Are Low Carbohydrate Diets Safe and Effective

INTRODUCTION: In a recent article, I established that low carbohydrate diets are not new and that recently published six-month results of a non-randomized, parallel arm, outpatient intervention demonstrated it was so effective at improving blood sugar control in Type 2 Diabetes, that at the end of six months >75% of people had HbA1c that was no longer in the Diabetic range (6.5%).

But what about the long term safety and effectiveness of low carb diets?

To date, there have been 3 long-term clinical trials (2 years) published over the past 10 years that included a low-carbohydrate treatment group and in this series of three articles, I will look at the methodology and findings of each.

Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

The first study published in 2008, with research conducted between July 2005 and June 2007 was a 2-year Dietary Intervention Randomized Controlled Trial (DIRECT) to compare the effectiveness and safety of (1) a low-fat calorie-restricted diet, (2) a Mediterranean calorie-restricted diet and (3) a low-carbohydrate non–calorie-restricted diet.

The criteria for recruitment to the study was age between 40 and 65 years and a body-mass index (BMI) – which is the weight in kilograms divided by the square of the height in meters of at least 27, or the presence of Type 2 Diabetes (according to the American Diabetes Association criteria) or coronary heart disease regardless of age and BMI.

Subjects were randomly assigned within strata i.e. gender, age (below or above the median), BMI (below or above the median), history of coronary heart disease (yes or no), history of Type 2 Diabetes (yes or no), and current use of statins (none, <1 year, or ≥1 year).

Subjects in each of the 3 diet groups were assigned to subgroups of ~18 participants (total of 6 subgroups in each group) and each diet group was assigned a Registered Dietitian that met with their groups in weeks 1, 3, 5, and 7 and after that at 6-week intervals, for a total of 18 sessions of 90 minutes each.

Low Fat Diet– Participants were counseled to consume low-fat grains, vegetables, fruits, and legumes and to limit added fats, sweets, and high-fat snacks. For the low-fat, restricted-calorie diet they were instructed to consume up to 30% of calories from fat, 10% from saturated fat and up to 300 mg cholesterol/day, with 1500 kcal for women and 1800 kcal/day for men.

Mediterranean Diet– The moderate-fat, calorie-restricted diet is rich in vegetables and low in meat, with poultry and fish replacing beef and lamb. Subjects were instructed to consume 35% of calories from fat; the main sources of added fat were from 30-45 grams of olive oil and a handful of nuts (5-7, less than 20 grams) per day. Subjects were instructed to restrict energy to 1500 kcal for women and 1800 kcal/day for men.

Low Carbohydrate Diet– This low-carb, non-calorie restricted diet was modeled after the Dr. Atkins Diet and aimed to provide 20 g/day of carbohydrates during the induction phase (first 2 months), and returned to this level of carb restriction after each religious holiday. At other times participants were instructed to increase carbs gradually up to maximum of 120 g/day to maintain the weight loss. Total calories, protein and fat intake from any source (except trans fats) were not limited.

Adherence to the diets was evaluated by a validated food-frequency questionnaire (127 food items with portion-size pictures) at baseline and at 6, 12, and 24 months of follow-up, and the questionnaires were self-administered electronically. A validated questionnaire was also used to assess physical activity.

Weight – The participants were weighed without shoes to the nearest 0.1 kg every month.

Blood Samples – Blood samples were obtained by at 8 a.m. after a 12-hour fast at baseline and at 6, 12, and 24 months.

Results – Dietary Intake, Energy Expenditure, and Urinary Ketones

At baseline, there were no significant differences in the composition of the diets consumed by participants assigned to the low-fat, Mediterranean, and low-carbohydrate diets.

Daily energy intake as assessed by the food-frequency questionnaire, decreased significantly at 6, 12, and 24 months in all diet groups as compared with baseline and there were no significant differences among the groups in the amount of decrease.

The low-carbohydrate group had a lower intake of carbohydrates and higher intakes of protein, total fat, saturated fat, and total cholesterol  than the other groups.

The Mediterranean-diet group had a higher ratio of monounsaturated to saturated fat than the other groups, and a higher intake of dietary fiber than the low-carbohydrate group.

The low-fat group had a lower intake of saturated fat than the low-carbohydrate group.

Physical Activity – The amount of physical activity increased significantly from baseline in all groups, with no significant difference among groups in the amount of increase.

Urinary Ketone Production – The proportion of participants with detectable urinary ketones at 24 months was higher in the low-carbohydrate group (8.3%) than in the low-fat group (4.8%) or the Mediterranean-diet group (2.8%).

Note: of interest, participants in all groups produce urinary ketones.

Weight Loss

A phase of maximum weight loss occurred from 1 to 6 months and a maintenance phase from 7 to 24 months.

All groups lost weight, but the reductions were greater in the low-carbohydrate and the Mediterranean-diet groups than in the low-fat group.

The overall weight changes among the 322 participants at 24 months were −4.7 (10.3 lbs) ±6.5 kg (± 14.3 lbs) for the low-carbohydrate group, −4.4 (9.68 lbs) ±6.0 kg (± 13.2 lbs) for the Mediterranean-diet group and
−2.9 (6.38 lbs) ±4.2 kg (± 9.24 lbs) for the low-fat group.

Lipid Profiles

Changes in lipid profiles during the weight-loss and maintenance phases are as followed;

HDL cholesterol increased during the weight-loss and maintenance phases in all groups, with the greatest increase in the low-carbohydrate group (0.22 mmol per liter (8.4 mg per deciliter) compared to the low-fat group which increased by 0.16 mmol per liter (6.3 mg per deciliter).

