Dr. Keith Roach

DEAR DR. ROACH: I’m a healthy 75-year-old male. I’m a bit frustrated after seeing my regular doctor for a checkup and receiving a call from his medical assistant that he is suggesting a low-fat, low-carb diet. I asked for more specific diet suggestions, as I admit I am nutritionally ignorant (my late wife always bought groceries and prepared meals for us). Other than beef and bread, I’m not even sure what a carbohydrate is.
My LDL cholesterol is 152 mg/dL, my triglyceride levels are 256 mg/dL, and my A1C level is 5.8%. Ever since I was in my 20s, my A1C has been 5.6% or more in spite of the fact that I am very active and quite thin, and I do not eat desserts or add sugar to coffee, tea or cereals. I do suffer with severe neuropathy, but I simply work through that each day, as sitting isn’t part of my nature.
My weekly exercise routine consists of three days of strength training, plus running on the treadmill at the gym, and three days of walking 2.5 to 3.5 miles on days I do not go to the gym. I try to eat a good variety of vegetables, have fresh fruit every meal and seldom eat beef or anything fried, since fat causes stomach problems for me.
Looking at books online for information about low-fat/low-carb diets has been confusing and frustrating. So much contradictory material seems to be available. Do you know of any good resources? Obviously, my doctor isn’t going to be helpful. — J.R.C.
ANSWER: Before I give my opinion on a low-fat, low-carbohydrate diet on a 75-year-old person with diabetes, let me explain what this means. There are three types of macronutrients where we get energy from: carbohydrates, fat and protein. A well-balanced diet requires all components, although the proportions may vary greatly depending on an individual’s food choices.
Carbohydrates mean both simple sugars and chains of sugars, such as those found in starches like bread, pasta and rice. Fiber is also made of carbohydrates, but humans can’t use fiber for energy well at all. Fiber has many benefits, including helping regulate blood sugar in people with diabetes. Most fruits are essentially 100% carbohydrates, and vegetables, grains and legumes are mostly carbohydrates, with just a little amount of protein and negligible fat.
Fats are very large, energy-rich molecules found in oils, nuts, most animal meat, and in a few fruits like avocados. While fats have a bad reputation, there are four major kinds of fats, with the unhealthy fats being saturated (found in meat and tropical oils) and trans-saturated fats (not found in nature at all, only in processed foods, and fortunately being phased out). Polyunsaturated fats (in vegetable oils) and, particularly, monounsaturated fats (in olive and nut oil, with variable amounts in other oils) are healthy in reasonable amounts. Omega-3 is a type of healthy polyunsaturated fat.
Proteins are long strands of amino acids, found in meat and enriched plant foods like tofu. Beef has lots of protein, variable amounts of fat (much of which is saturated) and few carbohydrates.
So, a low-carb, low-fat diet really means a high-protein diet. It’s not so easy to get high protein without high fat, unless you know a lot more than your doctor or assistant told you. However, I just don’t agree with a high-protein diet for someone like yourself. Good amounts of healthy fats like those found in olive oil and fatty fish, along with fruits, greens and legumes, are all part of a healthy diet for people with and without diabetes.
A registered dietician or nutritionist can give you much more information.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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