benefits on energy and mental clarity.
I've been a doctor for about 20 years. I've worked as a family doctor, as a general Ob/Gyn and then most of my career in infertility. Interacting with obese patients in these different contexts I can tell you obesity is hard and nearly impossible to cure. I've preached "eat less, move more," I've sent patients to dieticians and even endorsed commercial programs like Weight Watchers, Bernstein, etc. which generally all involve calorie counting and fat restriction. I have never seen anyone lose weight and keep it off, ever. Even people who want a child more than anything in the world. I understand that it is pretty hard to change your eating behaviour when the benefits aren't immediate: when you are 45 and need to lose 30 pounds so you might live longer at 80, or you might drop your blood pressure, or you might have a bit less joint pain, ....it's pretty hard to restrict your calories and exercise more - that's human. Infertility patients are different as the potential benefit (a child) is pretty immediate and they are highly motivated people. They sit in my office, having wanted to be pregnant for months or, more typically, years and I tell them they need to lose weight to improve the odds my treatments will work, but they can't. I honestly used to think they couldn't lose weight because they just weren't mentally or physically strong enough to follow the "eat less and move more" dogma. I used to think to myself "if they really want a baby they'll lose weight." I've come to realize that I was wrong. These women are strong, it's just nearly impossible to lose weight (and keep it off) by counting calories and exercising.
Why is it so hard? Fat and calorie restriction makes us feel hungry and it says to our bodies "food is scarce, stock up." As a result, through insulin, leptin and other hormones, when we calorie restrict and cut fat down we become efficient as holding on to the calories we consume. Further, when we consume carbs, our insulin rises and we store sugar, largely as fat. So its counterproductive. It's quite remarkable how obesity rates have tripled in North America since the 1970s when the government and physicians started telling everyone to cut fat, count calories and exercise more. This advice is largely wrong and has had the opposite effect to what was intended: more obesity and obesity related disease in millions of people.
What works? I honestly do not know but I am seeing the pendulm swing away from low fat diets, towards a way of eating that is high in good fats, low in carbs and high in vegetables. I think the next food pyramid will look very different as we start to realize how weight loss and better health can come from lower carbs (fewer grains, less sugar, etc.) and higher fat in the diet. The next food pyramid will likely be a rectangle instead and good fats (think: avocado, olives, nuts, certain animal fats) will feature prominently, while grains and sugary food will be much, much smaller than the current (about 50%) they are now.
There aren't many papers (seven that I can find) that look at a low carb, high fat diet and fertility but the results do suggest a benefit for those who are overweight or obese. This fall at Olive we are embarking on a study, lead by an endocrinologist in Quebec, looking at lifestyle (weight, diet, health behaviours) and fertility. We are one of the research centres which is really exciting. It is through studying infertile women, their food and lifestyle, that we can understand what works and what does not to help them conceive. I will post more information for women who wish to enroll in the study over the summer.
This is a bandwagon I will likely stay on. I can't find my fitbit, my teeth aren't very white and I haven't done a yoga class in a year, but eating fewer carbs to improve my immediate quality of life and potentially give me more healthy years later on, is something I think I'll stick with. I'm also going to be part of research to quantify the benefits for my patients.