Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The problem with naming a diet low carb

Roxanne B. Sukol, MD
Conditions
May 12, 2011
Share
Tweet
Share

What does low-carb mean?  Well, the first thing it means is that something else has more carb.  So what are you comparing it to?   Breakfast cereal?  Angel food cake?  The standard American diet (sAd)?  Anything would be low-carb compared to those.

A whole bunch of folks at the Nutrition & Metabolism Society have been working hard to help people understand that carbohydrate, and not dietary fat, is the main dietary component causing our obesity and diabetes epidemic.  They say we all need to be eating a low-carb diet, and they have the research to prove it.

I agree with a lot of what they say.  But I disagree about what to call it.  I’m sort of saying the same thing as them, because I do believe that carbohydrate [especially refined carbohydrate, manufactured carbohydrate, processed and stripped carbohydrate] is one of the major players in the obesity epidemic.  I just don’t think we should be calling it a low-carb diet.  I admit it; I’m mincing words (instead of garlic).  But if it’s called a “low-carb” diet, that would mean that a high-carb diet is the normal default.

If you call something low,  then there must be a high somewhere.  If you call dessert “blond brownies,” there must be a not-blond type.  And there is.  If you call someone pro-, then everyone else can be presumed to be con-.  So if people advocate a low-carb diet, then what does a high-carb diet look like?  And the answer is — the American diet.  The standard American diet (sAd) consists mainly of illness-producing amounts of refined carbohydrate.  Cereal and toast for breakfast, sandwich and chips for lunch, pasta for dinner.  You want fries with that?  No wonder America has an obesity and diabetes problem.  That diet, the sAd, is profoundly unhealthy.  It causes diabetes, obesity, high blood pressure, arthritis, heart attacks, and strokes.  That’s not okay with me or my patients.  So why would I pick a name that presupposes the sAd is some kind of normal?  I wouldn’t.  That’s my point.

This perspective highlights the difference between absolute and relative comparisons.  Let’s pick an example from something quite familiar to me, the medical industry.  Imagine, for example, that a new medicine came to market that decreased the chance of developing a rare and horrible side effect (say, a severe rash) from 2 in 10,000 to 1 in 10,000.  For every 10,000 people who tried the medicine, the chance of getting the rash would be halved, from two to one.  You could say that the medicine was “twice as safe.”  That’s called a relative comparison.  And while it is true, technically speaking, it’s not the whole story.

The other way to look at this is that, in fact, the chance of developing the horrible rash is already very small, and it becomes slightly smaller if you switch to the new medicine.  That is the conclusion I reach from evaluating the absolute, or actual, numbers.

When we call smart eating a low-carb diet, we are making a relative comparison.  And relative comparisons are notoriously undependable because they don’t take into account where you started.  They tell you where you landed, but not how far you went.

I don’t want to call a diet with healthy amounts of carbohydrate “low-carb.”  What then?  Smart-carb?  Natural-carb?  Garden-carb?  Pre-industrial carb?  I’ve heard some people talking about the Paleo [PAY-lee-oh] (short for Paleolithic) or caveman diet, which presumes that the right amount of carbohydrate would be the amount that the average human ate in that pre-agricultural era.  Why pre-agricultural?  Because that’s before humans began to grow and domesticate grain, especially wheat.  Wheat (along with corn and soy) is the grain used to make large amounts of the processed, food-like products that may be found at the American supermarket.  But Paleo doesn’t feel right either, unless I don’t mind eating the Industrial Revolution diet.

It’s important to remember that all carbs aren’t all-bad.  Not for everyone.  It’s certainly true that some folks are so sensitive to carbs that even an apple a day will make their pants too tight.  Practically the only carbs this group of people can eat comfortably are green vegetables.  But there are lots of other people who can eat all the peaches and lima beans they want.  So, instead of low-carb, I’d like to hear people start saying they eat a low-grain diet, or a low-processed-food diet, or even a low-grain and low-fruit diet.  That’s going to tell me a lot more about how well this person understands his or her own metabolic needs.

When we call a diet “low-carb,” we are making a comparison with the sAd.  And the sAd is so high in processed carbohydrates that virtually every other diet is an improvement.  Low-carb, therefore, doesn’t tell us much.  It doesn’t say whether the recommendations target all grain, or only processed grain, or all grain and fruit, or all four categories of carbohydrate:  grains, fruits, beans and vegetables.  And it presumes that the sAd has a normal amount of carb.  Which it does not.

Roxanne Sukol is an internal medicine physician who blogs at Your Health is on Your Plate.

 

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Sunscreen advice from a dermatologist to prevent skin cancer

May 12, 2011 Kevin 12
…
Next

The best way to control a pertussis outbreak is to vaccinate

May 12, 2011 Kevin 4
…

ADVERTISEMENT

Tagged as: Patients

Post navigation

< Previous Post
Sunscreen advice from a dermatologist to prevent skin cancer
Next Post >
The best way to control a pertussis outbreak is to vaccinate

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Roxanne B. Sukol, MD

  • Fruit and sugar: Debunking the myths

    Roxanne B. Sukol, MD
  • The antidote to multitasking is mindfulness

    Roxanne B. Sukol, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Solving the different behaviors that lead to obesity

    Roxanne B. Sukol, MD

More in Conditions

  • Why coaching is not a substitute for psychotherapy

    Maire Daugharty, MD
  • Why doctors stay silent about preventable harm

    Jenny Shields, PhD
  • Why gambling addiction is America’s next health crisis

    Safina Adatia, MD
  • How robotics are reshaping the future of vascular procedures

    David Fischel
  • How the shingles vaccine could help prevent dementia

    Marc Arginteanu, MD
  • Why removing fluoride from water is a public health disaster

    Steven J. Katz, DDS
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
  • Recent Posts

    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions
    • Why interoperability is key to achieving the quintuple aim in health care

      Steven Lane, MD | Tech
    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 27 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
  • Recent Posts

    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions
    • Why interoperability is key to achieving the quintuple aim in health care

      Steven Lane, MD | Tech
    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The problem with naming a diet low carb
27 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...