Keto Water – replacing electrolytes

Many people who are accustomed to eating a carb-based diet, restrict their salt intake to avoid blood pressure, but when eating low carb high fat, there is the need to add salt to replace sodium right from the beginning. That is how “keto-water” came to be.


When eating low carb and when intermittent fasting (extending the amount of time between meals) insulin levels fall, and with it so does the kidney’s retention of sodium (salt). The kidneys excrete sodium in a process called naturesis so replacing the missing sodium is important. Sodium and potassium (as well as calcium and magnesium) are used in pairs in a number of systems in the body, so when the kidneys ‘dump’ a lot of sodium, potassium is soon excreted too, in order to balance the two electrolytes. If someone on a low carb diet doesn’t supplement sodium soon enough, their potassium levels could fall too low as a result, which may cause them to have excruciating headaches and/or irregular heart beat (heart palpitations).

It is fairly difficult to meet the Dietary Reference Intake for potassium on a conventional  carb-based diet, but on a low-carb diet – even with a very high non-starchy vegetable intake, it is still challenging as many of the good sources of potassium, such as potato and yams are not part of a low carb high fat diet. Mushrooms and avocado are some of the best sources, so include those foods often.

To be sure to get sufficient sodium and potassium, I make what I call “keto-water”.

NOTE: People with kidney disease (e.g. CKD) must avoid any salt substitutes or half-salts with potassium. Those taking blood pressure medication such as Ramipril have increased potassium retention and should also not use half-salts containing potassium.

“KETO-WATER”

Keto-water is 1 liter of club soda / seltzer to which 1/8 tsp of “half salt” has been added.

“Half salt” is a half-sodium / half-potassium salt that is sold under a number of brand names, including “Nu Salt” and “no Salt“.

I add a tiny twist of lime or lemon to round out the taste and also to add a source of Vitamin C and voila, “keto-water“!

Keto-water salts

Unless it is particularly hot out, or one’s needs are increased because they are exercising or have a fevertwo liters a day of “keto-water” is probably sufficient for most people.

Keep in mind that drinking keto-water will result in your body retaining more water along with the sodium, so it may appear as if your ‘weight went up’, but it is only the natural water retention that occurs (and is supposed to occur) when your body has sufficient electrolytes. Remember, weight form most people can fluctuate by as much as 4 – 4 1/2 pounds per day solely from the natural fluctuation in body water, so don’t weigh yourself too much.  I recommend a maximum of once a week, on the same day and at the same time.  When you are replacing the body’s necessary electrolytes (such as sodium and potassium), it is better to judge fat loss by loss of inches around various parts of your body (mid-arm, mid-thigh, neck, abdomen) than by the scale. Even easier, go by how your clothes feel!

Please don’t restrict sodium when eating low-carb for the sake of a number on the scale!  Your body needs the sodium and potassium to function properly.


 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/


Copyright ©2017 BetterByDesign Nutrition Ltd.  

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read or heard in our content. 

 

A Dietitian’s Journey – how I got my weight moving again

INTRO: After a seeming endless 6 week plateau with my weight barely budging, I decided to do some serious intermittent fasting and lower my carbs and bingo – my weight is dropping nicely!  Not only that, my fasting blood sugar is the best it has been since I was diagnosed as Diabetic ~10 years ago. Here’s an update.

Yesterday was my third day of intermittent fasting (IF) this week – where I didn’t eat anything after supper at night, until supper the next day.  This is my second week of doing intermittent fasting Monday to Friday and eating a regular, low carb high healthy fat supper at night.

Here’s an example of what I ate on one night, to give you an idea.  It was some Thai chicken thighs that had been marinated in coconut milk, red curry paste and curry and grilled on the barbecue, along with a huge mixed green salad, with some shaved Parmesan, raspberries, pepitas (pumpkin seeds) and homemade raspberry vinaigrette (great thing to do with over ripe berries!) that was made with Dijon mustard, wine vinegar and extra virgin olive oil. To start with, I also ate about a cup of snap peas with ~ 1  1/2 Tbsp of taramasalata (Greek carp roe spread) that didn’t have any of the usual bread in the recipe.

Keeping in mind that I am only a “sample set of 1”, here are my results;

Last week, which was my first week of regular IF, my fasting blood sugar, which had been stuck at the high to mid- 6 mmol/L (117 mg/dL) range for weeks, dropped to the mid- 5 mmol/L range (~99 mg/dL) for several days in row.

 

Yesterday, which was my third day of IF this week, my blood sugar just before dinner was the lowest it has been since I was diagnosed as Type 2 Diabetic ~10 years ago.

