The Indian environment militates against a Low Carbohydrate High Fat lifestyle but a small number of adherents still find it worthwhile
Madhavankutty Pillai | 25 May, 2016
TWO YEARS AGO, Priya Aurora, a 39-year-old writer with a media company in Shimla, boarded a bus to her office. The seats were taken and as she stood on the gangway, someone got up and offered her one. Priya realised with some shock that the person had thought she was pregnant. She had always been overweight but the scales had now hit 100 kg, embarrassing even her children, one of whom told her at a birthday that the best gift would be if Priya became thin.
The bus incident happened in December 2014. From 1 January, she began to test something her brother had suggested. Called the ketogenic diet, it involved bringing down carbohydrate consumption to the barest minimum. She dropped roti, rice and sugar, simultaneously replacing it with fat intake. Soon, she stopped eating even vegetables like tomatoes which have a higher degree of carbs.
The results were immediate. She lost 6 kg in the first fortnight. She was 100 kg when it started and now, in less than a year-and- a-half, she is 62 kg. She took health readings before the diet and six months after—her system was as perfect as it could be. “I feel like a super charged person all the time. I have not fallen sick even once since,” she says.
It was in early 2014 that Eleanor Valentina (Tina) and her husband, Natchi Lazarus who run a digital marketing firm based in Chennai, also decided that they needed to reduce. She was 65 kg and he was 123 kg. The trigger for Tina, 38, was a high blood sugar reading that indicated diabetes. They were careful eaters, consuming low fat salad, not eating after 6 pm, taking chapaatis instead of rice. They had enrolled in a gym. But it was not working. While researching online, Tina came across the Atkins diet, another low-carb one, and decided to give it a try.
Tina’s website Indianlchf.com shows in detail the gradual downward progression of their weight. She is now 55 kg and her husband 98 kg. Her blood sugar is normal without medication. “And we were able to maintain the diet,” she says. They eat only when they feel hungry and this is usually twice a day. The diet is made up of eggs, meat and vegetables, all prepared liberally with oil and butter.
Both Priya and Tina had to learn from scratch and that is because in India, low-carb dieters find no support from the medical community, nutritionists and dietitians who consider fat enemy number one and carbs the food group that should be eaten the most. In the West, there is a new health debate. The New York Times bestseller lists on health books inevitably see a few written by doctors arguing against carbohydrates and advocating good fats, and also guiding people by way of recipes on how to follow such a diet.
“I self-taught myself because there are no guides available for Indians,” says Priya. “It is primarily a Western diet and easier to follow there because everything comes with labels [which spell out how much carbohydrate there is in a food product]. In India, labels have just come in, but I don’t know how reliable they are. The barcodes also are not readable. I had to find out the calorie and nutrition break-up of everything that I was eating and slowly I built a database,” Priya says.
Tina dealt with the same black hole of local information. She says, “Based on the books I had read, I was cooking tuna salad and stuff like that. It didn’t strike me what Indian dishes I could cook. After some time, I was like, ‘Hold on, I can’t do this forever. I need Indian ingredients, Indian stuff that I have always enjoyed.’ Then I realised you just need to eat meat with a lot of fat in it. And you can keep eating the vegetables as you have always eaten. Once that realisation comes, it is very easy,” she adds.
Tina lost her first 5 kg very fast while her husband lost 11 kg before their weight plateaued. She didn’t know what to do further but then chanced upon a blog by Jason Fung, a Canadian nephrologist, who specialised in reversing diabetes by intermittent fasting of different durations. Low-carb dieters have a handful of doctors as their figureheads and Fung is one of them. He recently came out with a book, The Obesity Code, quoting the latest research that bolster the case for low carbs and high fat.
Tina started doing intermittent fasting too. She had one more insight after they went on a vacation. When she came back, instead of gaining weight as she had expected, she had lost 1 kg. It struck her that she had been eating more butter for those days and it was the increase in fat consumption that brought her weight down.
