I have recently been diagnosed as hypoglycemic and it was suggested that I go on a high protein/low carb diet. I have read the diets suggested by the Hypoglycemia Association, Inc. and Protein Power and have become quite informed. I was on a strict (to my preference) high carbohydrate/barely no protein diet. Currently, I have been dieting for almost 2 weeks eating 80 g prot/20 g carbs that includes mostly cruciferous vegetables, tofu, cheese, fish, and poultry while drinking at least 1 gallon of water per day (and sometimes 2 caffeine free diet sodas). My question/problem is that ever since last wednesday, my ankles and calves have been swollen. Most notably in my ankles and a couple of times a certain food (e.g., cooked spinach), caused the swelling to get worst such that it was difficult to walk. I sometimes have numbness (with no pains) and sometimes the swelling decreases, but constantly my feet look like they belong to an 8 foot gorilla (I am 5'2" and 87 lbs). I was taking two 90 mg potassium pills per day as suggested by PP but discontinued its immediately. Although I should probably be "raising" my feet, I constantly sit for my job and I constantly move about for my exercising. After a week, the swelling went away. Then a few days later, I ate some cooked spinach and I swelled up a little bit again! Plus this time, my lymph nodes (or the glands inside my jawbone) are very swollen (noticeable by others) making me feel that I have to throw up sometimes. I have never had problems with food allergies in the past and remember eating at the very beginning of my diet spinach dip w/cheese. I have heard about the oxalates in spinach but could I all of a sudden be supersensitive to it?

    Can anyone explain this or help me remedy the problem? My doctor has been no help at all. She is too concerned with me being underweight---another problem I am battling. Thank you in advance for your guidance.Take care.

    Do you know anything about the theory that insulin release is blunted when adrenalin is flowing? Your book covers a lot of topics, but does not address in particular how to sustain peak or endurance athletic performance when starting out with reduced glycogen stores. This is of critical interest to people who need a low-carb diet for medical reasons but who also want to remain active. I've learned that (apparently, based on blood test results) I can consume straightglucose/maltose/maltodextrin candy (SweetTarts or equivalent) in moderation during exercise, without causing hyperlipidemia. Do you have anything more to say about this subject?

    I've read that low-carb diets reduce thyroid activity, and one blood test seems to confirm that this has occurred in my case (after one year low-carb). I'm more prone to feeling chilly at times, and am generally more sluggish. Should I reduce my carb intake further (groan), per Atkins' "critical carb level" model, or do you have any other suggestions?

    What do you think of the Hellers' model, which is very low-carb except for one reward meal a day? They argue that insulin release is partly dependent on recent diet history. I haven't experimented with it myself.

    Do you have any new/revised information about eicosanoids, in particular, changes in your controversial recommendations about ALA? I've come to believe flax seed/oil is more good than evil. Any comments? Thank you

    Dr. Chales Gray at the U.S. Naval Hospital in San Diego has done extensive research on endurance and the low carbohydrate diet, using both lab animals (primarily swine) and naval recruits. He has found that performance and endurance on a low carbohdyrate diet are impaired until a period of low carb adaptation has taken place (usually about a week). Once adapted, the subjects' performance and endurance actually increase and surpass that recorded prior to the low carb diet (i.e. on a high carb one). He has also found that the enzymatic activity involved in the synthesis of glycogen increases with adaptation to a low carb diet--in other words, people who are low carb adapted make and store glycogen more easily even in the absence of much dietary carbohydrate. (Carbohdyrate can also be made from protein, and a small amount from the glycerol backbone of triglycerides, so even in the absence of dietary carbohydrate, glycogen sythesis goes on.) Dr. Gray did find that in subjects involved in intense activity (anaerobic exercise) performance was enhanced with the addition of small amounts of dietary glucose (i.e., SweetTarts). The only reason that dietary glucose would cause hyperlipidemia is if it stimulated an excessive and prolonged insulin rise, which is difficult to do during intense exercise because the insulin receptors become much more sensitive at this time (i.e., it takes much less insulin to deal with the dietary sugar when the receptors are sensitive). One caveat, however: a number of studies have shown that even small amounts of dietary carbohydrate during or immediately preceeding exercise (i.e., SweetTarts) blunts the release of growth hormone.

     As to your question about thyroid activity: reduced carbohydrate diets (and reduced calorie diets) sometimes decrease the activity of the enzyme that converts T4 (the inactive form of thyroid hormone that is released from your thyroid gland) to T3, the active form. We sometimes give our own patients small amounts of T3 during the weight loss phase of the program. Micronutrients also play a role in this conversion, especially iron and magnesium, so you might want to make sure that you have adequate levels of both. (You need to check your ferritin level (the storage form of iron) before you take extra iron, because elevated ferritin levels are a consequence of excess insulin and a major risk factor for heart disease. Don't take iron if your ferritin level is up.)

    As to the CAD, a large number of research papers have shown that the best way to lower insulin levels is to eat smaller meals spread throughout the day-- a la PP. An equally large number have shown that a huge meal (such as the reward meal specified in CAD) tends to cause an hyper release of insulin--especially when the meal is in the evening. We can't think of a single study showing that a large meal--especially one containing all the carbohydrates you can stuff in in an hour--reduces insulin levels. Now given this information, how can we reconcile it with the fact that some people DO lose weight on CAD? Here's how we think it works: Many people eat everything they want all day long. When they begin CAD, they can only eat everything they want for one hour during the day, so it makes sense that they would lose some weight. Given the biochemical realitites of the situation, we suspect that most people who lose significant amounts of weight on CAD probably eat a sensible low-carb reward meal most of the time.

    Since we wrote the section on eicosanoids, we have had brain transplants. (Unfortunately when Mike wrote that section he had fallen under the evil influence of our good friend, Barry Sears.) We, too, now believe that flax seed oil can be valuable and we take it ourselves and use it on many of our patients. However, in some people (those who are very ill, the elderly, diabetics, and certain others) the enzyme that converts LA to GLA may function poorly, in which case, the inhibitory effect of flax oil on delta-6-desaturase may be enough to cause problems. Thanks for your questions.