While I felt totally fine and had been working a full clinical day, I knew it was time to eat something!  I ate about 10 salted almonds and went about preparing dinner.

Blood glucose values from June 22nd until June 29th, inclusive

I should add, that last week I also started walking daily ~ 2-3 km (1  1/4 -2 miles) around a local man-made lake (I posted a video below, so you can see it).  The first two days I could only go once around, as I had fractured a rib last Friday and it was still quite painful.  I starting walking daily because it was supposed to be good to alleviate the muscle pain accompanying my injury and I found it helped a lot, so I kept doing it each morning.  Then I realized how great it felt to be walking in such a beautiful place, so now it has become a morning routine.

My blood pressure is doing amazing now.

It had stalled between Stage 1 hypertension and pre-hypertension for about a month, but when it creeped back up to Stage 2 hypertension for two days in a row, I decided to go see my doctor and get prescription for a ‘baby-dose’ of Ramipril (2.5 mg).

 

There is a strong family risk of heart attack and stroke, and a blood pressure that hit 160/90 was not something to fool around with.

I plan to staying on the meds until I lose another 20 pounds, or until my blood pressure becomes too low – whichever comes first.

Look at my blood pressure now.

The only day that was high (Stage 1) was last Friday, before I started on the lowest dose of Ramipril.

The rest of the time I am in pre-hypertension and one day was totally normal! I am looking forward to seeing the continued dietary changes, bring it down even further.

As I planned to do 3 months after I started eating low carb, I have a requisition for blood work and an appointment for mid-July to have that done.  I will be getting my HbA1C checked and my cholesterol, along with some liver and kidney function tests as well as electrolytes (important on this hypertensive medication).

One of the other dietary changes that I made, besides the intermittent fasting, was that I cut my carbs considerably. I was not doing well on 50 gm of carb per day, my weight loss had been stalled, my blood pressure as well and it had been a month of no significant progress, even though I was in low stage ketosis. I cut my carbs down to 35 gms per day (sometimes a little less), but making sure to have lots of non-starchy vegetables and protein and of course, plenty of healthy fats in the form of olive oil, coconut milk and nuts.

In short, I feel amazing.

The weight is dropping, the inches are dropping, my blood sugar is approaching more normal values and my blood pressure is being kept in check, while I continue this process of eating low carb high healthy fat and daily walks. I’m not hungry during the day even though I am not eating, because my body is happily accessing my own fat stores for energy. I think the limiting factor at this point is that my body is not quite used to synthesizing the enzymes needed for it to make glucose from my stored fat (a process called gluconeogenesis), so I will be monitoring my blood sugar closely, to make sure it doesn’t get too low.

I want to encourage you, that if your weight is staying stable for longer than you’d like, I’ve posted some things on the blog that would be helpful (located under the Food For Thought tab). One article is on tracking carbs, and the next one is on where calories factor in.

If your weight has plateaued, and you’ve been eating low carb high fat and your not losing weight as you’d like to, these two articles should help.

If you’d like to learn more about how I can help you accomplish your own weight loss or insulin-resistance lowering goals, please send me a note using the “Contact Us” form above.

Keep in mind that for the month of July only, I am offering a substantial savings on taking both an assessment package and a weight management package, so please visit the front page to find out more about the Canada Day special.

To our good health!

Joy

Note: I am a "sample-set of 1" - meaning that my results may or may not be like any others who follow a similar lifestyle. If you are considering eating "low carb" and are taking medication to control your blood sugar or blood pressure, please discuss it with your doctor, first.

Copyright ©2017 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/

 

 

Tracking Carbs Instead of Counting Calories

I have found that people wanting to lose weight simply don’t want to weigh or measure food or count calories – and who can blame them! I design Meal Plans for my clients so they don’t need to. As I will explain in this article, with a Standard Meal Plan (based on a traditional macronutrient distribution), carbohydrate, protein and fat are all laid out, based on the food exchanges. With a Low Carb High Healthy Fat Meal Plan or a Hybrid Meal Plan, carbohydrate percent, protein- and fat percent are also laid out, but for those seeking to lower insulin resistance or lose weight or both, tracking carb intake is important.  In this article, I’ll explain tracking carbs.

Firstly, what is a Meal Plan?

What is a Meal Plan?

A Meal Plan isn’t a “menu” that tells you what foods you have to eat, but indicates how many servings of each category of food you should aim to eat at each meal. I explain more about what a food category is, below.

The first step in designing a person’s Meal Plan after I’ve done their assessment, is to determine their overall caloric needs based on age, gender, activity level, desired weight loss (or gain), as well as any special considerations such as growth, weight loss, pregnancy or lactation, etc.

