Dr Keith Roach
Dear Dr. Roach: I am a 75 year old healthy male. I’m a little frustrated after seeing my regular doctor for a checkup and getting a call from his physician assistant who was suggesting a low-fat, low-carb diet. I asked for more specific dietary suggestions, as I admit to being nutritionally ignorant (my late wife always bought groceries and cooked meals for us). Other than beef and bread, I’m not even sure what a carbohydrate is.
My LDL cholesterol is 152 mg/dL, my triglyceride levels are 256 mg/dL, and my A1C level is 5.8%. Since I was 20, my A1C has been 5.6% or more despite being very active and fairly thin, and I don’t eat sweets or add sugar to coffee, tea, or cereal. I have severe neuropathy, but I just work with it every day, as sitting is not in my nature.
My weekly exercise routine consists of three days of strength training, plus running on the treadmill at the gym, and three days of walking 2.5 to 3.5 miles on the days I don’t hit the gym. I try to eat a good variety of vegetables, fresh fruit at every meal and I rarely eat beef or anything fried as fat causes stomach problems.
Looking at online books for information on low-fat, low-carb diets has been confusing and frustrating. A lot of contradictory material seems to be available. Do you know any good resources? Of course, my doctor won’t help.
From the JRC: Before I give my opinion on a low-fat, low-carb diet on a 75-year-old person with diabetes, let me explain what that means. There are three types of macronutrients from which we get energy: carbohydrates, fats and proteins. A well-balanced diet requires all components, although the proportions can vary greatly depending on an individual’s food choices.
Carbohydrates include both simple sugars and chain sugars, such as those found in starches such as bread, pasta and rice. Fiber is also made from carbohydrates, but humans cannot use fiber well for energy. Fiber has many benefits, including helping regulate blood sugar in people with diabetes. Most fruits are essentially 100 percent carbohydrates, and vegetables, grains, and legumes are mostly carbohydrates, with only a small amount of protein and negligible fat.
Fats are very large, energy-rich molecules found in oils, nuts, most animal meats, and some fruits such as avocados. While fats have a bad rap, there are four main types of fat, with unhealthy saturated fats (found in meat and tropical oils) and trans-saturated fats (not found in nature at all, only in processed foods, and thankfully being phased out). Polyunsaturated fats (in vegetable oils) and especially monounsaturated fats (in olive and nut oils, with varying amounts in other oils) are healthy in reasonable amounts. Omega-3 is a type of healthy polyunsaturated fat.
Proteins are long strands of amino acids, found in meat and enriched plant foods like tofu. Beef is high in protein, varying amounts of fat (many of it saturated), and low in carbohydrates.
So, a low-carb, low-fat diet really does mean a high-protein diet. It’s not that easy to get high protein without high fat, unless you know a lot more than your doctor or caregiver has told you. However, I disagree with a high protein diet for someone like you. Good amounts of healthy fats like those found in olive oil and fatty fish, along with fruits, vegetables and legumes, are all part of a healthy diet for people with and without diabetes.
A registered dietitian or nutritionist can give you much more information.
Readers can email questions to ToYourGoodHealth@med.cornell.edu.
#lowfat #lowcarb #diet
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