Carbohydrate Restriction Discussion Hello everyone! This is the 10th installment of our dialogue-style content.
This time, we have Dr. Haruyo Oshiro, a specialist and instructor in the Department of Diabetes and Metabolism, Japan Diabetes Society, and a customer of Fusubon. He will also answer questions about carbohydrate restriction, so please take a look.
(Kawatani) Thank you for taking the time to see me today, Mr. Oshiro.
(Oshiro) Thank you very much!
(Kawatani) I learned about and started practicing carbohydrate restriction through a members-only online media that does not rely on advertising. Mr. Oshiro, could you tell us how you found out about carbohydrate restriction?
(Oshiro) It all started with my own personal issues. From an early age, I grew up completely fascinated with carbohydrates, especially the deliciousness of staple foods.
Not only white rice, but also brown rice, glutinous rice, and multigrain rice were all delicious.
He also likes toast and sweet bread, and can easily finish off about three pieces in one sitting.
My parents placed a lot of importance on healthy eating, so I would secretly eat extra staple foods.
When I became a university student, my friends used to laugh at me and call me a "skinny big eater," but I never put on weight, and in the excitement of being away from my parents, I became even more obsessed with eating staple foods.
Then, around the time I started working as a medical intern, I began to feel a dull pain behind my eyes about two hours after eating.
About three hours after eating, my hands would always start shaking and I would feel uneasy and irritable.
Then, about four hours after eating, I started to feel lethargic and very sleepy.
These symptoms seemed to be particularly pronounced after I was busy and only ate a staple food in my mouth.
This trend continued so much that I decided to look up in medical books what diseases could cause these symptoms.
As a result, it was determined that the most likely disease was impaired glucose tolerance (a condition that increases the risk of developing diabetes).
In this state, after ingesting a large amount of carbohydrates, the hormone insulin, which lowers blood sugar levels, is not released at the right time. When blood sugar levels are at their highest, they do not come out with a sudden surge, but rather come out slowly over time. This results in a drawn-out release of insulin.
As a result, although you may experience high blood sugar levels shortly after ingesting carbohydrates, you may experience low blood sugar levels a few hours later.
This also coincided with the fact that my birth weight was less than 2500g, putting me in the high-risk group for impaired glucose tolerance. So I thought that if I was going to try treatment, I should try treatment for diabetics. And I decided to follow the treatment for type 1 diabetes, which requires more strict treatment than other types of diabetes. After doing some research, I came across a book by Dr. Richard Bernstein from the United States, who is himself a type 1 diabetes patient. The book touted a low-carbohydrate diet.
(Kawatani) I see. Impaired glucose tolerance is a symptom similar to hypoglycemia, isn't it? I think it was a good idea to look into the treatment of type 1 diabetes instead of type 2 diabetes.
Mr. Oshiro, please tell us about your daily work as a doctor. If you have ever used carbohydrate restriction in treatment, please let us know.
(Oshiro) I am engaged in medical checkups and the treatment of diabetes and metabolic disorders (hormonal diseases such as diabetes, dyslipidemia, and thyroid disease). For obese patients with a BMI over 30, and for patients who are found to have a preference for and consume a lot of carbohydrates during the medical interview, I suggest carbohydrate restriction.
It may be inevitable, but I get the impression that it is difficult to accept in rice-producing regions.
On the other hand, patients who don't mind cutting down on their staple foods but can't stop snacking were quite pleased.
Additionally, patients who complain of mood swings and insomnia also seem to have a tendency to consume a lot of carbohydrates as snacks or late-night meals.
Since I am unable to listen to your concerns in detail, it is difficult for me to suggest a low-carb diet, but I believe that if it were implemented, it would have a certain degree of effect.
(Kawatani) Thank you. There are a lot of low-carb products on the market, but calorie restriction still dominates the treatment of diabetes, and carbohydrate restriction has not yet gained widespread acceptance.
Since the culture of rice farming is deeply rooted in Japan, I always suggest eating staple food last (carb-last), eating brown rice as much as possible, and avoiding sugar products.
Please tell me what to be careful of when restricting carbohydrate intake. I would especially appreciate it if you could tell me about the considerations depending on age, such as for people with chronic illnesses, children, and the elderly.
Points to note when restricting carbohydrate intake
(Oshiro)
○People with a chronic illness that makes them susceptible to hypoglycemia (e.g., liver cirrhosis)
Those with a chronic illness that contraindicates high fat intake (e.g. pancreatitis)
People with a chronic illness who cannot effectively use protein or fat as energy
People who fall into any of the above categories cannot implement carbohydrate restriction.
If you have been diagnosed with a metabolic disorder, you will need to check with your doctor about whether or not it is possible to restrict carbohydrates.
