0

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Reasonably healthy choices for someone who's been put on low-carb, low-salt, low-fat, low-potassium diet for medical reasons?

Answered on August 19, 2014
Created October 25, 2012 at 3:48 AM

My aunt-in-law has a number of health problems and has been asked to avoid carbs, salt, fat, and potassium as much as possible by her doctors while still keeping her calories up to 1200-1500 a day. I know this isn't a strictly paleo thing, but does anyone know some reasonably healthy foods she could eat to up her caloric intake? She's having difficulty getting over 700-800 calories a day with these restrictions, and wants to maximize her nutrient intake as much as possible. I'm usually anti low-fat, of course, but she has so many serious health issues that I'm wary of recommending she go against her doctor's advice. She's willing to travel to both Whole Foods and Trader Joe's. Any ideas?

UPDATE - here are the macronutrient amounts her doctors want her to aim for: fat 30-50g, protein 80-100g, carbs 150-200 g.

77877f762c40637911396daa19b53094

(78467)

on October 26, 2012
at 01:17 AM

If she isn't going to buck her MD's advice, which is wise. The moderate carb might be kinda ok if she sticks to slowest digesting starches possible. I'd consider cooking and refrigerating the starch and re-heating. Lowers the GI slightly.

77877f762c40637911396daa19b53094

(78467)

on October 26, 2012
at 01:16 AM

Not with NAFLD. That is high PUFA and will cause more liver issues.

77877f762c40637911396daa19b53094

(78467)

on October 26, 2012
at 01:15 AM

With impaired kidney function, if that is true, I really can't imagine high protein to be a good call. I would stick to veggies, low-carb fruit like raspberries, I'd avoid as much PUFA as I could. I agree with Jamie on that. I'd hit veggies really hard and meat to the tolerance of kidneys. In general just going Paleo is probably closest to what is beast. I know Stephan Guyenet (whose name I always misspell) had several good articles on NAFLD.

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:21 PM

Whats shes been given is a pretty standard doctors nonsense. But its most likely higher in carbs, and lower in fat than its needs to be. If I had NFALD and diabetes, my proirity would be low carb, high fat paleo, with no fruit (maybe vit c tablets for c), no sugar and no o-6 oils. Of course, again, thats not knowing her heart history. Normally high sat fats are fine, but if your cholesterol is way too high, and youve had a heart attack, your body is going abberant with its processes, so in that rarer circumstance, lowering sat fats might make sense.

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:17 PM

In addition, she should avoid all simple carbs (fruit/sugar) like the plague for awhile to recover her liver. So I would ignore those macros suggested, and instead suggest that she eat small portions of white rice and tubers for her carbs (no simple carbs), and that she up her MUFA intake to give energy in place of carbs (avocado, olive, nuts and the oils of). She definately wants to avoid o-6 oils, and probably wheat. And she could probably handle some saturated fats too, but not knowing her background thats a guess.

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:16 PM

I see they are suggesting moderate carb. Thats not going to help the diabetes, from what I have heard. To help that shes better off under 100 grams carbs a day, or at least 150 (I doubt shes active). If shes inactive, she should do fine at under or around 100.

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:08 PM

Hope thats helpful?

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:08 PM

Main things to definately restrict are the vege oils, and the fructose (for the liver disease), and perhaps the carbs for the diabetes. But because such a diet generally only works in the context of fat for energy, shes going to need to work out which ones she can have. MUFAs are a starting point at least, and SFAs are possibly okay, depending on her health issues. Also for her live she should avoid drugs/herbs/alcohol anything the liver has to process.

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:06 PM

For NFLD, she needs to restrict PUFA fats (vegetable oils) and fructose (fruit and table sugar). For diabetes, she may wish to restrict carbs. I cant comment on the rest, cause we dont know what it is (and doctors speculate regarding heart disease, especially given the heart prefers to run on fats). So I think based on this, she doesnt have to restrict all fat. Possibly sat fats to some degree, if shes had a heart attack/plaque recently. But MUFAs at least should be okay (avocado, nuts, olives). And if she doesnt have serious heart issues, sat fats might be too.