More about calories in the next article, but suffice to say here, calories are generally not the focus in Low Carb High Healthy Fat eating, carbs are.

The next step is to set the macronutrient distribution (% of calories from carbohydrate, protein and fat) of the Meal Plan according to what would best suit the person’s clinical needs, goals and lifestyle. This is something I discuss with people during the assessment, and which is ultimately up to them.  The Standard macronutrient distribution is ~45-65% carbohydrate, ~15-20% protein and ~30% fat. Generally speaking, unless there is a compelling clinical reason for using a Standard Meal Plan, I encourage people to consider the benefits of a low carb high healthy fat eating.

The Low Carb High Healthy Fat macronutrient distribution is ~5-10% carbohydrate, ~20% protein and ~65-70% healthy fat, with the Hybrid macronutrient distribution falling somewhere in between.

In the final step, I design a person’s Meal Plan based on the foods that they’ve told me they like, avoiding those they don’t, and factoring in the time of day they either need to (for scheduling reasons) or prefer to eat. Then we meet for me to go over their Meal Plan with them, and for me to teach them how to easily and accurately estimate their portion sizes, using visual measures. More on visual measures, below.

The only thing left for them to decide is what they want to eat!

Food Categories – Standard Meal Plan

In a Standard Meal Plan or Hybrid, categories include Starchy Vegetables and Grains, Fruit, Non-Starchy vegetables, Meat, Poultry, Meat and Egg or Cheese, and Legumes (pulses). These categories are based on how many grams of carbs are contained in the foods in make up that category.

Take, for example, the Starchy Vegetable and Grain Category.  This group includes all the standard “carbs” such as bread, pasta, rice and cereals as well as “starchy vegetables” such as peas, corn, potatoes, sweet potatoes / yams and winter squash (such as acorn or butternut squash). All foods in this category have 15 gm of carbs per serving (where a serving is 1/2 cup or the equivalent of 1 slice of bread).

So, 1 slice of bread has 15 gms of carb, 1/2 cup of peas has 15 gms of carb, 1/2 cup of rice has 15 gms of carb, 1/2 cup of oatmeal has 15 gms of carb, and 1/2 a hamburger bun has 15 gms of carb.

If a person’s Meal Plan indicates that they can have 2 servings from the Starchy Vegetable and Grain category, that could be 2 pieces of toast, or 1 cup of oatmeal, or 1 cup rice, etc. Their Meal Plan doesn’t tell them what food they have to eat, just how much from each category.

Here is an example of what a Standard Meal Plan looks like;

 

 

As you can see, all the calculations have been done.

In this example, this Meal Plan was for an 85 year old man who wanted to gain weight and was based on 45% of his calories coming from carbs, 21% from fat and 34% from fat.

Estimating Portion Sizes

When I’ve taught someone to accurately estimate their serving sizes using visual measures, the amount of macronutrients (carbs, protein, fat and calories) they will take in following their Meal Plan will be what was planned.

What are Visual Measures?

Visual measures are easy and accurate means to estimate serving sizes. For in-person clients, this might be based on the size of their hand or fingers, such as (depending on the size of a person’s hand) a 1/2 a cup (dry measure) may be the amount of something round (like frozen peas) that could be contained in their scooped hand, without rolling out. An ounce (by weight) might be the size of two specific fingers on their hand, or a Tbsp may be the amount of the last digit on their thumb. For Distance Consultation clients, the standard used in teaching visual measures are standard size items, such as the size of a golf ball or four dice stacked up.

Tracking Carbohydrates

Where tracking carbohydrates comes into play is with Low Carb High Healthy Fat Meal Plan or a Hybrid Meal Plan – especially when lowering insulin levels or losing weight is desired. Keeping track of carbohydrates on these kind of Meal Plans is nothing like needing to count calories! It is very easy.

On a Low Carb High Healthy Fat Meal Plans, the macronutrient distribution for carbs is set quite tightly. For men, total carbs would be somewhere between 80-100 grams and for women, it may be set as low as 35 gms carb or as high as 50 gms. It depends on their needs. Naturally, Hybrid Meal Plans will have higher total daily carbs.

Since there are no Starchy Vegetables and Grains and Milk on these Meal Plans (cheese is used, just not milk due to the carb content), the Food Categories on a Low Carb Meal Plan or Hybrid are different than on a Standard (or traditional) Meal Plan).

