Fever and Books

Well, my beautiful little low-carb n=1 has had her first fever. Just a few days shy of her 2nd birthday she started running axillary temperatures between 39 and 40. No other symptoms, just a fever and lethargy. She was the perfect little patient, she stayed in our big bed all day sleeping and watching Max and Ruby on the tv. Not a peep of complaint. By the following morning, she was back to her normal active, chatty self, running around the house, dancing, chasing the cat, playing with balls in the yard – it’s hard to keep up. I think these mild childhood illnesses exist partly to strengthen the bond between parent and child. You feel so protective and close to them when they are sick at that age. Anyway, I can no longer boast that she has been completely free of fever although she is still yet to have a rash.

She is talking in complete sentences, now, too and she definitely has a lot to say. This morning, after sharing my breakfast of frittata, tomato and mayo, she said, “Thanks for the nice breakfast, Dad”. And she has discovered that it pleases me when she says, “Daddy’s car is good”. We are still on track with her low-carb high fat diet. It’s not so much that we don’t allow any carbs but that she isn’t attracted to them. My 11 year old son, for instance, sometimes eats brown toast with almond butter for breakfast and will offer some to his sister. She will sample the almond butter and leave the toast untouched. He has actually switched to scrambled eggs now with a little sausage or bacon which makes me happier. He is currently taking a sailing course where he spends all day on the water, solo in a small dinghy, so he needs a good breakfast. Both of them are thriving on diets virtually devoid of sugar and very low in starch. I really can’t see any justification for adding those types of foods into their diet.

Even though we are approaching the end of summer, the traditional time for reading a book or two, I want to talk about books because there have been a number of new ones published in the last year or so that I am recommending.

The first of the new batch, of course, is the latest in the Atkins diet series, “The New Atkins for a New You”. The Atkins Nutritional corporation, which owns the publishing rights, contracted with three researchers I know well to write the definitive update of this popular low-carb diet. Drs Steve Phinney, Eric Westman and Jeff Volek have all done excellent research on low-carb diets. Steve did his PhD work at MIT on high-fat low-carb diets in the late 1970s. He showed that exercise tolerance, which drops when you cut carbs, actually will return to baseline or better if you stick with the diet. This was lost on earlier researchers who stopped their studies before their subjects had sufficient time to adapt. Steve figured this out by reading the diaries of European explorers who lived among the Inuit and who ate the Inuit diet of 80% fat and 20% protein. He has continued to contribute to our understanding of diet and metabolism over the years both in academia and in the corporate world. His focus has been on the use of nutrients for therapeutic purposes and he holds several patents in this area. Eric Westman runs a clinic at Duke University where he treats diabetics with a low-carb diet and gets excellent results. He started researching low-carb diets about 12 years ago when he observed some of his patients using this method to shed weight and get off meds. He actually went up to Manhattan and met with Dr. Atkins to learn firsthand how the diet worked and what kinds of results one could expect. He then did one of the first modern trials of a low-carb diet which was published in 2002 and has continued to do research and publish in this area since that time. Dr Jeff Volek is a kinesiologist and registered dietitian at the University of Connecticut where he has a large lab and, at any given time, about 20 grad students. He has been publishing very well executed studies which show the benefits of low-carb dieting on a range of conditions associated with insulin resistance. I use his material in my lectures because they are the best resources we currently have to demonstrate the “efficacy” of low-carb diets vs the usual studies which demonstrate “effectiveness”. This is an important distinction since efficacy is what we want while effectiveness can be influenced by any number of factors that reduce compliance. When you look carefully at most of the low-carb studies, especially the ones that get published in high impact journals, they make a mess of the low-carb arm and therefore get poor compliance. Then an “intention-to-treat” analysis is used on the data which waters down the reported benefits of low-carb. Jeff’s studies are done properly, with high compliance, so that the benefits of low-carb are more clearly represented in the results. All that to say that this team of authors has the scientific and clinical chops to deliver when it comes to writing a guide on how to effectively do a low-carb diet. They have done a good job with this book and I have been recommending it to all and sundry. One of the things I especially like is that you don’t even need to read the book to get started, you can just go to page 246 where there are extensive meal plans, and start eating according to the diet. You can then read the book at your leisure as the pounds fall away.

The second recent book is the latest from my friend Gary Taubes, “Why We Get Fat and What To Do About It”.  After his 2002 New York Times article, “What if it’s all a Big Fat Lie”, and his subsequent opus, “Good Calories, Bad Calories”, established him as arguably the most knowledgeable and prodigious critic of the foibles of nutritional science in the western world, Gary has become an icon in the low-carb universe. I recommend GCBC but I know that many people find it too densely scientific to get through. To me it reads like a whodunnit and I couldn’t put it down but I had already been immersed in the science of nutrition for awhile. I think Gary’s publisher noticed that this was an issue, as well, and pressured Gary to write a lighter version that would be more accessible to the general reading public.  He has done a good job of that with WWGF. My wife couldn’t put it down and her science background is in math and computers. For anyone who wants to understand the history of nutritional science and that there are actually competing ideas as to what might be a healthy diet, I highly recommend this book. If you are new to this area, you will find things you assumed were bedrock in terms of nutritional advice are, in fact, highly debatable and, in some cases, outright wrong. One of the things my wife tells her friends when recommending the book is that it is not just about weight, it is about all aspects of health.

