Why the Chinese Restaurant Effect Matters

Dr. Bernstein's Theory:
Bulky foods cause a greater insulin response

Dr. Bernstein is a Type 1 Diabetic that treats other diabetics. In his book, The Diabetic Solution, I came across something very interesting that I didn't notice before.

It's called the:

Chinese Restaurant Effect

This strange phenomenon that Bernstein talked about could put to rest the conflict between Atkins 2002 and Atkins 20.

There is a lot of controversy within the Atkins world about the counting process of Induction net carbs. 

The Atkins book written in 2002 said to limit the amount of salad and other vegetables you eat. Recommended amounts were a maximum of 2 cups of salad and 1 cup of cooked veggies per day OR 3 cups of salad, if you skip the cooked vegetables. 

Doing this doesn't normally cause your daily carb count to be 20 net carbs. It's quite a bit less and usually won't even give you a carb count that comes close to mostly vegetables, unless you consistently choose to eat higher carb produce.

So what's going on?

Why was Dr. Atkins original Induction Diets all shorter on carbs?

Perhaps, Dr. Bernstein can provide the answer for you.

Counting Your Vegetable Carbs on Induction can be Confusing

The Atkins Nutritionals, Inc. marketing company that owns the Atkins name (the ANA) takes Dr. Atkins recommendation about the number of Induction net carb counts literally, so they changed the rule of how to count those carbs.

Currently, Atkins 20 recommends that you eat 12 to 15-net carbs per day in vegetables alone.

You count those vegetable carbs by weighing and measuring your food with the help of a food scale and carb counter, instead of using the measuring-cup method that Dr. Atkins recommended. 

Previously, the ANA required you to eat exactly 20-net carbs per day, or get as close to that as you could get, with it better to go a little over than a little under. But today, they have relaxed that advice and now recommend 18 to 22 carbs a day, on Atkins 20 Phase 1, if I remember correctly.

Basically, the ANA tossed out Dr. Atkins recommendation of eating up to 20 carbs, or LESS, per day because 2 cups of salad and 1 cup of cooked vegetables doesn't fulfill their requirements of a minimum of 12-net carbs per day.

And they want you to hit that target, regardless of your carb sensitivity.

The controversy between Atkins 2002 and Atkins 20 has always confused me, especially since the spirit of what Dr. Atkins always stood for was individuality, and not just becoming one of the herd.

Dr. Bernstein might have provided us a clue as to what Dr. Atkins knew when he decided to implement cup limitations for vegetables and salad instead of requiring his patients and readers to weigh out those carbs using a food scale.

Atkins was always all about easy, and building from a solid foundation feels more like living than dieting for the rest of your life does.

What is the Chinese Restaurant Effect?

Chinese cuisine uses lots of bulky, high-fiber vegetables in their dishes. While they do toss lettuce into their soups and stir-fries, they don't actually eat salad in the amounts that Americans typically do.

Even with all of that bulk, lots of people complain about being hungry a couple of hours after consuming a huge, vegetable-heavy, Chinese meal. There are many theories as to why that is. Some people think the vegetables digest quickly and others believe it's due to the lack of protein.

However, in The Diabetes Solution, Dr. Bernstein actually takes the time to explain why this occurs from a diabetic perspective:

The cells in the upper part of the small intestine release hormones into the bloodstream whenever they are stretched after a large meal. These hormones signal the pancreas to produce insulin to help the glucose get into your body's cells faster.

This third-phase insulin response is something I had never heard of before.

First phase insulin response occurs almost immediately when you begin eating because it is based on what you ate at your last meal, and not the current one. Phase 2 insulin response occurs when basal insulin isn't enough, such as after a meal heavy on carbs.

But according to Dr. Bernstein, you can get a third dose of insulin when the food hits the small intestines, due to the amount of food being digested.

A very small amount of insulin can cause a large drop in blood sugar, so the pancreas simultaneously produces the hormone glucagon to offset the potential effect of this third dose of insulin.

Glucagon encourages the liver to break down glycogen into glucose and dump it into your bloodstream.

