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Q&A with a low-carb nutritionist
Everything you wanted to know about a low-carb approach
The term low-carb often evokes confusion or fear as a draconian and extreme approach. I dismissed it as a fad diet prior to doing my research as well! But the philosophy is based on hard science and extremely sound principles, and a growing number of people (including me) are seeing benefits today. It can be extremely effective long-term when you tailor it to be sustainable for you.
I had a great conversation with Heather DiBiasi, who is a registered dietitian and weight loss expert. She follows a low-carb framework with her clients and helps women lose weight by balancing their blood sugar and regulating hunger hormones. She does a wonderful job of demystifying what it means to be low-carb and making it approachable and sustainable. Here is a summary of the conversation in a Q&A format.
So, does low-carb mean no carbs?
No, definitely not! I get asked all the time, how many carbs is low-carb? And there really is no definition. Even with the ketogenic diet (which you don’t need to be on even if you’re low-carb) there are 5 different types - ranging from the most extreme version which is used to treat epilepsy, to the more relaxed version that you see on social media. If you were to put a range, 45% or less of your daily calories coming from carbs would technically be low. I don’t count calories so I’m not looking at it that way. Some people would say that 100g or less of carbs per day is low-carb, but it really depends on your body weight, your body composition and so many things.
I like to look at low-carb as really emphasizing protein, fat and veggies on our plate, and portioning and balancing the starchy and sugary carbohydrates - potatoes, rice, breads, fruit, etc.
But vegetables are technically carbs as well. So what are the types of carbs that you advocate portioning?
My clients and I eat high-quality carbs every day, just in a portion, and maybe not for every meal. Some of my clients actually do have it for every meal and that’s still considered low-carb, compared to the standard diet.
High-fiber whole-food carbs are always ideal - sweet potato, lentils, beans, chickpeas, whole grains. Some of these provide a protein boost too, which is great for vegetarians. There are some really good bean-based pastas available these days and I also like low-sugar fruit like berries.
I don’t consider non-starchy vegetables to be carbs in my plan - they have carbs but they have so much fiber that it doesn’t impact blood sugar.
Why is it important to balance your blood sugar and hunger hormones?
Our body is always trying to maintain its blood sugar homeostasis (balance). So when your blood sugar is too high or too low, it tries to fix that as a priority, rather than weight loss.
Consider this classic cycle for example - Breakfast is one of those meals we tend to eat starchy or sugary - even those considered ‘healthy’ such as granola, oatmeal or fruit and honey. This spikes your blood sugar (glucose) really high, really quickly. When glucose spikes, your body releases insulin, which is a normal response that everyone needs to survive. But when your glucose is so high, it makes your body overreact - insulin comes shooting out and drops your glucose really low - that then becomes a sugar crash which means we’re starving going into lunch. So we eat tacos, a sandwich, chips, leading to another spike and crash. By the time we get home we are tired, irritable and hangry. And so we just make an easy pasta - and then an hour later we’re craving dessert. So you’re just out of control when your blood sugar is on this roller-coaster all day.
When you start eating meals that are designed to balance your blood sugar, you’re regulating your hunger hormones and your insulin, so you don’t have cravings or feel lethargic all the time.
Why does calorie counting not work?
Because it’s not all about the calories. Insulin is a fat storage hormone. So when you’re constantly releasing insulin because your blood sugar is so high, you cannot burn fat. It can be frustrating - my clients come to me eating these ‘healthy’ meals but they can just not lose weight because their insulin is always elevated.
Beyond weight loss, constantly elevated insulin can lead to insulin resistance which is linked to most if not all chronic illnesses including diabetes, heart disease and even Alzheimer’s.
I feel really strongly that a fasting insulin test should be a part of your annual physical. You could be insulin resistant for ten years before you develop pre-diabetes or another health condition! And if we were able to catch that early, we would be able to prevent so many chronic illnesses.
Tell us about your journey to develop your nutritional philosophy
My journey started in my teens, when I was struggling to lose weight going into high school. I tried everything and it was not necessarily healthy - the low-fat craze of the 90s, skipping meals, just coffee until dinner, juicing, you name it! I was yoyo dieting and losing the same 5-15 pounds for a decade. Then I took a nutrition class - the way the teacher explained how powerful food was - it was eye-opening and I fell in love with it.
