Low Carb Cheese Cake

My amazing wife, among her many talents, makes a wonderful low carb cheese cake.  She has taken the recipe found in Maria Emmerich's "Secret Weight Loss Recipes" and modified it to our family's taste.  It has quickly become one of my family's favorites. 

Low Carb Cheesecake = 1 gram carb per serving
Individual spring-form serving pans

Crust:

2 cups almond flour

1/4 cup coconut flour

1/2 cup butter melted

Pinch of salt

1/2 cup erythritol

Mix and press into spring-form pan.

5 (8 oz) packages cream cheese, softened

1 cup erythritol and 1 tsp liquid Stevia

1 TBS vanilla

1/2 cup whey Protein

1 cup sour cream

3 eggs

Preheat oven to 350F. Mix cream cheese, sweetener, protein and vanilla with an electric mixer

until blended. Add eggs one at a time, mixing on low after each until blended. Blend in sour

cream and pour over crust. Place a pan of water on the lower rack place cheesecake on rack

above. Bake for approximately 45 minutes until set. Watch carefully! 

Refrigerate overnight.

Freezes well too!

My wife will often bake them in individual sized pans (as in the picture above) so that I can pull one out of the freezer, let it thaw and cover it in whip cream and a sprinkle of berries.  Tastes fantastic!

One serving is = 1 gram of carbohydrate.

Social Medial Bacon Style . . .

The Skinny On Sweeteners

I am frequently asked about the sweeteners that can be used with a low carbohydrate diet. There are a number of sweeteners available that can be used with cooking; however, many of them are not appropriate for use with a low carbohydrate diet.

First, and foremost, we must understand how these carbohydrates or sugars are labeled or named so that we can identify them in the food products we eat. Most sugars are labeled with the ending “ose".

With an understanding that weight gain or weight loss is controlled by the hormone insulin, our overall goal is to lower the insulin levels in the blood stream. Glucose (a carbohydrate in its most simple form) stimulates insulin to rise. A Low carbohydrate diet works because insulin levels are significantly lowered throughout the day. Elevation in cholesterol, elevation in triglycerides and stimulus for production of uric acid also occur because of surges in the hormone insulin. The most common stimulus for insulin to rise is the body’s recognition of the presence of carbohydrates or sugars.

Sucrose, fructose, glucose, dextrose, lactose, and maltose are very common sugars you’ll see in the ingredient list of many products containing carbohydrates. All of these types of sugars will stimulate a significant insulin rise and lead to weight gain, elevation in cholesterol and triglycerides.

Other very commonly used names that you will find containing the sugars above are: white and brown sugar, succanat, corn syrup, high fructose corn syrup, honey, malt syrup, cane juice, cane syrup, rice syrup, barley syrup, maple syrup, molasses, turbinado, and fruit juice concentrate. Beware of products that contain "no added sugar" because they will often contain sugar concentrates in the form of concentrated grape or apple juice.

Fructose is sometimes promoted as a suitable sweetener for patients with diabetes or people who are wanting to follow a low-carb diet; however even though it does not cause a significant insulin rise, it is rapidly absorbed by the liver and converted into glycerol which leads to increased triglyceride and cholesterol levels. Even though fructose occurs naturally in regular fruits and some vegetables, it is usually only present in small amounts. The fiber in these fruits or vegetables balances out the fructose content. Today, fructose is added commercially to many foods in a highly refined purified form as high fructose corn syrup. Be careful because this form of fructose is found in soft drinks, ice teas, fruit drinks, jams, jellies, desserts, baked goods and even in many baby foods. This form stimulates an extremely powerful stimulus in the liver to form triglycerides and leads to fatty liver disease, a form of non-alcoholic cirrhosis (J Am Diet Assoc, Lustig RH, 2010 Sep; 110 (9):1307-21).

Artificial Sweeteners
Most artificial sweeteners fall into a class that is referred to as “non-nutritive” meaning that they have no nutrient value to the human body. They provide a sweet taste to the senses without raising the blood sugar. These sweeteners can be useful in cooking and in maintaining blood sugars; however, it is important to realize that many of them still stimulate an insulin response.

Aspartame
The most popular artificial sweetener in use today is aspartame (NutraSweet™, Equal™). Aspartame is calorie and carbohydrate free; however, it is not the ideal sweetener. Because of its chemical instability, it breaks down under heat into its chemical constituents - namely phenylalanine and aspartic acid. This makes it notably unsuitable for cooking or for storage for more than a few days.

Second, in light of its safety profile maintained by the manufacturer, a number of people of experience side effects including headache, stomach upset, migraine and exacerbation of depression (Neurology October 1, 1994, vol. 44: 1787). Most people enjoy without problem, however.

