How I Got Started With Low-Carb

I thought it would be appropriate to start my blog by sharing the story of my background and how I discovered the field of nutrition and metabolic health. Much has been written online and elsewhere. I don’t hope to supersede this content but to add my own voice to the discussion. 


Like many others, I had struggled with weight for most of my life. I was never particularly thin throughout childhood and the issue was compounded by the stress of college, medical school and then particularly during residency training. Residency was a unique combination of stress and interrupted sleep along with, for a first time in my life, a steady salary allowing me the ultimate freedom about what to put in my body. 


I had become increasingly aware of my weight problem and I knew I needed to take action to correct it. Attempts at calorie restricting diets never lasted very long. I developed an intensive exercise routine. I took up jogging and eventually cycling. I was really enthusiastic about it. I was proud of all the 5K events I completed and I extra long bike rides throughout the city including the “5 Boro Bike Tour” in 2018.


But, I was never able to sustainably lose much weight. I resigned myself to the fact that I was doing all I can. After all, how bad it would it be if I didn’t do all this exercise?


My relationship with food was another story. I had convinced myself that I “live to eat.”  The NYC restaurant scene was super exciting to me and I had developed a reputation among my friends as the go to “foodie.” The thought of changing what I ate was unbearable to me as it had become part of my identity. 


I had gotten married in November of 2018. It was a lovely event but the whole night I was dealing with a poorly fitting tuxedo even though it was supposed to have been adjusted for my size. I was bothered by how big I looked in all of the photos.

The Eureka Moment 


A week or so after my wedding, I was browsing my Audible app and I received a serendipitous recommendation for the book “Why We Get Fat” by Gary Taubes. To this day I cannot explain why it was recommended to me as it was quite unlike any any of my previous purchases, but it could not have come at a more opportune moment. I was in the right mindset to make a change. 


The concepts espoused by Mr. Taubes now seem basic to me,  but when I first read it, the book completely turned the conventional wisdom on its head by negating many commonly held beliefs. In summary

• The advice to “eat less and move more” is fundamentally wrong. The medical community espouses this dogma and then blames patients for being non compliant with it. 
• Weight is NOT determined by calories but instead by hormones, especially the hormone insulin which promotes the storage of body fat.
• High carbohydrate foods, specifically refined carbohydrates and sugar, raise insulin levels more than any other foods. 
• Dietary fat does NOT raise insulin significantly, therefore dietary fat does alone does NOT translate to body fat. In fact dietary fat keeps you more satiated for longer. Societal preference for lowering dietary fat has been detrimental.
• Physical exercise has many benefits but weight loss is NOT among them.
• People are NOT overweight because they don’t exercise, they can’t exercise because poor diet promotes the storage of energy as fat.
• The most effective strategy to lose body fat is to dramatically lower dietary intake of carbohydrates. 

The Aftermath 


The idea of giving up many of my favorite foods (pizza, bread, rice, cake, sugary fruit) was a major psychological hurdle but I knew I needed to try something different. So one random day, I told my wife that I was going to try out a “low carb” or “Keto” diet. Thankfully she decided to join me.


The first one or two weeks were not easy. Meal planning was a struggle. Carb cravings were present throughout the day. Finding options at the convenience store was exceptionally frustrating. The disruption to my usual routine was the biggest obstacle to overcome.


But after a few weeks, I started getting used to it. Even better, I was starting to notice some benefits. I became less hungry, my sugar cravings disappeared and even my afternoon post prandial crash vanished, I started thinking more clearly, and slowly but surely, the numbers on the scale started to drop. 


Thankfully the pounds haven’t returned. At the time of this writing, I have been “low-carb” almost two years. I have maintained weight loss of about fifty pounds. Rather than being a passing phase, this lifestyle has become routine for me and I have no intention to change.


The Realization


My personal experience with diet resulted in me taking a professional interest in the subject of nutrition. I was trained as a Family Medicine doctor. During my training I witnessed first hand the damage done by diseases of poor lifestyle. I saw the devastation inflicted by diabetes and cardiovascular disease, including strokes, heart attacks, amputations, and kidney failure. 


My experience with trying to medically manage these conditions was deeply frustrating. Despite extensive counseling and medicine, these patients continued to get sicker. It is a major reason why I did not continue with primary care medicine after my training. 


After discovering “Keto” I was inspired to take a fresh look at what was wrong with our approach. After consuming many books and articles, and attending multiple conferences I have come to the realization the food that we consume is the most important factor in protecting and improving our health our health. The main points that I emphasize are the following.

• Poor diet is the single greatest cause of poor metabolic health or “metabolic syndrome.”
• Metabolic Syndrome is caused by abnormally elevated levels of insulin in the body or “insulin resistance.”
• Insulin resistance is a major contributor to the chronic diseases of modernity including, but not limited to obesity, diabetes, cardiovascular disease, dementia, and even certain cancers.
• Lifestyle change through improved diet is more powerful than any medication in preventing and treating these conditions.

Each of these points has a lot of nuance that can be discussed. But, on the whole, I truly believe that this approach offers our best opportunity to tackle this problem on a wide scale. This is the way prevent metabolic dysfunction at its root. On a personal note, both my wife and I have extensive family history of diabetes and we had both resigned ourselves to the thought that we will get it too. We can now say, with some confidence, that we can prevent this. This is a real source of optimism.