If you eat enough to feel stuffed, if you force yourself to get in all of those vegetable carbs currently recommended (about 6 cups a day), or you force yourself to eat more than it takes to make you feel full, your blood sugar can go up dramatically, due to that glucagon release, even if you haven't exceeded your carb allotment for that meal.

And according to Bernstein, this happens even if you're eating something indigestible like sawdust because it's the stretching of the intestines, and not the actual carb count that makes the body believe you have just eaten something that needs a lot of insulin to digest it.

Dr. Bernstein called this phenomenon:

The Chinese Restaurant Effect

This Chinese Restaurant Effect could explain why there is such a huge variation in the amount of carbohydrate that each of us can tolerate. Dr. Bernstein discovered the phenomenon when a patient admitted to eating an entire head of lettuce just before going swimming every day.

She thought lettuce was a free food.

Lettuce isn't a free food, although it can seem like that when you are counting up the carbs in a single cup or two of torn greens. The carb count is very low. There's like 10 carbs in a whole head of lettuce.

Under normal conditions, if you were a Type 1 Diabetic, 10 carbs would only raise your blood sugar a maximum of 50 mg/dl. If your blood sugar is a normal 84, that would take your glucose up to 134 mg/dl, just under the 140 mg/dl that causes damage to the body.

Yet, this woman's blood sugar went up 160 mg/dl, which was above what it was before she ate the lettuce! If her blood glucose level had been 84, which it probably wasn't, that would be 244 mg/dL -- just from eating lettuce!

Why Does the Chinese Restaurant Effect Matter to Low Carbers?

Okay. Maybe you don't have diabetes, and if you do, it's not Type 1, so why does the Chinese Restaurant Effect matter to you?

If you eat a lot of bulky vegetables, just because you believe you should, you will feel very full. Stuffed, even. Vegetables take up a lot of room in the stomach, which is why it has to stretch to get them to fit.

Your stomach can only hold about 2 to 4 cups of food comfortably at any one time. Any more than that, and it has to stretch to accommodate the extra bulk.

The result of having to digest all of those vegetables will be increased blood sugar, due to the release of glucagon, and increased insulin level, due to the higher blood glucose. Plus, all of the complications to your health, hunger, and cravings that come from both of those.

According to Dr. Bernstein:

Two cups of salad has the same effect on the body as if you'd eaten 12 grams of carbohydrate!!!

One cup of cooked vegetables adds another 8 carbs.

So using the old Atkins 2002 rules, that's 20 carbs in vegetables alone, not counting any of the other low-carb condiments, dairy, and incidentals you're eating.

On Atkins 20, you're getting much more than 20 carbs on Induction because you're advised to eat 6 cups of vegetables, instead of just 3.

The bottom line?

Even though it looks like Dr. Atkins made a mistake with his cup method, he really didn't because if Dr. Bernstein is correct, the body will handle that 2 cups of salad and 1 cup of cooked veggies as if you were eating 20 carbs of vegetables.

If this is true, then the 2002 Induction Plan as originally written is providing the body with MORE than 20 net carbs due to the bulk, since you can also eat up to:

• 4 ounces of hard cheese
• 2 tablespoons of heavy cream
• 2 tablespoons sour cream
• 1/2 avocado
• several green or black olives
• juice of 1 lemon
• spices and seasonings without sugar

These extra foods are on top of all of those vegetables.

The Atkins Diet was Designed to Control Blood Sugar

In Dr. Atkins experience, most of his patients had hypoglycemia to some degree, and a large proportion had gastrointestinal problems, so the major purpose of the Atkins Diet, as he originally designed it, was to keep your blood sugar as steady as possible and your intestines happy.

Eating very low carbs allows cravings and hunger to go down dramatically, making it easier to stay on plan.

It seems that staying below your own personal tolerance level for carbohydrates is only one aspect of glucose control. And that how much you eat in a single setting is as important as the number of carbs.

This might explain why some people struggle to lose weight eating at 20 net carbs, and why they feel better eating less. Maybe it's the Chinese Restaurant Effect that no one wants to talk about.