Acesulfame Potassium
A second popular sweetener has been identified by the food and beverage companies called acesulfame potassium (Ace-K™, Sunette™). This sweetener is not fully absorbed by the gut, and yields no calories, nor does it raise blood sugar. It also contains no carbohydrates. To many palates, it has a slightly bitter savor, so it is often combined with aspartame to eliminate the bitter aftertaste. The problem with acesulfame potassium is that there are a number of studies revealing it significantly increases insulin response without raising blood sugar. Studies show that the insulin response is as remarkable as if a person ingested an equivalent amount of glucose (Horm Metab Res. 1987 Jun; 19(6):233-8.). It appears thatacesulfame potassium works directly on the pancreas to stimulate insulin release (Horm Metab Res. 1987 Jul; 19(7):285-9).

This product appears to be one of the most popular artificial sweeteners currently used in a number of low-carb products. It can be found in many of the protein bars and protein shakes on the market. It is also found in Coke Zero™, Pepsi One™ and a number of other diet sodas. I have found in my private medical practice that this sweetener significantly limits weight loss.

Sucralose
Sucralose (Splenda™) is actually derived from regular sugar in such a way that the body doesn't recognize it, and it is not absorbed. It contributes no calories or carbohydrates to the body in its pure form. Amazingly, it remains stable in heat and has become ideal for cooking and baking. It is available as a bulk sweetener and actually measures equivalently to table sugar. Be aware, however, Splenda™ is not carbohydrate free. Because of the maltodextrin used to make it bulk in nature, it contains about 0.5 g of carbohydrate per teaspoon, or about 1/8 of the carbohydrate of sugar. It does cause some insulin release and may lead to weight gain or difficulty with weight loss when used in excess (J Clin Oncol [Meeting Abstracts] June 2007 vol. 25no. 18_suppl 15127). 1 cup of Splenda™ is equivalent to 2 tablespoons of sugar, or 12-15 grams of carbohydrate in 1 cup of Splenda™.

Saccharine
Saccharine (Sweet’N Low™, SugarTwin™) is another unstable chemical when heated, however, it does not react chemically with other food ingredients and thereby stores well. It was used for quite some time as one of the original sweeteners. It does not increase glucose or blood sugar, but it does stimulate an insulin response and can be problematic in weight loss (Am Jour Physiol - Endo April 1980 vol. 238 no. 4 E336-E340). It is often combined with other sweeteners to preserve their shelf life.

Cyclamate
Cyclamate (SugarTwin™, Sucaryl™) is a sweetener available in Canada that is often combined with saccharine and is similar to sucralose. However, there is some controversy over this substance as it is known to cause bladder cancer in rats. There has been no human occurrence in its 30 years of study (Ann Oncol, October 2004, 15(10): 1460-1465.doi: 10.1093/annonc/mdh256). This product is currently banned in the US because of the notable potential for cancer. Cyclamate is stable in heat and therefore is an alternative for cooking and baking.

Stevia
Stevia is a non-caloric natural sweetener which contains no carbohydrate. He is to rise from a South American plant and has been widely available for use in Asia for many years. It comes from a shrub called Stevia rebaudiana that has very sweet leaves. Stevia is in extract, a white powder that is derived from these leaves. It can be found today commercially in extract, powder, or in a powdered green herbal leaf. It has an intense sweet taste which actually does have the potential to be slightly bitter. Stevia has two faults. First, it is so very sweet that it is hard to know just how much to use when cooking. Second, he often has a slight bitter taste as well as a sweet one. Therefore, stevia is often combined with fructooligosaccharide (FOS). FOS is a sugar, but it is such a large molecule that humans cannot absorb it. It does not raise blood sugar and it does not stimulate insulin release. Stevia does not increase blood sugar and appears to improve insulin sensitivity in the pancreas (Metabolism, 2003 Mar;52(3):372-8.). FOS is only half as sweet in table sugar; therefore, it makes it a perfect partner for stevia.

Sugar Alcohols
Sugar alcohols are also called polyols. These are a class of long-chain carbohydrates that are neither sugar nor alcohol. Included in this group are maltitol, sorbitol, mannitol, xylitol, erythritol, lactitol, and hydrolyzed starch hydrolysates (HSH). These sweeteners give the texture and sweetness of sugar to corn syrup and can be used to make crunchy toffee, chewy jelly beans, and slick hard candies, moist brownies and creamy chocolate. However, they are incompletely absorbed by the human intestine. This causes problems, as side-effects of these long-chain carbohydrates include gas, bloating and diarrhea for a significant portion of people. The other issue is that there seems to be notable variability in people's ability to absorb these long-chain carbohydrates. In other words, these sweeteners affect people differently and may actually increase the blood sugar and insulin release in varying degrees among individuals.