Food Categories in a Low Carb Meal Plan include Non-Starchy Vegetables, which exclude “Starchy Vegetables” such as peas, corn, potatoes, sweet potatoes / yams and winter squash – with some intake guidelines around root vegetables such as carrots, beets and parsnips. The Fruit category here is specified more narrowly than in a Standard Meal Plan – generally focused on berries and low sugar citrus such as lime and lemon, as well as tomatoes and cucumbers (yes, both are technically ‘fruit’).

Meat, Poultry, Meat and Egg or Cheese is pretty much the same as with a Standard Meal Plan, with an ounce of any of these protein foods being 1 serving and individuals being able to have several servings at each meal (based on their caloric needs, factoring in any weight loss). The fat contained in the Meat, Poultry, Meat and Egg or Cheese is already calculated when the Meal Plan is made, so “Fat” here means added fat. The Fat category includes everything from olive oil, avocado (both the fruit and the oil), coconut oil, butter, olives and nuts and seeds.

Foods in the Meat, Poultry, Meat and Egg or Cheese category have little or no carbs in them and Non-Starchy Vegetables are generally around 5 gm of carb per cup and berries, which are in the Fruit category are roughly 15 gm of carb for 1/2 a cup. A few berries on a salad isn’t usually a problem, but more than that can easily put us over our maximum amount of carbs for the day, which I call the “carb ceiling“.

Where it becomes particularly important to track carbohydrates when one is seeking weight loss is with foods such as nuts and seeds.  It is very easy to eat a handful of nuts and end up exceeding one’s daily maximum number of carbs.

[an article written a month earlier will provide detailed information regarding the carbohydrate content of nuts: http://www.lchf-rd.com/2017/05/23/oh-nuts/]

Carb Creep

“Carb-creep” is when we eat more carbs than we think we are, which results in weight loss slowing, or even stopping. When one reaches a plateau  where they haven’t lost any weight for longer than a week or two, then tracking carbs to see if there is carb creep is advised.

A man’s carb limit may be set to 80-100 gms per day and a woman’s may be as low as 35 gms or as high as 50 gms.  That is not a lot and it is easy to inadvertently exceed this amount of carbs in the course of a day. A few splashes of milk in several cups of coffee, a handful of peanuts walking by the bowl near the photocopier and an ounce or two of 72% dark chocolate (for heart health, of course!) can quickly put us over our carb ceiling. This is where it’s important to evaluate food choices that may be putting your over your carb ceiling.

Want to know more about having a Meal Plan designed for you?

Please send me a note using the “Contact Us” form above and I will reply to you, usually by the next business day.

To our good health!

Joy

Copyright ©2017 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/


 

 

A Dietitian’s Journey – a few thoughts on “exercise”

There are two words that I’ve noticed aren’t talked about much in low carb high fat (LCHF) circles; one is “calories” and the other is “exercise“. I think that’s because both have been tied to the old “calories in, calories out” model.

I think it’s important to reframe both of these within a LCHF context, because both have a role to play in us being successful in improving health as well as losing weight, even though the reasons for that are very different than in the “calories in, calories out” model.

In the traditional high carb, low fat paradigm, restricting calories and increasing exercise are seen as the foundation of weight loss – based on the assumption that “calories out” is only the calories we burn in activity.  As explained in this week’s blog on “Do Calories Matter When Eating Low Carb“, there are other demands on the energy we take it (calories) that are higher priority than exercise, such as regulating our body temperature and providing energy to keep our heart pumping.

(You can read about that here: http://www.lchf-rd.com/2017/06/19/do-calories-matter-when-eating-low-carb/)

In the low carb, high fat model, overall calories need to be understood within a diet that is 70% fat and <10% carbohydrate and exercise needs to be understood within the context of lowering stress levels (i.e. cortisol), as well as increasing metabolic rate so that fat stores continue to be burned long after activity ends.

Below is a very short video from my morning walk, with a few thoughts on “exercise”.

To our health!

Joy


 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/


Copyright ©2017 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read or heard in our content. 

One in Two People Will Get Cancer – new report finds

A new report released by the Canadian Cancer Society predicts that almost one in two Canadians will be diagnosed with cancer in their lifetime.

One half” is a very sobering number!

Currently, cancer is the leading cause of death in Canada, accounting for almost 1/3 of all  of all deaths (30%).

Heart disease is the second leading cause of death, accounting for 1/5 of all deaths (20%).

In an interview with Peter Goffin of the Toronto Star, Dr. Robert Nuttall, Assistant Director of Health Policy at the Canadian Cancer Society attributed this alarming new statistic that 1/2 will get cancer in their lifetime to the “aging population” – notlifestyle factors“. 