If those two books weren’t enough to completely fill a beach vacation reading list, my friends Phinney and Volek recently came out with, “The Art and Science of Low Carbohydrate Living”. After they wrote the new Atkins book, they wanted to develop a manual that could be used by physicians to manage their patients on a low-carb diet. I gather that the Atkins people weren’t interested so Steve and Jeff decided to go ahead on their own. I had met with an Atkins VP last summer at a conference in Switzerland where we had several conversations about where they could go with the brand. I felt strongly that there was enough evidence now to advocate this type of diet for the treatment of metabolic syndrome and type 2 diabetes and that the corporation should start targeting physicians. It seemed to me that to go in this direction would enhance their brand by getting more widespread buy-in from physicians and anything that promotes the diet would, I believe, increase sales of their products. The books, for example, could be recommended by physicians to their patients to guide them on the diet. At any rate, I gather that this was a no go, in fairness, possibly because the corporation was in the throes of another take-over at the time so Steve and Jeff set out to write the definitive physician’s guide on their own. The result is a book that, while it targets physicians, is accessible to the general reading public. It is written in a casual and, at times, witty style while providing lots of good information on the why’s and how’s of low-carbohydrate dieting. Some people who have read it have told me it is the most convincing of the low-carb books so far. The authors certainly have the scientific background to deliver what you need to know about the metabolic consequences of high-fat low-carb vs the alternatives and they do so in a way that is readily understandable and backed up with the appropriate citations. Another good book for anyone who is starting to question the current dietary recommendations for healthy living.

Okay, one more to go. Jeff O’Connell was a writer for Men’s Health when I first heard from his a few years back. He was interested in the study at Alert Bay and wanted to do a story on it for the magazine. He had developed an interest in diabetes and had begun to write about it. As it turned out, he was not able to get up here to visit the study but in the meantime did arrange for me to be featured as one of the 20 “Health Heros” in their 20th anniversary commemorative edition. A couple of years went by and then, out of the blue, I heard again from Jeff asking if he could visit. By this time the study had wound down so I suggested he follow me as I visited a string of First Nations communities in the north and spoke at a local diabetes conference in a small northern town. During those few days I learned that Jeff had developed pre-diabetes, that his father was severely affected by advanced type 2 diabetes and that he had a book advance to write about this epidemic that is now gripping the world. The result is his just published book, “Sugar Nation”. Now I am perhaps a little biased, and you may see why when you read his flattering portrayal of me in the book, but I am again highly recommending this book to anyone interested in learning about the diabetes epidemic and how we got into such a fix. His personal quest to understand his condition and his travails in obtaining helpful advice from the medical profession and the other authorities who are supposed to be leading us out of this morass becomes a damning expose of the madness of the current approach. His down-to-earth writing style and his ability to discuss the science in easy to understand terms make this book very accessible. He concludes that a combination of carbohydrate restriction and exercise is the solution to both the prevention and the treatment of diabetes and insulin resistance. I agree with him, although my focus has been more on the carbohydrate restriction side of things. I have to confess that after reading his book, however, I did shift my morning exercise routine from cardio to high intensity interval training. So far, so good. I’ll let you know how that has worked out once ski season starts.

I hope you find these mini-reviews helpful and I certainly encourage you to read any or all of these books to better understand how a seemingly simple shift in your diet can have huge beneficial consequences in your life.

7 thoughts on “Fever and Books

  1. I hope your little one is all better now. Even though all the books and the pediatrician swore up and down that kids did not get fevers from teething, my kids did. Otherwise they were rarely sick.

    Dr Jay’s Reply:

    She is fully back to normal now. Thanks.

  2. Hello Dr Wortman,

    I am so glad i came across your blog. I have type 2 diabetes and my doctor has given me a one month grace period to get my sugars regulated or i have to be put on meds. Your truly a great inspiration. How do i find out how to do the diet that you follow? I am a little familiar with low carbs but i am a little hesitant as i don’t know how much potassium to take and other electrolytes and vitamins. I had ileoanal reservoir surgery quite a while back so i have to make sure i get enough electrolytes. I look forward to hearing from you and am blessed to have found you.

    I live in Vancouver B.C.

    Sandy 🙂

    Dr Jay’s Reply:

    As you will see from reading here and from other low-carb diet sites, carbohydrate restriction can be an effective way to manage type 2 diabetes. Simply removing digestible starch and sugar from you diet can often obviate the need for medication. In your case, however, given your bowel surgery, you should approach this with caution and do it under the supervision of your doctor. Having said that, I see no reason why a low-carb diet would not work for you. As I said in the post, the new Atkins book is a good guide. For diabetics, I recommend staying on the induction phase indefinitely. Also, the Phinney and Volek book offers good advice and is one you may wish to share with your doctor. Good luck.