Maltitol, sorbitol and xylitol seemed to be worse offending culprits in this class of artificial sweeteners. They cause an insulin response of about half that of normal sugar (American Journal of Clinical Nutrition, Vol 65, 947-950). Maltitol and sorbitolhave also been shown to increase cholesterol (International Journal for Vitamin and Nutrition Research, 1990 Vol. 60 No. 3 pp. 296-297). Erythritol is absorbed and excreted unchanged and appears to have no insulin response (Food and Chemical Toxicology Volume 36, Issue 12, December 1998, Pages 1139-1174). Erythritol also seems to inhibit fructose absorption (http://rave.ohiolink.edu/etdc/view?acc_num=osu1180462637).

So, in summary, which sweeteners will not cause weight gain or cholesterol changes? From the research that is presently available, aspartame, Stevia, anderythritol have no weight gain or cholesterol changes associated with them. Splendais a great sweetener, but excessive quantities will limit your ability to loose weight. All of the other sweeteners listed above have significant insulin response when ingested and will make it more difficult to lose weight. I have found that combinations of Stevia, Splenda and erythritol seem to provide adequate texture and remove any aftertaste that may be found when using them individually.

Green Eggs & Ham . . . I like them, Sam I Am!

You know, Dr. Seuss was right, the whole egg is actually good for you.
A recent study from the University of Connecticut demonstrated that eating the whole egg actually decreases LDL (the bad cholesterol) sub-particles and insulin resistance in Metabolic Syndrome better than the egg white or the egg substitute. 

I like green eggs and ham!
I do!! I like them, Sam-I-am!
And I would eat them in a boat!
And I would eat them with a goat...
And I will eat them in the rain.
And in the dark. And on a train.
And in a car. And in a tree.
They are so good so good you see!

Fat Thoughts on Cholesterol . . .

As a medical bariatrician and family practitioner specializing in low-carbohydrate diets, I often see the panic stricken look on people's faces when they look at their cholesterol profiles just after starting a carbohydrate restriction life-style.  

First, it is very important to understand that if you check your cholesterol within the first 4-6 weeks of dietary changes, there will be a transient rise in the cholesterol profile as your adipose tissues (fat cells) release your new fuel source into the blood stream and the mitochondria in the one trillion cells in your body convert from the use of glucose to the use of ketones (derived from triglycerides) as the primary fuel source.  This is not a problem as the body is designed to handle this increase in triglyceride and cholesterol. I explain to patient's that we are essentially making the figurative change from "un-leaded fuel to diesel fuel."

Second, the standard cholesterol profile does not give you a true picture of what is occurring at a cellular level.  The standard cholesterol panel checks Total cholesterol (all the forms of cholesterol), HDL (the good stuff), LDL-C (the bad stuff) and triglycerides.  It is important to recognize that the "-C" stands for a calculation usually completed by the lab. 
Total cholesterol, HDL and triglycerides are usually measured and LDL-C is measured using the Friedewald equation [LDL = total cholesterol – HDL – (triglycerides/5)].
Third, it is also important to realize that HDL and LDL are actually transport molecules (the buses for the triglycerides (the passengers). HDL is taking triglycerides to the fat cells and LDL is taking triglycerides from the fat cells to the muscles and other organs for use as fuel. 
When you being a low carbohydrate diet, your blood glucose availability as the primary fuel source drops and triglycerides become the primary source.  It takes your body 4-6 weeks to increase the number of mitochondria necessary to effectively use triglycerides as the primary fuel.  (This is why many athletes and patients who are active will feel slightly sluggish during their exercise for the first few weeks). 
Once your body accommodation to the new fuel, there will be a notable drop in LDL-C and a rise in the HDL.
But this still doesn't answer the question and relieve the panic seen above. A deep sigh and the look of relief occurs when I explain that LDL-C doesn't give us the real story. 
To make it simple and understandable, LDL is made up of three main sub-types  big fluffy ones, medium sized ones, and small dense ones. It's the small dense ones that contain lipoprotien A [Lp(a)] found in increased vascular risk. Recent studies reveal that heart disease and atherosclerosis is caused by the small dense LDL molecules. 
A low carbohydrate diet causes the small dense cholesterol to drop and there is a rise in the two other sub-types   This shift in sub-types can actually elevate the Total Cholesterol number and occasionally the LDL-C. 
If you are following a low carbohydrate diet, get your cholesterol levels checked.  It is more ideal to get an NMR Lipoprofile or VAP Cholesterol test that will give you an LDL particle number and this can be explained more fully by your doctor. 
Now, off to the fridge . . . where did I put that package of bacon . . . ?