59fa7cd87fb9d669adf21e5cf3e7ada5

on October 25, 2012
at 07:53 PM

This is not a very restrictive diet, if she stops eating processed foods she should have no problem with it. Virtually anything she prepares herself will get her where she needs to be.

59fa7cd87fb9d669adf21e5cf3e7ada5

on October 25, 2012
at 07:45 PM

Okay, that is a lot more doable, that's pretty close my my diet. Any number of choices there.

264b5c21793329052ac3d84da8c41abd

(100)

on October 25, 2012
at 07:35 PM

LikesLardinMayo - she has non-alcoholic liver cirrhosis, type 1 diabetes, and some kidney/heart problems, though I don't know exactly what in those cases. She is actually not a someone I know super well - she hit me up for advice because she knows I frequent Trader Joe's/Whole Foods, which are the stores her doctor suggested she check out to find things that might fit within these paramaters, and she's accustomed to shopping almost exclusively at Wal-Mart and doesn't really know where to start finding food to fit into this ultra restrictive diet. Of course, now I'm not coming up with anything!

264b5c21793329052ac3d84da8c41abd

(100)

on October 25, 2012
at 07:32 PM

She has pretty severe non-alcoholic liver cirrhosis and type 1 diabetes - I think she also has some kidney/heart problems, but I'm not totally sure what. The way she explained it to me, one doctor recommended all of these restrictions - I've updated the post with what they're considering 'low-fat' and 'low-carb' in her case. Re: futher thought 2 - Good point. I could at least suggest that she ask about incorporating more generally accepted healthy fats - avocado and olive oil, etc. as suggested above - and see what her doctor thinks.

59fa7cd87fb9d669adf21e5cf3e7ada5

on October 25, 2012
at 07:30 PM

Add me to the "wtf?" crowd, sounds like she is going to have to live on unseasoned chicken breast

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:52 AM

If it were merely about avoiding excess carbs, salt, potassium, fat - that I could understand, and it would be doable. Its also worth considering what kind of carbs and what kind of fats are we talking about...all of them, slow, fast? MUFA, SFA, PUFA?

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:51 AM

Carbs or fats are superior for energy to protein from my understanding. I dont think there is such a thing as low carb, low fat (at least not as a sustainable healthy diet), unless we are talking medium type levels, not truely low. I am inclined to ask, do those doctors understand nutrition and energy metabolism? What levels are being recommended? And for what conditions? Sodium and potassium also somewhat confuses me, those are essential electrolytes. Not having them can make you sick, or be dangerous. maybe its too complex to explain, but perhaps seek a second opinion there...

76211ec5301087de2588cfe3d6bccba9

(1178)

on October 25, 2012
at 06:22 AM

it sounds like a really unhealthy diet, and I can only imagine it exacerbating whatever medical condition she has, unless it's something rare that involves atypical metabolic pathways

77877f762c40637911396daa19b53094

(78467)

on October 25, 2012
at 05:12 AM

Ok, understanding that no one here is an MD, what condition means low-carb, low-fat etc....?

264b5c21793329052ac3d84da8c41abd

(100)

on October 25, 2012
at 04:34 AM

I've been doing massive amounts of web-research for her and I'm running into the same problem - namely, thinking that eating like this and getting adequate calories might actually be impossible. I don't know exactly how they're defining low-fat and low-carb. Honestly, from her confusion, it doesn't sound like they've been all that clear with her either. She was using carnation instant breakfast type drinks to try and keep her calorie intake up, but since those are high in potassium, that's out (and of course, I'd like to see her with a healthy, whole foods alternative anyway).

264b5c21793329052ac3d84da8c41abd

(100)

on October 25, 2012
at 04:29 AM

Amanda - yeah, I just shot her a quick note to ask about that, because I've been wondering the same thing. She's doesn't need to lose any weight, so I worry about the effects of a super high protein diet.

77877f762c40637911396daa19b53094

(78467)

on October 25, 2012
at 04:16 AM

Rabbit starvation only occurs in lean people. A protein only diet for an overweight person is just a Protein Spared Modified Fast. Still that is a low-calorie diet.

4b5be253ac1981c690689cab7e4bf06d

(3043)

on October 25, 2012
at 04:00 AM

Have they given her a macro ratio to shoot for? Because low fat and low carb means higher protein, which can lead to rabbit starvation and protein poisoning.