Books advocating this lifestyle have a common theory connecting the explosion of obesity and lifestyle diseases since the 1980s onwards to a simultaneous rise in the consumption of carbohydrates. This is also the period from which the medical establishment around the world began formally recommending that carbohydrates account for the largest chunk in a diet, followed by fruits and vegetables, then dairy and meat, and finally that fats should be had sparingly.
Low-carb dieters invert this food pyramid. Fat accounts for the largest component of their diet. Different low-carb diets— ketogenic, Paleo, Atkins, etcetera—permit different levels of carbs. While there is no uniform definition of a low-carb diet, a very intense one wouldn’t permit more than 20 gm of carbohydrates in a day. One thing they all do is turn the body to using fat as the primary source of fuel.
Low-carb diet advocates say that studies linking fats to heart disease and obesity were faulty and that over the past two decades there has been overwhelming research which shows just the opposite—that taking large quantities of good fats like virgin oils, unprocessed cheese and nuts brings down fat in the body, reversing a wide variety of lifestyle diseases. They claim that the traditional view is wrong that your weight is a function of how many calories you take in versus how much is expended. Eating less just makes the body outsmart you by expending less energy and then subconsciously increasing your hunger so that over a long period you just return to your earlier weight.
Instead, low-carb adherents blame weight loss or gain on hormones, primarily insulin, that make cells hoard fat. One of the foremost nutrition scientists in the world, David Ludwig of Harvard University, who wrote a recent bestseller, Always Hungry?, says gaining weight is the result of what is termed the Insulin-Carbohydrate Model. As he wrote in a recent article on Medium.Com, ‘According to a radically different way of thinking, excessive weight gain occurs because fat cells have been triggered to take up and store too many calories, leaving too few for the rest of the body. We overeat in an effort to keep enough calories in the blood stream for the brain, muscles and other vital organs, but those extra calories ultimately wind up in fat cells, creating a vicious cycle of hunger, overeating and weight gain. In other words, overeating is a consequence, not the cause, of an underlying metabolic problem…. So what’s triggered fat cells into calorie storage overdrive? The obvious answer is too much of the hormone insulin… And what’s raised insulin levels? That’s just Endocrinology 101: all the fast-digesting, processed carbohydrates that flooded into our diet during the low-fat craze of the last 40 years — white bread, white rice, prepared breakfast cereals, potato products, crackers, cookies, and of course concentrated sugar and sugary beverages.’
Insulin is the main culprit in the low carb dieting galaxy. That is also the reason why the majority of the small community of such dieters in India is made up of Type 2 diabetics, who suffer from high blood sugar levels because their bodies have developed insulin resistance.
IN FEBRUARY 2011, when Anup Singh, an engineer from Indore, found himself diagnosed with diabetes, he was certain of one thing—he would not take medicines which would create lifelong dependence. Singh started scouting the net for information and found a few forums on ‘Low Carb High Fat’ (LCHF). In June that year, Singh switched to the diet.
Singh went off rice completely, restricted himself to two chapaatis a day; every vegetable under the ground was off and he was liberal in his intake of fat, especially virgin coconut oil and he ate four eggs a day. In March this year, he tried to intensify it to a ketogenic diet but couldn’t maintain it beyond two weeks. But the experience was worth it because now he does not even have the chapaatis and is off grains altogether.
“On high carb, you want to eat every two hours because once you eat, insulin shoots up and then crashes again. LCHF has no spikes and crashes and many of us on the diet feel no hunger. I haven’t had breakfast in ages,” he says. His diabetes is not just under control, the blood sugar numbers are better than normal.
Soon after he was diagnosed with diabetes, Singh became part of a popular online health forum but says his strong advocacy of a low-carb-high-fat diet led to its moderators censoring and even blocking him once. “Then I thought, ‘Why not start my own forum?’” he says. Dlife.in, as it is called, went live on August 2014. Many low carb high fat diabetics from the earlier forum got together here. Now Singh says they have over 1,000 users of which he thinks around 600 have benefited following the diet.