Nutall said;

“The important thing to remember here is that the biggest driver behind this is the aging population. “Canadians continue to live longer, and cancer is primarily a disease that affects older Canadians.”

Japan has the oldest population in the world, with ~1/3 of people aged over 60.

What do their statistics show?

According to the Institute for Health Metrics and Evaluation, Japan’s leading causes of death (2015) were:

  1. cerebrovascular disease (stroke)
  2. cardiovascular disease (heart disease)
  3. lower respiratory infection
  4. Alzheimer’s disease

Lung cancer was 5th, followed by stomach cancer (6th) and colorectal cancer (7th). In Japan, a country with the oldest population in the world, cancer of any kind wasn’t even in the top four!

Are half of us really going to get cancer because of the “aging population” or is it because of “lifestyle factors“?

Looking at the top 4 Causes of Cancer in Canada:

Ten Most Common Cancers in Canada – projected for 2017
  1. Lung cancer is the number one form of cancer and the Canadian Cancer Society indicates that more than 85% of lung cancer cases in Canada are related to smoking tobacco.

  2. Colorectal cancer is the second leading cause of cancer and the Canadian Cancer Society indicates that risk factors for colorectal cancer include (a) diet , (b) being overweight, (c) physical inactivity and (d) smoking.

  3. Breast cancer (in both men and women) is the third leading cause of cancer. Apart for personal and family history of breast cancer and other genetic factors, the Canadian Cancer Society list the following known risk factors: (a) exposure to ionizing radiation, (b) use of oral contraceptives (c) alcohol and (d) being obese.

  4. Prostrate cancer which only affects men, is the fourth leading cause of cancer and the only known risk according to the Canadian Cancer Society is family history.

Major Risk Factors for the top 4 Causes of Cancer

Here are the major risk factors for the top four leading causes of cancer in Canada;

  1. smoking
  2. diet
  3. being overweight
  4. physical inactivity 
  5. exposure to ionizing radiation (x-rays)
  6. use of oral contraceptives
  7. alcohol

Except for use of x-rays, all of these are lifestyle factors!

Diet, being overweight and being inactive are three things that can be changed easily and sustainably!

A low carb approach can be particularly helpful, as it can not only address being overweight, but new studies have found that a number of cancer cells feed exclusively on glucose.  It is thought that a ketogenic lifestyle may play a role in reducing the glucose available for some types of cancer.

We being told that the biggest driver behind the projection that half of us will get cancer in our lifetime is the aging population– when it would seem that the underlying risk factors of these cancers are lifestyle factors.

In fact, the Canadian Cancer Society says themselves that half of the cases are preventable;

“We already know a lot about how to prevent cancer. If we, as a society, put everything we know into practice through healthy lifestyle choices and policies that protect the public, we could prevent about half of all cancers.”

We will all age and this is not preventable, but by addressing lifestyle factors including smoking, diet, overweight and physical inactivity and others, we should be able to prevent almost 1/2 of all cancers.

Have questions on how I can teach you how to eat healthier and work with you to help you tackle being overweight and inactive, then please send me a note using the “Contact Us” form on this web page.

To your good health!

Joy


 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/

Copyright ©2017 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


References

Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-type/lung/risks/?region=on#ixzz4kZ5AnNz6

Canadian Cancer Society, http://www.cancer.ca/en/about-us/for-media/media-releases/ontario/2011/not-enough-canadians-being-screened-for-colorectal-cancer-leading-to-many-unnecessary-deaths/?region=on#ixzz4kZ5vSGSS

Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-type/breast/risks/?region=on#ixzz4kZ8RvXbm

Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-type/prostate/risks/?region=on#ixzz4kZ9J6o64

Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-101/cancer-research/prevention/?region=on#ixzz4kZ9jQJwt

Institute for Health Metrics and Evaluation, http://www.healthdata.org/japan

The Toronto Star, Peter Goffin (Staff Reporter), Tue June 20 2017, https://www.thestar.com/news/gta/2017/06/20/half-of-all-canadians-will-get-cancer-in-their-lifetime.html

New Obesity Study Sheds Light on Dietary Recommendations

As mentioned in the previous article, a new study published Monday, June 12, 2017 in the New England Journal of Medicine analyzed data from 68.5 million adults and children in 195 countries and found that 1/3 of people worldwide are overweight or obese and are at increased risk of chronic disease and death, as a result.

Data from one country, China, stood out among all of them due to record high rates of childhood and adult obesity;

  • In 2015, China had the highest incidence of obese children in the world (~10%) along with India. 
  • In 2015, China along with the US had the highest incidence of obese adults (>35%). 