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4 Answers

1
F9638b939a6f85d67f60065677193cad

(4266)

on October 25, 2012
at 03:38 PM

Low fat is usually a code-word for low animal fat so use avocados and olive oil, and just eat regular trimmed beef and skinless chicken rather than super rich ribeye steaks or bacon.

77877f762c40637911396daa19b53094

(78467)

on October 26, 2012
at 01:16 AM

Not with NAFLD. That is high PUFA and will cause more liver issues.

0
3491e51730101b18724dc57c86601173

(8395)

on October 25, 2012
at 07:33 PM

"UPDATE - here are the macronutrient amounts her doctors want her to aim for: fat 30-50g, protein 80-100g, carbs 150-200 g."

I would call this a moderate carb, low fat, calorie-restricted diet. Pretty much the conventional wisdom. Not sure what health issues that is meant to address. Conventional medicine THINKS it will decrease cholesterol, blood sugar, etc., but that doesn't work that way. And if the cause of her underlying problems is leaky gut, food allergy, or autoimmune, that diet protocol will make the doctor feel better, not the patient. Perhaps she'll have some weightloss from calorie restriction, but not necessarily FAT loss. Sigh . . .

Same old, same old.

59fa7cd87fb9d669adf21e5cf3e7ada5

on October 25, 2012
at 07:45 PM

Okay, that is a lot more doable, that's pretty close my my diet. Any number of choices there.

0
E246df7366ba4b48f75b53378ed33282

(424)

on October 25, 2012
at 10:54 AM

I can't see how this is possible either. If you're avoiding carbs and fat that's 2 out of 3 macronutrients down. You can't sustainably get the majority of your calories from protein without becoming seriously ill (i.e. rabbit starvation/protein toxicity).

Why has she been recommended this diet? I'm not a doctor but I'd be interested to know what health condition requires this way of eating.

And when you say 'doctors', are the doctors individually recommending both low fat and low carb or is it one doctor recommending low carb and another recommending low fat?

I've had the problem in the past where I've been recommended mutually exclusive things for the same health problem by different people. Sometimes you just have to make an informed choice and go with one recommendation - you can't always accomodate every medical suggestion you get.

Further thought 1: I'm guessing your Aunt has more than one health problem. Again, if this is the case, it might be a matter of choosing one path to tackle the most serious problem (in consultation with your doctor) rather than trying to tackle all the problems simultaneously by following two contradictory diets at once.

Further thought 2: Is the 'low fat' prescription related to a specific health issue? Low fat can be a default blanket health recommendation from some health professionals, regardless of the actual health problem. (BTW, I'm not suggesting for one minute that a high fat diet is appropriate for your Aunt - just idle speculation on my part).

264b5c21793329052ac3d84da8c41abd

(100)

on October 25, 2012
at 07:32 PM

She has pretty severe non-alcoholic liver cirrhosis and type 1 diabetes - I think she also has some kidney/heart problems, but I'm not totally sure what. The way she explained it to me, one doctor recommended all of these restrictions - I've updated the post with what they're considering 'low-fat' and 'low-carb' in her case. Re: futher thought 2 - Good point. I could at least suggest that she ask about incorporating more generally accepted healthy fats - avocado and olive oil, etc. as suggested above - and see what her doctor thinks.

0
77877f762c40637911396daa19b53094

(78467)

on October 25, 2012
at 04:18 AM

I don't really see how this is possible. I mean she can eat huge bunches of veggies plus lean protein but it is going to be almost impossible to eat 1500kcal of protein. I'm 6'5 and 280lbs and I couldn't do it, not even if I tried.

How are we defining "low-fat" and "low-carb"?

59fa7cd87fb9d669adf21e5cf3e7ada5

on October 25, 2012
at 07:53 PM

This is not a very restrictive diet, if she stops eating processed foods she should have no problem with it. Virtually anything she prepares herself will get her where she needs to be.

77877f762c40637911396daa19b53094

(78467)

on October 26, 2012
at 01:15 AM

With impaired kidney function, if that is true, I really can't imagine high protein to be a good call. I would stick to veggies, low-carb fruit like raspberries, I'd avoid as much PUFA as I could. I agree with Jamie on that. I'd hit veggies really hard and meat to the tolerance of kidneys. In general just going Paleo is probably closest to what is beast. I know Stephan Guyenet (whose name I always misspell) had several good articles on NAFLD.