Human bodies are tuned to process carbs fastest into glucose, which we need for energy. But diabetics cannot dispose of this glucose efficiently and consequently blood sugar rises. If you reduce carbs to the bare minimum, then there is no spike in blood sugar. There is also a mechanism in the body by which, in the absence of glucose, the liver breaks down fat into ketones which can be an alternative fuel source. The bodies of low-carb dieters are fuelled by a higher ratio of ketones. “The body can run on either glucose or ketones. Except for 30 gm glucose per day, entire glucose can be replaced by ketones,” says Singh.
Patients in the forum have maintained records of their sugar, cholesterol, triglycerides and other health readings before they started on the diet and after. Many are on minimum medication now and some altogether off it. I put up a query in the forum asking for experiences with low-carb-high-fat diets. Twenty seven people replied and their stories followed similar patterns. Many had been diabetic for years and seen their medication gradually and inevitably increase in strength and numbers. After switching over to low carb, their diet would change from foods like rice, chapaatis, breads, idlis and dosas to eggs, coconut oil, nuts, ghee, chicken, cheese, nuts, etcetera. One of them used to have ‘baingan bharta with cabbage leaves washed in cold water and freeze dried for 5 minutes before eating’. Their blood sugar levels would start coming down almost immediately leading to their doctors bringing down medication.
But strangely, doctors would at the same time also warn them against this diet. They liked the effect, but not the process. Arun Kumar from Patna wrote, ‘After 4 month on LCHF first I met my endocrinologist (under whose treatment I was for a decade) and showed my blood and lipid report. He was happy to see my report and asked how I did it. But when I told him about my new diet LCHF, he listened patiently and said, ‘do what you want but don’t come to me again.’’
Another person had this to say: ‘After seeing my results doctor is very impressed …but he says he cannot recommend this diet to everyone, as they may not do it with proper understanding as I do.’
Many of them just didn’t tell their doctors because they knew what the reaction would be. They went on the diet and stuck to it despite their own prejudices against fat, their family, friends, the medical establishment all trying to tell them that carbs were necessary and fat was bad. Only the results of their glucometer readings told them that this was working for them.
A sample like this is not necessarily accurate because I only got the voices of the converted. There would presumably be some who had gone on the diet and failed. The only way to confirm is to have objective studies on it but in India there is no proper attempt made by the medical community. “Anybody can come and audit our medical reports. Not 20, if you want 400 people for a medical trial, we are ready. But nobody will do it,” says Singh.
There have been studies done that link refined carbohydrates to diabetes in the Indian context. Sudha Vausdevan, head, Department of Foods Nutrition & Dietetics Research with the Madras Diabetes Research Foundation, who has co-authored a number of papers on such studies, attributes it in part to the carbohydrates we consume being more polished than in earlier times. Processed grains lose their bran, fibre and micronutrients, leaving only the starchy endosperm, which is more glycaemic, which means they make the blood sugar shoot up faster.
She doesn’t however think high-fat-low-carb is a solution, though. ‘A balanced diet should provide around 50-60 per cent of total calories from good quality carbohydrates (like whole grains which are low glycaemic and non-glycaemic-fibre rich), 10-15 per cent of calories from protein and 20-30 per cent from both visible (oils) and invisible fat (found in all plant foods),’ says Vasudevan, in a joint email response along with Kamala Krishnaswamy, a former director of the National Institute of Nutrition. Krishnaswamy was also chairperson for the manual on Dietary Guidelines for India, which is arrived at by a collaboration of experts on nutrition. The manual talks about the quantity and quality of food groups to be eaten by Indians for optimum nutrition and to maintain an appropriate weight. It informs medical practitioners what they should recommend.
Vasudevan and Krishnaswamy say that historically Indians have always been eaters of cereals, which are high in carbohydrates and the PDS system also distributes cereals. ‘Sustainability of culturally acceptable diets are very important. In addition, if the diet is low in carbohydrates (as a percentage of calories per day) then the other two energy contributing nutrients, fat and protein, will go up. High fat diets are also unhealthy. Today, energy imbalance—energy consumed versus spent (burn)—is the key to obesity and related chronic diseases like diabetes and heart disease. In India, protein foods are usually expensive like meat, fish, chicken and pulses,’ they write.