List of Low-Carb Bloggers

Nice list of low-carb bloggers in no particular order . . . HERE.

Legend Has It . . . How Diabetes Was Discovered and How That Makes Me Fat

The German physiologist Oskar Minkowki was the first person to identify the role of the pancreas in diabetes.  Legend has it that on a momentous day in 1889 Oscar  noticed that urine collected from his pancreatectomized dogs (dogs that had surgical removal of their pancreas) attracted a very large number of flies.  He is said to have "tasted" the urine and to have been struck by its sweetness.  (Only in 1889 could you get away with tasting dog urine.)  He then made a very astute observation and realized that the pancreas controlled blood sugar concentration and was a key factor in diabetes mellitus.
Thirty years later, Fredrick Banting and Charles Best identified insulin as the key hormone produced by the pancreas controlling the level of blood sugar.  However, what Oscare Minkowski couldn't taste was the very high level of acetone in the urine which is produced by the liver in the conversion of fat to ketone bodies.  Had Oscar lost his sense of taste, instead of noting the sweetness to the urine he might have noted the pungent smell of acetone.  He would have then concluded that the removal of the pancreas causes fatty acid metabolism to go awry.  He then would could have extended his hypothesis and concluded that the preeminent role of insulin was not in the control of blood sugar alone, but in the control of fat metabolism.
We have become fixated upon the function of insulin and its effect upon diabetes, and in doing so, we have neglected the fact that insulin has even greater effect upon the storage and use of fat and protein in the body.
A series of discoveries from the 1920s-1960s let to a revolution in the understanding of the role of insulin in fat metabolism.  At that time, fat was assumed to be relatively inert and carbohydrates were seen at the primary fuel for muscular activity (which is still commonly believed today).  The belief was that fat is used for fuel only after being converted in the liver to suspiciously toxic ketone bodies.  Forty years of research overturned this assumption, however, it had no influence upon mainstream thinking about fat gain and obesity.  In 1973 when all the details of fat metabolism had been worked out, Hilde Bruch, the foremost authority on childhood obesity, stated "it is amazing how little of this increased awareness . . . is reflected in the clinical literature on obesity."
JAMA just released it's compendium on obesity research and the simple science of insulin's effect on fatty acid metabolism is STILL being ignored. Instead, main stream medicine is starting to push patients toward a very expensive and risky gastric bypass surgery. This scares me.
Hippocrates said, "Let food be your medicine and let medicine be your food."  The body responds with hormonal effect to what we feed it and the science explaining this has been ignored. We have been brainwashed with the dogma that the "calorie is king."

Mayor Bloomburg eating donuts
two days after trans fat ban

Based on this we are now legislating food behavior.  New York has now banned trans fats by the New York City Board of Health and has legislated all soda sizes to no larger than 12 oz. We are creating health policy on bad science.  Let's go back and look at the science before we let our legislators start cooking for us, or soon our grocery stores will look like our government run school cafeterias offering school lunches.

Vanilla Low Carb Ice Cream

I love ice cream. I mean I really love ice cream. This has been one of my vices for years that I thought I would have to forever give up to follow a low carbohydrate dietary lifestyle . . .but worry myself no more!  
My sweet wife did it again.  She perfected the ice cream recipe she has been working on for the last year. 

You have to try this recipe.  It's delicious.  

Thanks, sweetheart!

Vanilla Low Carb Ice Cream:

1 cup Almond or Coconut Milk

1 quart of Heavy Cream

1 tsp Vanilla

1/2 cup Erythritol

1 scoop Vanilla Protein Powder

1/2 tsp of Salt

Blend for approximately 20 minutes in a 2 Quart Cuisinart Ice Cream Maker (that's the one we use) or the ice cream maker of your choice until the desired consistency and then place what you don't finish eating in the freezer for later.

Low Carb Chocolate Chip Cookies

I love chocolate chip cookies! However, over the last three years, as I have followed a low carbohydrate diet I have not been able to indulge my chocolate chip cookie craving -- until recently.  

My gorgeous and very ingeniousness wife has perfected her chocolate chip cookie recipe and - Oh, Wow! - are they good. 

Warm tasty chocolate chip cookies that are actually good for you served up by a beautiful blond in a very cute apron. . . I think this is what heaven is like. 