So I went to school to be a dietitian and somehow stumbled on the low-carb approach, which I found really interesting. I started doing all of my research papers on it. The research is unbelievable. The evidence shows how amazing it could be for inflammation, cardiovascular disease and weight loss. The weight loss part was exciting - although I probably went a little extreme with it in the beginning and cut out all carbs before I realized that wasn’t sustainable. That’s when I started to develop my framework around a sustainable approach. If you go on vacation or have one night out, it doesn’t matter. If you’re focused on building healthy habits 80-90% of the time, you can return to that lifestyle.
When your blood sugar is in-control you feel in-control - that’s why people love it.
It is rare to find nutritionists that embrace a low-carb message - it often seems to be considered a fad. Why do you think that is?
When it comes to preventative care, the training materials in school are so far behind the current research. So unless you’re keeping yourself up-to-date on the research you will be behind.
The other issue is that people can take low-carb diets to an extreme, which is hard to sustain, so it gets pulled into the anti-diet movement and gets a lot of pushback.
We are looking at eating low-carb as a short-term fix when it doesn’t have to be. If you are open-minded enough to understand the research and the science behind it, then you can learn how to apply it in a sustainable and healthy way.
What’s your take on intermittent fasting?
There’re a lot of benefits to fasting but people can get really excited and don’t implement it in a way that works for them. For example - they fast way too long, skip breakfast, then go into lunch at 2pm, starving, and make choices that may not be optimal! For some women especially, very long fasting windows can put stress on their body, particularly during their menstrual cycle. I think 12 hours is a beautiful window that is very achievable and people have to see how they feel beyond that, if it works for them. Everyone is different.
I personally recommend fasting within our circadian rhythm that is shown from research as being most effective for weight loss, because it really aligns us with our hormones. We know from research that insulin doesn’t work as well at night time - so eating earlier in the day is helpful for weight loss. Have an earlier dinner and start eating earlier in the morning.
How do you go about starting someone on a low-carb framework?
I would start them with one serving of carbs per meal: 15-20g is the range I typically use. If they’re going to have that pasta (I grew up half-Italian, so I know!), let’s portion it to half a cup and really fill up the plate with veggies, protein and healthy fat. If they’re seeing results - improvements in their blood sugar, weight, mood - then we may just keep it at that. If not, we would start pulling it out gradually, perhaps from dinner first, and see if they do better.
How do you think about constructing a balanced meal for vegetarians and vegans?
I always recommend my clients have proteins, fat and veggies on their plate. Carbs are optional. My meal formula is 20-30g of protein, 10-25g of fat and 2 cups of veggies at lunch and dinner (optional for breakfast).
Proteins really help with satiety, in addition to building muscle. Animal proteins like fish, eggs and dairy are great protein sources if people do eat them because they have all the essential amino acids and are more biologically available. When you eat vegan proteins you’re only absorbing about 60-70% of the amino acids. So if you’re using pea protein, for example, you will not absorb as much of it as if you were using an animal source, for example whey. And that’s okay, I do use pea protein myself and you don’t need to worry about it but it’s just good to be aware. You can use a high quality pea-protein shake that will get you 20g of protein.
Emphasize healthy fats - they will shut off your hunger hormones - avocadoes, nuts and seeds, olive oil are all great sources.
Loading half your plate with veggies is especially important. Aim for non-starchy veggies in a variety of deep colors such as spinach, cabbage, peppers, brussels sprouts, green beans and so on. The fiber sends a signal to your brain that you’re full which is especially important for vegans and vegetarians who may not be using animal protein.
A lot of people ask me if nuts are a protein or if beans are a protein. I don’t count them as a protein source in my plan - they are a fat source or a carb source but if you combine them they give a nice boost of protein. That can help elevate your protein intake if you’re not eating animal protein. For example, half a cup of beans = 8g of protein, a serving of nuts = 7g of protein, then you can have a meal with 15g of protein, which is good. But limit the serving size because those are mainly sources of carbs or fat, not protein.
What are your go-to recipes that are vegetarian or vegan?
I love developing healthy breakfast recipes that give people a balanced start to their day! My favorites are Protein pancakes (vegetarian), Fat Burning Smoothie (can be vegan) and Breakfast cake (can be vegan).
Thanks to Heather for sharing her philosophy and advice! I hope the information here helped some of you! Are there any other questions you would want to ask Heather? Just reply back to this email or contact her via her website.
You can read more about my journey to a low-carb lifestyle as a vegetarian here.
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