© Whole Foods Magazine
October 2004

Low-Carb Diets Benefit From Supplements:

An interview with Dr. Christine Horner

By Richard A. Passwater, Ph.D.


Low-carb dieting has certainly been in the news lately, especially since the medical and scientific communities started looking into what Dr. Robert Atkins had been reporting for all these years. It was easier for physicians and nutritionists to simply dismiss the reports of Dr. Atkins without so much as examining what his diet was actually doing for people – making many of them healthier. Finally, when researchers did look into the low-carb diet, they found confirmation of Dr. Atkins’ results and concluded that low-carbs diets can be healthy and have their place. However, some low-carb diets may not be nourishing, and low-carb diets are not for everyone. This is the theme of this chat with diet expert, Christine Horner, M.D.

Dr. Atkins and I became mutual admirers after he interviewed me on his radio show on the publication of my 1977 book, Supernutrition For Healthy Hearts. He liked my evidence that dietary cholesterol wasn’t the cause of heart disease and I liked his recommendations that nutritional supplements were of benefit to many people – especially dieters. This is the point that I want to discuss with Dr. Horner because so many people are on low-carb diets and they are not taking the dietary supplements that they need for optimum health while on the diet.

Christine Horner, M.D., FACS, is a nationally known surgeon who practiced in the greater Cincinnati area and now resides in Taos, NM. She holds two board certifications--from the National Board of Surgery, and the National Board of Plastic Surgery. Dr. Horner was recognized as a leader in her field shortly after launching her plastic and reconstructive surgery practice. She initiated a national campaign to pass laws requiring insurance companies to pay for breast reconstruction following mastectomy. Her five-year crusade, the Breast Reconstruction Advocacy Project (BRA Project), led to the passage of laws in 35 states and a federal bill that was signed into law by President Clinton on October 21, 1998. The law was unprecedented because it was the first ever passed by Congress requiring insurance companies to pay for a specific surgical procedure.

For over a decade, Dr. Horner worked with the American Cancer Society. She was appointed to The American Cancer Society’s Breast Cancer Detection Task Force for the state of Kentucky from 1993-97, served as the ACS spokesperson for the state of Kentucky on breast cancer issues from 1992-97, chaired the “Relay for Life” event in 1993 and 1994, served on the board of directors of the ACS Kentucky Division and was vice president of the Kentucky Division in 1993-94. She worked with the National ACS office in its Medical Content Oversight Work Group for TLC magazine in 1997 and contributed articles to Coping Magazine. In 1994 the ACS honored Dr. Horner with the Kentucky Division Lifesaver Award.

Dr. Horner has also been recognized for her outstanding surgical abilities. In 1997, Dr. Horner was honored with the YWCA’s Career Women of Achievement Award. In 2001, she was named by her peers as one of Cincinnati’s “Top Doctors.”

Dr. Horner has written Waking the Warrior Goddess: Dr. Christine Horner’s Program to Protect Against and Fight Breast Cancer, which is due to be released in the spring of 2005.

And recently she was named as the spokesperson for Body Rewards, a specialized line of nutrients from Enzymatic Therapy that is designed to fill in nutritional gaps for low-carb dieters.


Passwater: Dr. Horner, why did you decide to become a physician?


Horner: Around the age of 10, I remember having an epiphany while watching a dramatic “doctor” show on television. As I watched the actor “doctor” save a dying man on the street by thrusting an empty ink pen into the suffocating man’s trachea to alleviate his obstructed airway, a wave of intense emotion passed through me and I suddenly knew that being a surgeon was my destiny. No other profession in the world seemed more rewarding to me than that the ability to save human lives with expert surgical skills. After that moment, I never wavered from my goal to become a surgeon. It didn’t feel like I had a choice or an option in the matter. It felt like a demand from a divine force; I had to do it. Providence dictated it.


Passwater: That is compelling, but now your field isn’t general surgery. You specialize in plastic surgery, which doesn’t appear to the lay person to be involved with such dramatic emergency procedures. Why did you select plastic surgery?