And for the main focus, diabetic patients, I would like you to make sure to declare to your doctor that you will be introducing carbohydrate restriction . There are some diabetes medications that are prescribed on the assumption that you are consuming a lot of carbohydrates. These include SU drugs, glinide drugs, and SGLT2 inhibitors. At first glance, there are only a few categories of drugs, but they are sold under a variety of names by various pharmaceutical companies.
Please check with your pharmacist or doctor to see if any of your medicines fall under these categories.
If a doctor prescribes these medications without understanding carbohydrate restriction, it may lead to unexpected hypoglycemia or, conversely, the treatment may not be very effective.
Also, from the perspective of diabetic nephropathy, one of the diabetic complications, we would like to ask you to speak to your doctor. The most important thing in treating diabetic nephropathy is to reduce salt intake.
Next comes protein restriction, but I think we are still at a stage where we have not reached a firm conclusion as to its effectiveness.
A carbohydrate-restricted diet can result in a relative increase in salt and protein, which may worsen the condition of diabetic nephropathy depending on the severity of the condition.
It is important to implement carbohydrate restriction while paying attention to the severity of diabetic nephropathy and the ingredients and menus used.
According to a presentation by Dr. Satoru Yamada, Director of the Diabetes Center at Kitasato Institute Hospital, Kitasato University, patients with diabetic nephropathy who were deemed suitable for the introduction of the hospital's low-carbohydrate diet did not experience a deterioration in renal function, at least during the observation period of several years.
Finally, regarding carbohydrate restriction for children and the elderly, I think it may actually be a desirable dietary pattern, unless it causes psychological stress or problems such as stomach upset.
This is because a carbohydrate-restricted diet that provides plenty of protein and quality fats is thought to be effective in maintaining muscle mass and promoting hormonal function .
In particular, I think that a "gentle carbohydrate restriction" that involves cutting staple foods in half is easier to continue.
We think it would be safe if you pay attention to the level of additives and the amount of "red meat and processed meat from four-legged animals" that you feed your children, as there have been reports that there are concerns about an increased risk of carcinogenicity.
(Kawatani) Thank you. It can be difficult if you have a chronic illness, so it's essential to seek proper advice from your doctor .
It may be most important to manage your post-meal blood sugar levels while you are still healthy. Many people who are on a carbohydrate restriction diet are concerned about LDL cholesterol, but what is your view on LDL cholesterol?
I believe Dr. Ebe and others would say that if triglyceride levels are low and HDL cholesterol levels are high, even if LDL cholesterol is high, there is likely to be little small-particle LDL or oxidized LDL, so it is not a problem.
It seems that many people become anxious when their LDL levels are high and their doctor talks about prescribing drugs to lower cholesterol. If you are anxious about this, it seems to me that measuring remnant-like lipoprotein cholesterol (RLP-C) would be useful. What do you think?
When carbohydrate restriction increases LDL cholesterol
(Oshiro) I still believe that LDL cholesterol levels should be strictly controlled for patients with diabetes, chronic kidney failure, cerebral infarction, and obliterative arteriosclerosis. These diseases make patients more susceptible to ischemic heart disease.
Also, there seem to be more reports on the relationship between LDL quantity and ischemic heart disease than on the relationship between LDL quality and ischemic heart disease. Therefore, the issue of LDL quantity cannot be ignored in patients with the aforementioned diseases.
On the other hand, if there are no chronic illnesses mentioned above, and HDL cholesterol is over 40 and TG (triglycerides) are under 150, in other words, as long as the quality of LDL is good, we do not recommend treatment.
I think that measuring the RLP value is useful for understanding the degree of risk of ischemic heart disease. If you do not have the above-mentioned disease name, you may not be able to measure it due to insurance issues, so please consult with your doctor.
By the way, there is an impression that the higher the HDL cholesterol, the better, but among patients with levels over 100, there are cases where the patient has a pattern that makes them more susceptible to developing ischemic heart disease, so interpreting cholesterol levels is always very difficult.
The standards and content of treatment for dyslipidemia are likely to continue to change in the future. We must be careful not to be left behind.
(Kawatani) I see. That's helpful. Could you please tell us about your everyday diet?
(Oshiro) I try to limit carbohydrate intake to about 40g at each meal.
In my case, if I exceed this amount, the symptoms mentioned above naturally appear. When I measure my blood sugar with a self-monitoring device, it shows that my blood sugar level is 188 mg/dl two hours after eating, and 36 mg/dl four hours after eating, so I can confirm that I have taken in too much carbohydrate.
Through these experiences, I've become able to avoid eating too much sugar. Although it's bad manners, I end up eating breakfast while walking around and getting the kids ready to go.
Therefore, I only eat things that I can eat with one hand: 1-2 cherry tomatoes, 3 pieces of cheese, 20 almonds, one vegetable side dish from the night before, 1 spoonful of unsweetened yogurt, acai powder, and one piece of low-carb bread (Fusbon's or my own).