I wanted to have a look at the Dietary Guidelines for Chinese Residents (Chinese: 中国居民膳食指南) in the years prior to 2015, to determine how they may have contributed to these high rates of overweight and obesity.

The Food Guide Pagoda

The Chinese Dietary Guidelines, known as the ‘Food Guide Pagoda’ was first published in 1989 and revised in 1997. The 2007 revision was developed in conjunction with a committee from the  Chinese Nutrition Society, in association with the Ministry of Health.  A new revision came out in 2016.

The 2007 ‘Food Guide Pagoda’ (the one that was in effect at the time the 2015 overweight and obesity statistics came out) was divided into five levels of recommended consumption corresponding to the five Chinese food groups.

  1. Cereals – in the form of rice, corn, bread, noodles, crackers and tubers make up the base of the Pagoda.
  2. Vegetables and Fruits – form the second level of the Pagoda
    According to the Chinese Dietary Recommendations, the majority of foods in each meal should be made up of cereals, including rice, corn, bread, noodles, crackers and tubers (such as potatoes), followed by Vegetables and Fruit.
  3. Meat, Poultry, Fish & Seafood and Eggs form the third level, and it is recommended that should be ‘eaten regularly’, but ‘in small quantities’.
  4. Milk & Dairy and Bean & Bean Products – form the fourth level.
  5. Fat, Oil and Salt – form the roof of the Pagoda and are recommended to be eaten in moderation.

Specific Dietary Recommendations (2007-2015)

The main recommendations of the 2007 Chinese Dietary Guidelines were as follows:

  • Eat a variety of foods, mainly cereals, including appropriate amounts of whole grains.
  • Consume plenty of vegetables, fruits and tubers (e.g. potato, taro, yam etc.)
  • Consume milk, beans, or dairy or soybean products every day
  • Consume appropriate amounts of fish, poultry, eggs and lean meat.
  • Reduce the amount of cooking oil
  • Divide the daily food intake among the three meals and choose suitable snacks.

The Results (2005-2015)

1. Leading cause of death

In 2015, heart disease overtook Chronic Obstructive Pulmonary Disease (COPD) as the second leading cause of death, followed by stroke.

In 1990, the leading cause of death in China was Chronic Obstructive Pulmonary Disease (COPD) largely contributed to by smoking, followed by heart disease and diarrhea.


2. Leading cause of premature death

In 2015 as in 2005, stroke was the leading cause of death, followed by heart disease.

 


3. What caused the most death and disability combined?

In 2015, stroke was leading cause of death in China, followed by heart disease.

 


Magnitude of the Problem – China compared to the US and Canada

In 2015, for every 100,000 people in China, 2,237 people died from heart disease and 1,672 people died from stroke.

In the US, for every 100,000 people, 457 people died from heart disease and 1,617 died from stroke.

In Canada, for every 100,000 people, 327 people died from heart disease and 1,106 died from stroke.

Rates of stroke in the China and US were quite similar. Both China and the US had the highest number of obese adults (>35%) in the world. 

China’s “solution”?

China concluded that “dietary risks drive the most death and disability” – especially stroke and heart disease which were the two leading causes of all forms of death, of premature death and of disability in 2015.

In response to these high rates of stroke and heart disease among Chinese, the Chinese government, with the assistance of the Chinese Nutrition Society produced a revised version of the Chinese Food Pagoda in 2016.

New Dietary Recommendations (2016)

The Chinese have stated that “there have been no significant changes in dietary recommendations” (Wang et al, 2016) when compared with the previous version of the 2007 Food Pagoda and are emphasizing the following recommendations:

Eat a variety of foods, with cereals as the staple – The daily amount of cereals and potatoes consumed for body energy production should be 250–400 g, including 50–150 g of whole grains and mixed beans, and 50–100 g of potatoes. The major characteristic of a balance diet pattern is to eat a variety of foods with cereals as the staple.

Balance eating and exercise to maintain a healthy body weight – this is based on the same “calorie in / calorie out” model that the US and Canadian recommendations have been based on. “Avoiding ingesting excessive food and physical inactivity is the best way to maintain energy balance”.

Consume plenty of vegetables, milk, and soybeans – The daily vegetable intake should be in the range of 300–500 g. Dark vegetables, including spinach, tomato, purple cabbage, pak choy, broccoli, and eggplant, should account for half this amount and should appear in every meal. Fruits should be consumed every day. The daily intake of fresh fruits, excluding fruit juice, should be between 200 and 350 g. A variety of dairy products, equivalent to 300 g of liquid milk, should be consumed per day. Bean products and nuts should be frequently eaten in an appropriate amount for energy and essential oils.

