LOSE IT! - - Contents -

Dr Schoonbee an­swers your ques­tions

Q: Will I be de­fi­cient in cer­tain nu­tri­ents if I don’t eat carbs? I was told to eat every­thing in mod­er­a­tion. A: I com­pletely un­der­stand why you ask this ques­tion – we’ve heard so much con­tra­dic­tory nu­tri­tional in­for­ma­tion over the years that we aren’t sure who or what to be­lieve any­more. What we do know is that there are three macronu­tri­ents that pro­vide energy: pro­tein, car­bo­hy­drates and fats. We need all three to sur­vive but our bod­ies are able to ‘make’ sugar (carbs) out of fat and to use ke­tones as an energy source in the ab­sence of glu­cose. On the other hand, our bod­ies can’t make all the build­ing blocks needed for pro­teins and fats. That’s why the build­ing blocks for pro­tein are called es­sen­tial amino acids and the build­ing blocks for fats are called es­sen­tial fatty acids. We have to get these via our diet; with­out them, we’ll die.

There are ex­am­ples and early stud­ies of peo­ple who have sur­vived on a zero-carb diet for over a year with­out com­pro­mis­ing their health but there have been no long term stud­ies. We rec­om­mend a low-carb lifestyle to keep in­sulin lev­els low, which also re­duces in­flam­ma­tion and the risk of meta­bolic syn­drome.

Q: I weigh 168kg. I’m con­sid­er­ing bariatric surgery be­cause I was told I could lose a lot of weight this way but I’d have to adopt a healthy long-term lifestyle to main­tain the weight loss. Would you rec­om­mend low carb? A: Be­fore de­cid­ing to have bariatric surgery it is im­por­tant to take the pos­si­ble health risks of such a ma­jor pro­ce­dure into ac­count. Pos­si­ble com­pli­ca­tions in­clude bleed­ing and sep­sis and, in the long term, com­pli­ca­tions such as dump­ing syn­drome (caus­ing di­ar­rhoea, nau­sea or vom­it­ing), mal­nu­tri­tion, bowel ob­struc­tion, gall­stones, ul­cers and stom­ach per­fo­ra­tion. You should def­i­nitely look at other op­tions that can help you to achieve the same goals of weight loss and health­ier liv­ing.

I have per­son­ally fol­lowed a low-carb lifestyle for more than five years and have wit­nessed many in­stances of mirac­u­lous lev­els of weight loss in my pa­tients – some of them have halved their own weight. I’d ad­vise you to fol­low the low-carb lifestyle too. It is healthy and, above all, sus­tain­able, which is how it dif­fers from other di­ets that I have tried be­fore.

Watch the video ‘Brian’s in­cred­i­ble story of weight loss’ on YouTube or read Brian Berk­man’s in­spir­ing story in the first is­sue of LOSE IT! Brian was in your ex­act po­si­tion and man­aged to lose the weight that he needed to solely through fol­low­ing a low-carb diet.

Q: I have eczema on my scalp and I started fol­low­ing a low­carb diet as I heard it could help. How­ever, I haven’t re­ally no­ticed an im­prove­ment. Does this mean I need to ad­just my carb lev­els or are there other fac­tors to con­sider? What else can I do to re­lieve it? A: There are many dif­fer­ent causes of eczema so one has to find and treat the cause, if pos­si­ble. A very com­mon type is atopic eczema, which de­vel­ops due to an au­toim­mune re­sponse. It is com­mon in ‘atopic’ fam­i­lies with a his­tory of al­ler­gic con­di­tions such as hay fever, asthma and mi­graines and these pa­tients will all ben­e­fit from a low-carb diet.

In adults the most com­mon eczema of the scalp is called se­b­or­rheic der­mati­tis, which can cause chronic itch­i­ness and dry sca­li­ness (dan­druff). It is be­lieved that this skin con­di­tion is caused by an al­ler­gic re­ac­tion of the skin to the pres­ence of fungi and their me­tab­o­lites. This is why it is also treated with an an­ti­fun­gal ke­ta­cona­zole sham­poo. An­other pos­si­ble cause of scalp eczema is con­tact der­mati­tis trig­gered by cer­tain sham­poos or soaps, in which case you should avoid us­ing these sham­poos.

Q: I’ve re­cently been di­ag­nosed with di­ver­ti­c­uli­tis. Can a low-carb lifestyle help with man­ag­ing this or will it make it worse? A: To un­der­stand the ef­fects of diet on di­ver­ti­c­uli­tis it’s im­por­tant to ex­plain the dif­fer­ence be­tween di­ver­tic­u­lo­sis and di­ver­ti­c­uli­tis.

Di­ver­tic­u­lo­sis is com­mon in the el­derly (70% of oc­ta­ganari­ans will have these lit­tle bulging pouches pro­trud­ing from the wall of the dis­tal colon, which is the last, bot­tom part of the colon). The known con­tribut­ing fac­tors to the de­vel­op­ment of these pouches are old age and ge­net­ics. Other the­o­ries sug­gest a lack of fi­bre in the diet or in­creased in­tra­lu­mi­nal pres­sure due to chronic con­sti­pa­tion as pos­si­ble causes. How­ever, all of these the­o­ries are de­rived from lim­ited data with no de­fin­i­tive proof. Un­com­pli­cated di­ver­tic­u­lo­sis usu­ally has no symp­toms.

Di­ver­ti­c­uli­tis is what de­vel­ops when these pouches be­come in­fected with bac­te­ria, which causes symp­toms of se­vere lower ab­dom­i­nal pain, fever, blood in the stools and di­ar­rhoea or con­sti­pa­tion. This con­di­tion needs to be treated with an­tibi­otics to pre­vent com­pli­ca­tions such as ab­scess for­ma­tion or bowel per­fo­ra­tion. As the low-carb lifestyle pro­motes a healthy gut and low­ers in­flam­ma­tion it should not make your di­ver­ti­c­uli­tis worse.

There are three macronu­tri­ents that pro­vide energy: pro­tein, car­bo­hy­drates and fats. We need all three to sur­vive.

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