264b5c21793329052ac3d84da8c41abd

(100)

on October 25, 2012
at 07:35 PM

LikesLardinMayo - she has non-alcoholic liver cirrhosis, type 1 diabetes, and some kidney/heart problems, though I don't know exactly what in those cases. She is actually not a someone I know super well - she hit me up for advice because she knows I frequent Trader Joe's/Whole Foods, which are the stores her doctor suggested she check out to find things that might fit within these paramaters, and she's accustomed to shopping almost exclusively at Wal-Mart and doesn't really know where to start finding food to fit into this ultra restrictive diet. Of course, now I'm not coming up with anything!

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:16 PM

I see they are suggesting moderate carb. Thats not going to help the diabetes, from what I have heard. To help that shes better off under 100 grams carbs a day, or at least 150 (I doubt shes active). If shes inactive, she should do fine at under or around 100.

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:06 PM

For NFLD, she needs to restrict PUFA fats (vegetable oils) and fructose (fruit and table sugar). For diabetes, she may wish to restrict carbs. I cant comment on the rest, cause we dont know what it is (and doctors speculate regarding heart disease, especially given the heart prefers to run on fats). So I think based on this, she doesnt have to restrict all fat. Possibly sat fats to some degree, if shes had a heart attack/plaque recently. But MUFAs at least should be okay (avocado, nuts, olives). And if she doesnt have serious heart issues, sat fats might be too.

264b5c21793329052ac3d84da8c41abd

(100)

on October 25, 2012
at 04:34 AM

I've been doing massive amounts of web-research for her and I'm running into the same problem - namely, thinking that eating like this and getting adequate calories might actually be impossible. I don't know exactly how they're defining low-fat and low-carb. Honestly, from her confusion, it doesn't sound like they've been all that clear with her either. She was using carnation instant breakfast type drinks to try and keep her calorie intake up, but since those are high in potassium, that's out (and of course, I'd like to see her with a healthy, whole foods alternative anyway).

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:17 PM

In addition, she should avoid all simple carbs (fruit/sugar) like the plague for awhile to recover her liver. So I would ignore those macros suggested, and instead suggest that she eat small portions of white rice and tubers for her carbs (no simple carbs), and that she up her MUFA intake to give energy in place of carbs (avocado, olive, nuts and the oils of). She definately wants to avoid o-6 oils, and probably wheat. And she could probably handle some saturated fats too, but not knowing her background thats a guess.

76211ec5301087de2588cfe3d6bccba9

(1178)

on October 25, 2012
at 06:22 AM

it sounds like a really unhealthy diet, and I can only imagine it exacerbating whatever medical condition she has, unless it's something rare that involves atypical metabolic pathways

77877f762c40637911396daa19b53094

(78467)

on October 25, 2012
at 05:12 AM

Ok, understanding that no one here is an MD, what condition means low-carb, low-fat etc....?

59fa7cd87fb9d669adf21e5cf3e7ada5

on October 25, 2012
at 07:30 PM

Add me to the "wtf?" crowd, sounds like she is going to have to live on unseasoned chicken breast

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:08 PM

Hope thats helpful?

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:08 PM

Main things to definately restrict are the vege oils, and the fructose (for the liver disease), and perhaps the carbs for the diabetes. But because such a diet generally only works in the context of fat for energy, shes going to need to work out which ones she can have. MUFAs are a starting point at least, and SFAs are possibly okay, depending on her health issues. Also for her live she should avoid drugs/herbs/alcohol anything the liver has to process.

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on October 25, 2012
at 10:21 PM

Whats shes been given is a pretty standard doctors nonsense. But its most likely higher in carbs, and lower in fat than its needs to be. If I had NFALD and diabetes, my proirity would be low carb, high fat paleo, with no fruit (maybe vit c tablets for c), no sugar and no o-6 oils. Of course, again, thats not knowing her heart history. Normally high sat fats are fine, but if your cholesterol is way too high, and youve had a heart attack, your body is going abberant with its processes, so in that rarer circumstance, lowering sat fats might make sense.

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