Consume an appropriate amount of fish, poultry, eggs, and lean meat – The consumption of fish, poultry, eggs, and meat should be in moderation. The appropriate weekly intake is set at 280–525 g of fish, 280–525 g of poultry, and 280–350 g of eggs with an accumulated daily intake of 120–200 g on average. Fish and poultry should be chosen preferentially. The yolk should not be discarded when consuming eggs, and less fat and fewer smoked and cured meat products should be eaten.

Final Thoughts…

China now has some of the highest rates of childhood obesity in the world (~10%) and is tied with the US for the highest rate of adult obesity (>35%) yet to address the issue of incredibly high rates of stroke and high rates of heart disease, the 2016 Chinese Dietary Recommendations define a balance diet pattern as a daily adult intake of;

1/2 lb – 1 lb (250-400 gm ) of cereals, grains and potatoes

1/3- 3/4 lb (200 – 350 gm) of fresh fruit

1 1/2 cups of milk

and

1/4 lb – 1/3 lb of fish, poultry or eggs (with meat “in moderation”)

These “new” recommendations seem to be based on the same “calorie in / calorie out” model familiar to us in the West and that fail to take into account how the body compensates on a carbohydrate-based calorie restricted diet diet (see previous blogs).

The Chinese are being told that “the best way to maintain energy balance” (Wang et al, 2016) is to;

  1. exercise more (150 minutes/week plus 6000 steps/day)
  2. eat less fat and animal protein
    and
  3. consume most of their calories as rice, corn, bread, noodles, crackers and potatoes 

Over the last four decades,  Americans and Canadians have reduced their fat consumption from ~40% in the 1970’s to ~30%, increased the amount of carbohydrate as whole grains, fruits and vegetables, are consuming low fat milk, eating more fish and drinking less pop and presently, 2/3 of adults considered overweight or obese.

Should we expect different results in China?

How I can help you

If you are looking to achieve a healthy body weight, lower blood sugar, blood pressure and triglycerides, I can help.

I take a low carb high health fat approach and can teach you how to eat well, without weighing or measuring food, or counting “points”.

Want to know more?

Send me a note using the “Contact Us” form, on the tab above.

To our health!

Joy

Copyright ©2017 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


You can follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/


References

Global Burden of Disease (GBD) 2015 Obesity Collaborators, Health Effects of Overweight and Obesity in 195 Countries over 25 Years, N Engl J Med, DOI: 10.1056/NEJMoa1614362

Global Health Data Exchange (GHDx), http://ghdx.healthdata.org/geography/china

Wang S, Lay S, Yu H, Shen S. Dietary Guidelines for Chinese Residents (2016): comments and comparisons. Journal of Zhejiang University Science B. 2016;17(9):649-656. doi:10.1631/jzus.B1600341.

 

Obesity Pandemic – new study

In the last few years, we’ve heard the term “obesity epidemic“, but a new study published this past Monday, June 12, 2017 in the New England Journal of Medicine seems to indicate that it is now an “obesity pandemic“.

Researchers analyzed data from 68.5 million adults and children in 195 countries to assess (1) the prevalence of overweight and obesity in 2015 and (2) the trends in the prevalence of overweight and obesity between 1980 and 2015.

The “short story” is that a 1/3 of people worldwide are now overweight or obeseput another way, two billion people globally are overweight or obese and are at increased risk of morbidity (chronic diseases) and morbidity (death), as a result.

The Significance

Epidemiological studies (studies of different populations from around the world) have identified high BMI as a risk factor for cardiovascular disease, type 2 Diabetes, hypertension, chronic kidney disease and many types of cancer.

Furthermore, overweight children are at higher risk for the early onset of diseases such as type 2 Diabetes, hypertension and chronic kidney disease.

Body Mass Index (BMI) is the weight in kilograms divided by the square of the height in meters

Obesity is defined as having a Body Mass Index (BMI) > 30 kg/(m)2

Overweight is defined as having a BMI between 25 and 29.9 kg/(m)2

Obesity Findings

Data showed that in 2015, there were 603.7 million obese adults worldwide and 107.7 million obese children.

The prevalence of obesity has more than doubled in 70 countries since 1980, and there has been a tripling of obesity in youth and young adults in developing, middle class countries such as China, Brazil, and Indonesia.

Worldwide, the prevalence of obesity is now 5% in children and 12% in adults — findings that mirror global trends in type 2 Diabetes.