I have been promising my patients this recipe for quite a few months, but have neglected to write it down and post it. I would forget to take a picture of the cookies before my family had eaten them all.  So, this morning I took a snapshot and I had a few moments while eating the cookies on the plate above.  Here is the recipe:

Low Carbohydrate Chocolate Chip Cookies

1 tsp vanilla

2 eggs

2 sticks (1 cup) of butter, softened

1/2 cup Splenda

1/4 cup Sweet Perfection

1/4 cup erythritol 

1/4 cup Just Like Sugar (chicory root sweetener)

1 tsp salt

1 tsp baking soda

1 tsp baking powder

1 1/2 cup almond flour

1 cup coconut flour

1/2 cup Carbalose flour

2 ChocoPerfection Milk Chocolate bars chopped 

Mix the vanilla, eggs, butter and sweeteners until creamy or fluffy. Add in all dry ingredients and mix. Add chocolate and mix. Place dough on parchment paper covered cookie sheets in 2 tsp sized scoops.

Bake at 350 degrees for 8-10 minutes. 

Makes 45-50 cookies

(~ 2 net carbohydrates per cookie)

Enjoy!!

Mom's Cream Cheese Waffles

Mother's Day is a great event in our home, and traditionally it is a chance to make breakfast for Mom.

In our home, Mom loves waffles.  But changing to a low carbohydrate diet put a damper on the waffles for a while, until my sweet wife found and perfected the following recipe. (She adapted this recipe from Jennifer Eloff's Cream Cheese Bran Waffle recipe found in her book, Splendid Low Carbing for Life Vol 1.) These waffles are amazing! They are now lovingly referred to in our home as "Mom's Cream Cheese Waffles."

Breakfast for Mother's Day in our home consisted of Mom's Cream Cheese Waffles, freshly grilled thick slice bacon and strawberry flavored whipped cream to top off the waffles and was easily prepared by my 11 year old daughter.  A perfect low carb Mother's Day meal. Enjoy!

Mom's Cream Cheese Waffles

Mom's Cream Cheese Waffles:

16 oz regular cream cheese (softened)

6 eggs

1 cup Carbalose flour

1 cup wheat germ

1/4 cup heavy cream

1/4 cup water

1/3 cup Splenda Granular

1 tsp baking soda

1 tsp baking  powder

1/4 tsp salt

In a food processor or electric mixer, blend the cream cheese until smooth.  Add the eggs and continue to blend.  Add the Carbalose flour, wheat germ, cream, water , Splenda, baking soda, baking power and salt.  Continue to blend. 

Pour 1/4-1/2 cup onto hot greased waffle iron. Close and cook for approximately 3 minutes.  

Yeild: 12-16 "plate sized" waffles

1 Waffle: approx. 7g protein, 9g fat, 3g carbs

Mid-Meal Protein Shake. . .

A number of my patients have asked what I use personally as a protein supplement and whether I use protein shakes.  I've struggled to find a great tasting protein shake that does not contain any artificial sweeteners (see my article The Skinny On Sweeteners) that raise the insulin levels.  Most of the pre-prepared shakes (including the Adkins, EAS, Muscle Milk, and many others) will significantly slow weight loss and knock you out of ketosis due to an insulin response stimulated by drinking them.

My sweet wife just perfected our family's favorite high fat, low carbohydrate protein shake.  Oh, it's good and  it's filling.  You'll love it and you won't be hungry for at least 3-4 hours after savoring this sweet taste-bud sensation. 

This is a great shake for a mid-meal snack or a quick meal on the go.

Tiffini's Low Carb High Fat Protein Shake:

• 3/4 cup of frozen strawberries
• 1 tbsp of extra virgin olive oil
• 1 scoop of ISO-100 Gourmet Berry flavor protein powder (carb free)
• 1 packet of Stevia
• 1 1/2-2 cups of heavy whipping cream

[One serving (~ 2 cups) is 4.5 grams of carbohydrate]

Blend to preferred texture. . . (may add more heavy whipping cream if it is still too thick). 
Enjoy!!

What's For Breakfast?

Many of my patient's ask me what I eat regularly.  I thought that I would document my meals for a few weeks to give you ideas and include recipes when pertinent.  Here was this mornings breakfast . . . and, Oh, was it tasty!

Definition: Vegetarian

Ketogenic Diet Reduces Diabetic Neuropathy

Very impressive kidney results were found in both Type I and Type II diabetic mice placed on a low carbohydrate ketogenic causing diet in just 8 weeks. The nephropathy (passage of protein through the kidneys) was completely reversed in all the mice. This is the first in what I suspect will be a series of articles showing that ketogenic diets have significant effect on reversal of age related and diabetic tissue damage.  See the article here.