Horner: A few months into my third year of medical school, I was assigned to the surgical service at the VA hospital. The first day of my clinical surgical rotation, I arrived at the hospital with excited anticipation. Finally, I would get a real taste of the life of a surgeon! Two days later, after 15 years of intense and unwavering focused intention to become a surgeon, I ran into the hospital supply room, locked the door, and fell to the floor sobbing. I hated it! Sleep deprivation and stress had taken such a heavy toll on the attending surgeons and surgical residents that it had caused them to all become nasty, extremely unhappy, zombies. I had no clue what medical specialty to go into now. No area of medicine I had experienced so far held any charm for me. But one thing was for sure, I definitely did not want to be a general surgeon.

On a whim, I decided to sign up for a plastic surgery rotation at the beginning of my fourth year of medical school. It seemed like it might be fun. I was right. After only one day, I realized that plastic surgery was the perfect profession for me. Plastic surgeons were happy, fun-loving people. What they did indeed had a profound impact on quality of a person’s life: restoring a face after an automobile accident, giving a child born with a cleft lip the opportunity to live a normal life, reconstructing the breast of a woman after she had to have this highly emotionally charged body part amputated for the treatment of cancer, and alleviating the devastating embarrassment and low self-esteem of a young man by simply reshaping his nose—a source of constant ridicule after it had grown to excessive proportions compared to the rest of his face.

Plastic surgery also has great appeal to me because it bestows the “operator” with concrete results and rewards. You get to see the results of your work. Unlike general surgery, where most of your work is on internal organs and therefore invisible, most plastic surgery is done on the surface of the body, where the fruits of all your hard work are displayed in front of you. Finally, plastic surgery encourages creativity and requires artistry. As an artist, I realized that plastic surgery would also fulfill my need for artistic expression through being a sculptor of the human body.


Passwater: I see. In my experience in the fire service, I have learned how plastic surgeons have changed the lives of people who felt like scarred monsters and lived a fate worse than death, only to be restored to normal lives by skilled plastic surgeons.

This leads me to ask about the Breast Reconstruction Advocacy Project (BRA Project). You went beyond the normal callings of a doctor by becoming an activist on behalf of not only your patients but all women dealing with breast cancer. Please tell us a little about the BRA project.


Horner: In 1993, less than two years after I opened my solo plastic surgery practice in the greater Cincinnati area, insurance companies suddenly began refusing to pay for breast reconstruction following mastectomy. Outraged, I started a national campaign to make it mandatory that insurance companies pay for reconstructive breast surgery to correct the devastating disfigurement caused by breast cancer surgery.

Initially I worked on the state level and successfully helped 35 states to pass laws. But shortly into the campaign I discovered a loophole law that made these laws ineffective. The only way to guarantee women the fundamental right to have their bodies restored to wholeness after cancer surgery was to pass a federal law.

I went straight to the top and met several times with President Clinton, the first lady and senators, including Ted Kennedy and Alfonse D’Amato. The breast reconstruction legislation successfully passed Congress and was signed into law by President Clinton on October 21, 1998.


Passwater: How did your career as a plastic surgeon and founder of the BRA project lead you to complementary and alternative medicine (CAM) and the nutritional supplement industry?


Horner: The year after I began my legislative campaign, my own mother was diagnosed with breast cancer. It claimed her life only nine months later. She had followed all of Western medicine’s advice: yearly mammograms and self breast exams. Her cancer was caught “early.” She should have had a “good” outcome. But she didn’t. Despite all of my medical training at the finest institutions Western medicine had to offer, when my mother got sick all I could do was helplessly hold her hand and watch her die.

After my mother’s death, I vowed to go after her cruel killer. It was clear to me that the only effective way to stop the epidemic of breast cancer, was to find out how to stop it from growing in the first place. I searched the medial literature and to my surprise I found thousands of studies that revealed the primary causes of breast cancer and how women can substantially lower their risk of developing it. Most of this lifesaving information fit under the umbrella of CAM: foods, nutrients, supplements, herbs, and lifestyle choices. I have compiled my findings about all the research-proven natural approaches to protecting against and fighting breast cancer into a book that will appear in the spring. Its title is Waking the Warrior Goddess: Dr. Christine Horner’s Program to Protect Against and Fight Breast Cancer.”