For lunch, I have one meat dish, one vegetable and mushroom dish, two bites of rice or one piece of low-carb bread, and one cup of black coffee. After the meal, I eat about 20 goji berries or about 1/8 of a peach, which is my favorite.
For snacks, I have a piece of cheese and a cup of black coffee.
Dinner is one fish, soybean or tofu dish, one vegetable or mushroom dish, one low-carb snack or regular snack with 10g of carbohydrates, and one or two glasses of wine. Sometimes I also have an egg dish. If I have an early dinner and get hungry in the evening, I eat one piece of cheese, about two hours before going to bed.
The differences between the children's menu and mine are as follows:
Add 1/4 of a palm-sized serving of fruit in the morning, kindergarten food for lunch, and 1/4 to 1/3 serving of staple food in the evening. Children's snacks are adjusted to have about 10g of carbohydrates per serving. For sweets, you can adjust the amount by referring to the ingredient list on the back of the box. The differences between my family members' menus and mine are as follows: Add 1/2 a palm-sized serving of fruit in the morning, and a pack of natto in the evening.
(Kawatani) I see. That's very helpful. I hope everyone reading this article will take note of it. By the way, what do you do when you eat out?
(Oshiro) Nowadays, even when I eat out, I don't get the amount of carbohydrates wrong.
We feel bad about leaving the main dish or palate cleanser, so when taking the order we ask things like, "I don't need it because I can't eat it," or "Cut it down to about a quarter of the amount, please."
Or, they can be taken home, divided into small portions and frozen, and consumed by adults over a period of a few days. If they offer you a staple food or sweet that you absolutely want to eat, you can drink tea, which is said to have the same effect as the diabetes treatment alpha-glucosidase inhibitor, and then eat it.
These teas seem to work for me, but I think the effect varies from person to person. I think it's best for each person to check the effect with a self-blood glucose monitor.
Also, if you let the people you are dining with know that you are on a carbohydrate restriction diet, you may be able to enjoy the meal even more. (Kawatani) I see.
I'm known as someone who restricts carbohydrates, and although people around me may think I'm quite a nuisance (lol), I try to avoid sugary products as much as possible, and when I eat out I still eat a fair amount of carbohydrates. Of course, I haven't had any soft drinks since I started restricting carbohydrates.
Recently, I've been seeing a lot of articles about orthomolecular medicine and I've been studying it myself, so are you interested in it too, Oshiro-san?
Carbohydrate restriction and orthomolecular
(Oshiro) I think orthomolecular medicine is a very attractive concept that draws out the power of living as a person. In my practice, I feel that the current medical system is more of a tension of "addition and subtraction" through medication and treatment.
Although there is some dialogue, consultations are generally short, and there are even times when the patient is the student and the medical professional is the teacher.
On the other hand, I think that orthomolecular medicine is a way of looking at "food," which is the source of life and the very essence of daily life. The digestive organs through which "food" enters are internal organs, but they are also the outside world, first receiving what comes in from the outside, then digesting and expelling it.
Orthomolecular medicine focuses on this issue and has the idea of being able to help find what is good for the human body from both inside and outside.
For our own bodies and the bodies of those we care about, it is like a mother who is close to our hearts and embraces us every day. Of course, if this approach causes a psychological burden, I think the appeal is that there is plenty of room to find a compromise that is truly "natural" for the person within the family, or between the patient and the medical professional.
(Kawatani) I also believe that orthomolecular medicine is an approach based on traditional Chinese medicine and is very effective in preventing disease.
I really like what biologist Shinichi Fukuoka says about dynamic equilibrium and the relationship between the parts and the whole. I believe that Western medicine is about seeking immediate results and not taking much time, whereas Eastern medicine is about treatment that doesn't produce immediate results and in some cases takes time and involves trial and error.
Once you become ill, it seems to me that it is difficult to cure simply by mechanically adding or subtracting parts, as Fukuoka expressed in terms of the relationship between "parts and the whole."
Once patients become ill, they will want visible results, such as quantitative numbers or diagnostic imaging results, and it may be inevitable that they will seek treatment that links cause and effect in a one-to-one manner and produces immediate results.
I am also committed to carbohydrate restriction, but if I were to get cancer, I don't know if I would 100% choose high-concentration vitamin C and ketone body therapy. If it's early stage cancer, I might want to have it removed, and I'll make a total decision based on factors such as the 10-year survival rate.
So I don't force anyone to restrict carbohydrates. I think it makes the most sense to get regular blood tests while you're still healthy and to find what suits your body best through food, Chinese medicine, and supplements.
I would like to continue to study the benefits and points to be careful about of carbohydrate restriction. I would be happy to hear various opinions from the medical field in the future. Thank you for today!
(Oshiro) Thank you very much!
<< Profile of Haruyo Oshiro >>
Diabetes and Metabolism Specialist and Instructor, Japan Diabetes Society Certified Specialist