  3. Just reading your post..good to hear your little one is feeling better now. That’s pretty young to start talking full sentences..truly amazing! 🙂

    Dr Jay’s Reply:

    We think she is really smart. But, then, I think all parents are hard-wired to think that of their kids.

  4. Ah, bless! Children can become ill so fast, but get better equally fast. I think the theory may well be correct that an immune system that doesn’t have enough to do becomes surly and attacks innocent bystanders, like pancreases, thyroids and joints, so consider this some early training!

    I was put off GCBC (The Diet Delusion in the UK) by its sheer size, and the fact that people I normally trust had described it as turgid. On a recent holiday the inevitable rain (plus I removed myself from t’internet and computers completely) gave me the opportunity to get into it and I found it quite un-putdownable until I’d finished. I think you just gave me my reading list for next year’s holiday.

    Eric Westman starred in an old BBC Horizon programme


    I just watched this


    sorry I don’t think the streamed version is available overseas, but there was some interesting stuff about the development of insulin resistance and gene expression. Although they were mainly concentrating on epigenetics rather than using current dietary/environmental changes to alter gene expression which IMO is basically what we are doing, some of the links may be worth a follow-up.

    This guy


    pointed out that a lot of the Indian diabetics weren’t actually overweight but had the metabolism of a fat person (like me). They were concentrating on “fixing” the next generation by feeding the mothers lots of micronutrients (vegetables) in an ongoing long term study, Sadly not enough emphasis on the effect of excess carbs.

    Dr Jay’s Reply:

    Thanks for the links. The phenomenon of slim people who are “metabolically obese” is interesting. I interpret that as evidence that overweight/obesity is not, in and of itself, a cause of the metabolic problems but, is rather an effect of the diet along with the other effects like hypertension, dyslipidemia, etc. This is further supported by the fact that there are obese people with none of these other problems. It is also apparent that different populations will develop different patterns of pathology related to their insulin resistance. Asians, for example, will develop hyperglycemia at lower BMIs than Caucasians. I also agree that epigenetics is important in all of this. It may explain why these problems show up a generation or two after a significant dietary change has occurred.

    All very interesting to be sure, but let’s not forget the fact that however one arrives at this place of metabolic dysfunction, a carbohydrate restricted diet appears to be the magic bullet for reversing the problem.

  5. Yes agreed. Something like 20% of Type 2s are not overweight, and 80% of overweight people are not diabetic. Considering the Indian experience the former number may be an underrestimate.

    My tentative theory is that different gene sets shunt the same environmental abuses into different pathways. The key is to find the factors that shut down the gene expression in real time. Insulin resistance makes evolutionary sense as an *acute* response to a temporary food glut, shunting the food into store as fat. Such foods would be fruit (high carb, high fructose), nuts (high Omega 6), seeds (high carb, high Omega 6) so it makes sense that these factors would switch on IR. A return to a normal level of input should switch the IR off, reduce hyperinsulinemia and thus permit the stored fats to be metabolised.

    Both the SAD and the low fat high carb diet contain factors that fail to shut down IR so we carry on storing (or attempting to store) food for a winter that never comes

    (that line courtesy of Dr T at Nephropal)

    In me and my skinny relatives with Type 2 or metabolic syndrome, everything works right up to the last step of stashing the fat so it continues to rattle around in the blood causing the obvious dyslipidemia and ensuing CVD. The plumper ones measure much better. Either way, OUR genes respond well to eating an anatomically correct quanitiy of carbs.

  6. Thanks, Jay

    I just ordered The Art and Science of Low Carbohydrate Living and Sugar Nation and await them eagerly. (The other two books I have already read and they are excellent.)

    i recall fondly when Allison, our daughter, began speaking in sentences. Once, when she was almost two, we were at my parents place for Easter. It had been a long day. The adults were playing Trivial Pursuit and the game was going on (there were 6 players). As the game wore on, Allison kept coming by and tugging my shirt indicating she wanted to get back home–she had been very quiet that afternoon. Eventually, I suggested we call it a game and my father (ever the Patriarch) said, let’s just play a few more rounds. Allison immediately interjected, “Stop it, Ernie! I want to go home!” After a collective jaw-dropping moment, the game ended, as ordered. That week the Seattle PBS station had a fund-raising drive. They said that by far their most successful fuind-raising item was a shirt with the infamous expression from Rumpole of the Bailey, “She who must be obeyed.” … in size extra small!

    Allison is in 11th grade now and will be reading the Illiad, Odyssey and Aeneid for her classics course, embarking on a lifelong journey through classic literature.

    Wishing a blessed journey for you and your daughter.


  7. I have read Sugar Nation and am a third the way through the Art and Science of Low Carbohydrate Living. Sugar Nation was excellent. A very approachable and informative book. It tells a story.

    The Art and Science is even better; although not a story, is the best guide to the relevant body processes and I have learned more from this book so far than from any other. (Good Calories Bad Calories is a close second place.)

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