I discovered that all of these techniques not only protected against breast cancer, but also lowered the risk of most chronic disorders and were the keys to promoting overall good health. In 1999 I teamed up with an award-winning TV news anchor in Cincinnati to host the first syndicated TV news segment on CAM. My goal was to teach people all the lifesaving information I had discovered. The segment aired in Cincinnati for three years and was syndicated to the Wisdom Television Network in 2001.


Passwater: Let’s be sure to chat again when the book is available. I know our readers and several women’s group who will be interested in learning about your findings. What you have done amazes me, but there is even more to your story. You decide to become a certified fitness trainer and weight lifter? I don’t know how you fit all of this into your busy schedule. What did you learn by doing this?


Horner: Well, yes, time did become a problem. So, in 2002 I decided to sell my surgical practice so that I could devote myself full-time to teaching people how to stay healthy naturally. First, I took a year off to recover from the stress of 20 years of surgical training and practice. I had always wanted to weight train, but never had the time because of my busy practice. So I hired a personal trainer, and after a few months I enjoyed it so much that I became a certified personal trainer myself.

I was amazed to discover that bodybuilders have an incredible understanding about human physiology and how to masterfully manipulate the shape and composition of the human body with exercise, foods, and nutrients. Their knowledge was far more sophisticated that what I had learned as a physician. Ironically, my profession had been all about reshaping the human body into a more aesthetically pleasing form, but when I entered the bodybuilders’ world, I realized how much I didn’t know about the subject. Yes, I knew what could be done surgically, but I had no idea about how to reshape the human body naturally.

Now, as a certified personal trainer and plastic surgeon, I have a very broad understanding of how to alter the shape and composition of the human body—what is possible to achieve both naturally and surgically. When it comes to reshaping the body, the key thing that bodybuilders know that most people may not is that food and nutritional supplements affect our shape and composition almost more than exercise. They know how to dramatically change their bodies using food. For example, altering the ratios of the macronutrients (fats, protein and carbohydrates) they consume and the portions and timing of their meals.

What are the major misconceptions that people have about low-carb dieting?

* Calories don’t count—only carbs do

* All carbs are the same and are bad

If you eat too much of any type of food you will gain weight. Research shows that our bodies do metabolize macronutrients differently. It appears that carbohydrates, especially refined carbohydrates, will put more weight on us compared to the same number of calories taken in as either fat or protein. But if you eat 3,000 calories a day or more of fat and protein, you will gain weight. So macronutrient composition and calories play a role in weight loss and weight control.

Not all carbs are the same. Refined carbohydrates like simple sugars, donuts, cakes, pies, and candies cause rapid increases in blood glucose, and as a consequence, the release of large amounts of insulin from the pancreas. Insulin facilitates glucose getting into fat cells—just what they need to manufacture more fat.

Complex carbohydrates, on the other hand, are metabolized very differently. These foods—including fruits, vegetables, and whole grains—are also high in fiber. Fiber slows down the absorption of the carbohydrates and does not cause glucose levels and insulin to surge. Complex carbohydrates are also packed full of important nutrients that are essential for our health.

Research shows that people who eat abundant amounts of fruits, vegetables and whole grains have much lower incidence of most chronic diseases. Refined carbohydrates, however, have very little nutritional value, and promote disease and obesity. They should, therefore, be consumed in very limited quantities or avoided.


Passwater: What are the common side effects and long-term health risks that accompany low-carb dieting?


Horner: This all depends on what low-carb diet a person is following. If for instance, a person is following a sensible low-carb diet that restricts refined carbohydrates, includes plenty of “good” carbs like fruits, vegetables and whole grains, and favors vegetable or lean animal sources of protein, then there should be no health risks, but rather an improvement in overall health. However, if one chooses to also restrict “good” carbs, eat large amounts of red meat and saturated animal fats, or tend to eat low-carb snack foods instead of vegetables, then problems could arise.