Most alarming was that in 2015;

  • high BMI accounted for four million deaths globally
  • almost 40% of deaths resulting from high BMI occurred in people who were overweight, but not obese
  • more than 2/3 of deaths related to high BMI were due to cardiovascular disease

Varying Risk

It is important to note that risk of outcomes related to obesity has not been found to be uniform across populations. For example, it has been reported that at any given level of BMI, Asians have been shown to have a higher absolute risk of Diabetes and hypertension, whereas African Americans have a lower risk of cardiovascular disease than other groups.

Addressing the Problem

To address the problem of overweight and obesity both here and around the world, requires correctly identifying its cause and for the last 40 years, excess dietary fat — especially saturated fat has been blamed as the villain and ostensibly responsible for the “obesity epidemic” and resulting “diabetes epidemic”.

But is it?

When one compares the Dietary Recommendations in both Canada and the United States since 1977 to rates of overweight and obesity in both of these countries, it seems apparent that it has been the promotion of diets high in carbohydrate that lies at the root.

In the next article, I’ll take a look at the Dietary Recommendations of the country with the highest rate of childhood obesity and adult obesity in 2015, as well as some of the highest rates of stroke and heart disease per capita, in the world.

How I can help

If you have eaten a ‘low fat diet’ and counted calories (or points) until you are blue in the face and are tired of doing the same thing over and over again, expecting a different outcome, why not drop me a note using the “Contact Us” form, above. I’d be glad to explain how I can help you achieve a healthy body weight, while normalizing your blood sugar, blood pressure and cholesterol levels.

To your health!

Joy

Copyright ©2017 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


you can follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/


References

Global Burden of Disease (GBD) 2015 Obesity Collaborators, Health Effects of Overweight and Obesity in 195 Countries over 25 Years, N Engl J Med, DOI: 10.1056/NEJMoa1614362

Gregg EW, Shaw JE, Global Health Effects of Overweight and Obesity, N Engl J Med, doi: 10.1056/NEJMe1706095

Karter AJ, Schillinger D, Adams AS, et al. Elevated rates of diabetes in Pacific Islanders and Asian subgroups: the Diabetes Study of Northern California (DISTANCE). Diabetes Care 2013; 36:574-9

A Dietitian’s Journey – 3 month update

Today marks 3 months since I started my own weight-loss and getting-healthy journey and so I’m posting this short update.

While I’ve only lost 7 pounds, I’ve lost a remarkable 4 inches off my waist, which is greatly encouraging, as I still have another 6 inches to lose (based on my height-to-waist ratio). I know without a doubt that this is entirely ‘doable’!

I look in the mirror and recognize the person looking back. I recently bought new jeans that are a full size smaller and when the weather has been hot, I’ve not only worn shorts, but I’ve wore them out of the house.

My blood pressure is very stable and now fluctuates between stage 1 hypertension and pre-hypertension; a dramatic improvement from the wildly erratic fluctuations between stage 2 and stage 1 hypertension, with a hypertensive emergency thrown in for excitement. It was that crazy high blood pressure which started me on this journey, but what keeps me on it, is how I feel. I feel great!

My blood sugar has been great after meals, but recently has become quite a bit higher several hours after eating, even though I have not eaten or drunk anything except water. From the reading I’ve been doing in the literature, this has been reported in those who previously had what is called “dawn syndrome” (high morning fasting blood glucose – which I had) after they’ve adopted a low carb high fat diet.  It seems that the second of the two stages of insulin release is suppressed in those such as myself,  causing blood glucose to remain higher for a longer period of time. One way of addressing this is via exercise, so it seems I will be doing this more than once in a while to manage this.

This morning it was gorgeous out; clear sky, cool temperatures and the track was beckoning me, and so I went. I haven’t worked out more than 2 or 3 times a month since I began my journey, but despite that, I noticed a huge improvement in my fitness level today. I can only attribute that to the loss of fat around my middle. I did an extra two rounds on the track at a pretty decent clip, with a total distance of 3.2 km (2 miles). I could have done another round (maybe two) but thought I might be too stiff tomorrow, and since my goal is to do this more often to address my second stage insulin suppression, I decided to ‘call it a day’ after 3 km. As I was leaving the track, I decided to take a short video to post along with this 3-month update. Have a look at the video which is posted below, and compare it with the one from 3 months ago (http://tinyurl.com/yb3unuff). My progress is evident.

Want to know how I can help you accomplish your own health and fitness goals?

Please send me a note using the “Contact Us” form above and I’ll be happy to reply.

To our good health!

Joy

Note: I am a "sample-set of 1" - meaning that my results may or may not be like any others who follow a similar lifestyle. If you are considering eating "low carb" and are taking medication to control your blood sugar or blood pressure, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.