MOST MEDICAL PRACTITIONERS don’t recommend low-carb-high-fat. Dr Prakash Chhajed (Wellnessmc.com), who is based in Indore, is not one of them. He has been practising medicine for 30 years, having post-graduated in Gynaecology, then Psychiatry followed by a diploma in Nutrigenomics. Two years ago, he heard about Dr Jason Fung and decided to employ his methods by advising patients with chronic lifestyle ailments to go on low-carb-high-fat and also intermittent fasting when necessary. One patient of his had diabetes for 10 years and suffered from fatty liver, cholesterol, blood pressure and psoriasis and he could go off all medication within six months.
Dr Chhajed says that the medical community in India has a closed mind and he himself followed a low-fat diet till some years ago. “Doctors here have never heard of this because of our conventional medical teaching in India. They think, ‘How can it work?’ That if they don’t give anti diabetic drugs then this complication or the other will develop,” he says.
The Indian environment also makes it difficult to sustain such a diet without great discipline. Ranveer Allahbadia, a 22-year-old fitness trainer who has a popular YouTube channel, went on a keto diet when he was in engineering college. But he wasn’t able to sustain it then because he says his knowledge was not correct. “I used to eat carrots, onions. Many who think they are on a keto diet are just doing a normal calorie deficit. KFC has this grilled chicken, I used to eat it thinking this is low on carbs. In that grilled chicken marinade they used to put sugar. That would break my keto,” says Allahbadia.
Now he is again the middle of a three-month keto diet but he has to cook all his meals. . “I don’t even have milk because even milk has carbs. You have to keep a track of everything you are eating and all you are left with is meat and oil. The only source of carbs is leafy vegetables which you are having only because you need the vitamins and minerals,” he says.
Allahbadia is doing it because he says it is necessary for his career. “I run a YouTube channel and a lot of people subscribe based primarily on how you look. In the middle, I had got a lot into powerlifting and had become really fat. The fatter we get, the stronger we get. So I needed to shake things up a bit. This was just, like, to get me an extreme change in two weeks. To start looking lean because lean is commercial,” he says. And he finds his look improving every week. “I am starting to see a six-pack and what I have achieved in one month would have probably taken me three-four months if I was doing a calorie deficit diet,” says Allahbadia.
One of the biggest problems he faces is maintaining a social life with this diet. “I am going for dinner and I am sitting with an empty plate in front of me, my friends are eating, my family is eating,” he adds.
Priya Aurora has a website, Ketoforindia.com, where she offers professional advice to people who want to get on a ketogenic diet and one of the things she tells them is to have a keto meal before going to a party so that they are not hungry.
Similarly, going to restaurants can be a problem because most menus are entirely carb driven. Tina and her husband have a strategy. “I have realised that everything in restaurants is dunked in cornflour. So I always check if the food is batter fried. We mostly order tandoori. I tell waiters, ‘give me steamed or stir fried vegetables instead of mashed potatoes.’ And I always carry small sachets of butter when I go out to eat. I take them out and smear butter on every bite I eat,” she says.
If she is travelling and unable to find low-carb foods, then she just takes it as a day when she can do an intermittent fast. Recently, Priya went for a wedding to Jabalpur and since it involved travelling by train and bus for a number of days, she decided not to carry food and instead break the diet temporarily. “It was an awakening because I hated those five days. I didn’t enjoy the food and I realised how much I was off it,” she says.
Since the diet relies mainly on nuts, virgin oils and meats, the diet can be expensive to maintain. Singh agrees but he says it is nothing compared to the money you save on medication. “It squares off in the long run,” he says.
Vegetarians are at a particular disadvantage since with carbs down, the protein percentage has to go up and meat is the best and easiest source of it. In extreme low-carb versions of the diet, they would need to take protein supplements. “I advise my (vegetarian) patients to eat pulses, nuts and some seeds to get their daily dose of protein,” says Dr Chhajed.
The biggest hurdle, however, is to get out of your own conditioning. Tina says that in the beginning the mind cannot even comprehend that fat is good. “It is trying to wrap itself around the idea that you can eat fat. It is like a strong building we have built over so many years—‘Don’t eat fat, don’t eat fat.’ You have to get out of that first,” she says.