Minor and commonly reported problems include constipation, headaches, bad breath, and sluggish digestion manifesting as indigestion, bloating and flatulence. More serious problems could arise from nutritional gaps if this type of diet is followed long term. Cholesterol levels may dangerously rise in some individuals. The lack of important plant nutrients may increase the risk of cancer, and other chronic disorders like heart disease. Other reported problems include impaired mental and physical function, lethargy, dehydration, mineral depletion, osteoporosis, cardiac arrhythmias, sudden death, and kidney stones.


Passwater: What is the best way to protect oneself if one is committed to low-carb living but wants to maintain optimal health?


Horner: The best way to maintain optimal health is to follow a “sensible” low-carb diet that restricts refined carbs, but includes the highly nutritious complex carbs—especially fresh, organically grown fruits, vegetables and whole grains. As a physician, I know that when people want to lose weight, they are sometimes desperate to do it quickly and will choose rapid weight loss over good nutrition. Certainly I have been guilty of that myself. Research shows that people who follow a very restricted low-carb diet do lose more weight initially than people who simply restrict their calories, or follow a low-fat diet. Sometimes an initial rapid weight loss can have great psychological benefits and helps people to continue on their weight-loss program. So for those who decide to severely restrict all carbohydrates for a few weeks, they should make sure they protect their health with intelligent supplementation.

Such a supplement program should address all the potential health problems associated with an extremely restricted low-carb, high-protein, and high-saturated-animal-fat diet. This should include a broad spectrum vitamin and mineral supplement; a “good” fat supplement that is high in omega-3 and omega-9 fatty acids to counter balance the saturated animal fats; important plant antioxidants such as lycopene, lutein, beta-carotene, and quercetin, as well as fiber; a cholesterol shield that lowers the absorption of dietary cholesterol; and a digestive formula composed of enzymes to aid difficult-to-digest proteins and fats.


Passwater: How about carbohydrate-blockers? Are there studies showing effectiveness?


Horner: Carbohydrate-blockers are made from white kidney bean extract, a substance that blocks amylase, an enzyme necessary to break down carbohydrates. Several studies have been published that show that they do work. A study published in 1993 (J Forensic Sci Soc. 1993 Apr-Jun;33(2):87-94) found that kidney bean extract showed the highest effectiveness of all the plant source amylase inhibitors tested.

In another study, published in 2002 (Nutrition, 2002 Sep;18(9):729-33), 62 overweight and obese people were given either two capsules of bean extract a day or placebo. The bean extract group had significant increased fat excretion in their feces and improved lipoprotein blood profiles.

Earlier this year, a study was published that proved carbohydrate-blockers were effective in improving weight loss. The study was designed according to the “gold standard”: randomized, double-blinded, placebo-controlled (Altern Med Rev. 2004 Mar;9(1):63-9). Half of the study participants were given a kidney bean extract and half were given a placebo. After eight weeks those taking the kidney bean extract lost 129% more weight and their triglyceride levels were three times lower than the placebo group.


Passwater: Could you also please address products intended to block cholesterol. Please discuss some studies showing the safety and effectiveness of cholesterol-blockers.


Horner: Cholesterol-blockers are made from “good plant fats” known as plant sterols. Cholesterol and plant sterols are absorbed into the body by the same protein receptor site in the bowel. You can think of a receptor site like a parking place. If you fill up the parking spaces with plant sterols, then cholesterol can’t park there and won’t be absorbed. There have been literally hundreds of studies documenting their safety and effectiveness.

Here are six:

 (1) Devaraj S et al. “Plant sterol-fortified orange juice effectively lowers cholesterol in mildly hypercholesterol healthy individuals.” Atherioscler Throm Vasc Biol. 2004 Mar;24(3):e25-8 Epub 2004 Feb 5

(2) Richelle M et al. “Both free and esterified plant sterols reduce cholesterol absorption and the bioavailability of beta-carotene and alpha-tocophernol in normocholesterolemic humans.” Am J Clin Nutri. 2004 Jul; 80(1):171-7

(3) Ostlund, RE. “Phytosterols and cholesterol metabolism.” Curr Opin Lipidol. 2004 Feb;15(1):37-41

(4) Hermansen K et al. “Effects of soy and other natural precuts on LDL:HDL ratio and other lipid parameters: a literature review.” Adv Ther.2003 Jan-Feb;20(1):50-78

(5) Normen L, et al. “Soy Sterols esters and beta-sitostanol ester as inhibitors of cholesterol absorption in human small bowel.” Am J Clin Nutr. 2000 Apr;71(4):908-13

(6) Pelletier X, et al. “A diet moderately enriched in Phytosterols lowers plasma cholesterol concentrations in normocholesterolemic humans.” Ann Nutr Metab. 1995;39(5):291-5

Exactly who should take cholesterol-blockers has not been established. However, the research shows that these products may play a valuable role in lowering the risk of cardiovascular disease. As a physician, I would recommend that anyone with mildly elevated cholesterol levels, or who chooses to consume a diet high in saturated animal fats and cholesterol would benefit from a cholesterol-blocker.


Passwater: Why do people on a low-carb diet report feeling crummy even if they are losing weight? What are the day-to-day experiences and remedial measure that can help?


Horner: Some people following a low-carb diet—especially during the induction phase that produces a metabolic condition known as ketosis—complain of lethargy, bad breath, headaches, and constipation. Vegetables are somewhat restricted and usually fruits and whole grains are forbidden. These foods supply energy and important nutrients, such as the vitamin B family, that are needed for energy metabolism. Therefore, low energy or lethargy can occur.

Ketosis is caused by the burning of fat and is associated with bad breath. Headaches can come from many causes but the general thought is that we are “addicted” to carbohydrates, and breaking the addiction can cause headaches. Also glucose is the preferred fuel for the brain. During ketosis the brain is using ketone bodies, which may initially cause headaches and also contribute to lethargy.

Constipation is reported in at least 68% of people who begin an Atkins-type diet. Plant foods are the only source of fiber.

Taking nutritional supplements can help to alleviate or improve many of these symptoms. A broad-spectrum vitamin and mineral supplement that supplies all the B vitamins, as well as energy- and metabolism-supporting minerals and nutrients—like magnesium, green tea, chromium, and vanadium—will help with lethargy and possibly headaches. A supplement that supplies powerful plant antioxidants and fiber will help to protect health and improve constipation.


Passwater: Is low-carb dieting just another fad or is it here to stay?


Horner: I believe the low-carb craze will move from its current extreme state to a more sensible state. I do believe that low-carb is here to stay, but I think the type of low-carb diet that will persist will be one that restricts “bad,” refined carbs, but has plenty of “good,” health-promoting and protective carbs like fruits, veggies, and whole grains. Instead of eating lots of low-carb snack foods that are low in nutrition, I believe that people will return to common sense and choose to eat real foods instead—especially fresh fruits, vegetables and whole grains.

Research also supports infrequent consumption of red meat and saturated animal fats because both are associated with a significant increases in serious chronic disorders. So a low-carb diet that recommends protein sources primarily from lean meats, fish, and vegetables will prove to be best. The diet should also be high in good fats like the omega-3s and omega-9s.

Research reveals to us the type of diet that is effective in weight loss and promotes health and, therefore, the type most likely to persist. It shows that people are successful in losing more weight initially with a low-carbohydrate diet, that refined carbohydrates do contribute to obesity and fuel serious chronic disorders like heart disease, diabetes and cancer, that saturated animal fats and red meat are not healthy long term, that the good fats and fresh fruits, vegetables, and whole grains are extremely important for good health.


Passwater: Your experiences are remarkable, and you have many things to teach us. Thank you for sharing several of them with us here. Is there a single “take-home” message that you can leave us with for now concerning the low-carb lifestyle and how to best support it?


Horner: The best way to support a low-carb lifestyle is to focus on limiting refined carbs, not “good” carbs. Choose nutritious whole foods over low-carb, low- nutrient snack foods. And don’t forget the importance of daily exercise and the use of intelligent supplementation. WF


© 2004 Whole Foods Magazine and Richard A. Passwater, Ph.D.

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