Triglyceride levels decreased significantly in the low-carbohydrate group 0.27 mmol per liter (23.7 mg per deciliter) as compared with the low-fat group 0.03 mmol per liter (2.7 mg per deciliter).

Of significance, LDL cholesterol levels did not change significantly within any of the groups, and there were no significant differences between the groups in the amount of change.

Overall, the ratio of total cholesterol to HDL cholesterol decreased during both the weight-loss and the maintenance phases. The low-carbohydrate group had the greatest improvement, with a relative decrease of 20% as compared with a decrease of 12% in the low-fat group.

High-Sensitivity C-Reactive Protein, High-Molecular-Weight Adiponectin, and Leptin

The level of high-sensitivity C-reactive protein (an assessor of inflammation often used to may be used to evaluate risk of cardiovascular disease.) decreased significantly in the low-carbohydrate group (29%), and also in the Mediterranean-diet group (21%) during both the weight-loss and the maintenance phases, with no significant differences among the groups in the amount of decrease.

The level of high-molecular-weight adiponectin (which regulates glucose levels, as well as fatty acid breakdown) increased significantly in all diet groups, with no significant differences among the groups in the amount of increase.

Circulating leptin, which reflects body-fat mass, decreased significantly in all diet groups, with no significant differences among the groups in the amount of decrease.

Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin

Fasting Blood Glucose

Among the 36 participants with Type 2 Diabetes, those in the Mediterranean diet group and low carb diet group had a decrease in fasting plasma glucose levels of 2.1 mmol/L (32.8 mg per deciliter) and 0.1 mmol/L (1.2 mg/dl) respectively, whereas those in the low-fat group had an increase 0.7 mmol/L (12.1 mg/dl).

There was no significant change in fasting plasma glucose level among the participants without Type 2 Diabetes.

Fasting Insulin 

Insulin levels decreased significantly in participants with Type 2 Diabetes and without Type 2 Diabetes in all diet groups, with no significant differences among groups in the amount of decrease.

HOMA-IR

Not surprisingly, since HOMA-IR is determined from fasting blood glucose and fasting insulin, among subjects with Type 2 Diabetes the decrease in HOMA-IR at 24 months was significantly greater in those assigned to the Mediterranean diet (-2.3) and low carbohydrate diet (-1.0) than in those assigned to the low-fat diet (-0.3).

Glycated Hemoglobin (HbA1C)

Among the participants with with Type 2 Diabetes HbA1C at 24 months decreased most noticeably in the low-carbohydrate group (0.9 ±0.8%), and moderately in the Mediterranean-diet group (0.5 ±1.1%) and low-fat group (0.4 ±1.3%). The changes were significant only in the low-carbohydrate group.

Changes in Biomarkers According to Diet Group and Presence or Absence of Type 2 Diabetes (figure 4, from publication)
DISCUSSION

In this 2-year dietary-intervention study, the low-carbohydrate diets was found to be both an effective and safe alternative to the low-fat diet for weight loss.

In addition to producing weight loss in moderately obese subjects, the low-carbohydrate demonstrated some marked beneficial metabolic effects including;

  • lower fasting plasma glucose: 0.1 mmol/L (1.2 mg/dl)
  • lower HbA1C: -0.9 ±0.8%
  • significantly lower triglycerides: -0.27 mmol per liter (23.7 mg per deciliter)
  • significantly higher HDL: +0.22 mmol per liter (8.4 mg per deciliter)
  • lower C-reactive protein: -29%

These results suggest that a low carbohydrate, non-calorie restricted diet that provides 20 g of carbs per day during the induction phase of 2 months, with slightly higher amounts of carbohydrates with the addition of nuts, low-carb vegetables and small amounts of fruit until goal weight is achieved (~30-50 g carbs) is both safe and effective over a two-year period.

References

Astrup A et al, Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008 Nov 13;359(20):2169-70.

free pdf available here: www.nejm.org/doi/full/10.1056/nejmoa0708681

Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

If you are taking medication to lower blood sugar or blood pressure, you should be monitored by your physician while following a low carb diet, as medication dosages will need to be adjusted - often soon after beginning.

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.

Evidence for Remission of Type 2 Diabetes Symptoms using LCHF

INTRODUCTION: A low carbohydrate, high fat diet is not new, in fact eating this way was the standard recommendation for treating Diabetes prior to the discovery of insulin.

More than 150 years ago, the first weight-loss diet book, written by William Banting, ironically a distant relative of Sir Frederick Banting, the co-discoverer of insulin focused on the limiting the intake of carbohydrates, especially those of a starchy or sugary nature. The book was titled Letter on Corpulence – Addressed to the Public (1864) and summarized the advice of the author’s physician, Dr. William Harvey that had enabled Banting to shed his ‘portly stature’.

In clinical practice, a ketogenic diet (very low carbohydrate, high fat, adequate protein) was successfully used in the Mayo Clinic nearly 100 years ago by Dr. R. Wilder as a treatment for epilepsy and continues to be used at Johns Hopkins University and other centers for this purpose.

In 1963, Dr. Robert Atkins in his own search for a weight loss plan came across an article in the Journal of the American Medical Association titled A New Concept in the Treatment of Obesity [1].  After he successfully lost weight by following its recommendations, he decided to enroll 20 overweight business executives in a 20 week trial. All lost weight and follow up records indicated that they continued to keep it off for at least a year. After establishing his medical practice in New York City, Dr. Atkins made some adjustments to the plan and incorporated it into his practice, helping his own patients successfully lose weight. In 1972, Atkins published his book Diet Revolution which was immediately successful but very controversial. Criticism of Atkins and his diet continues to this day.


Anecdotal evidence which relies on personal testimony is fine as encouragement (hence my blog A Dietitian’s Journey) and the clinical experience of physicians such as Dr. Jason Fung, a nephrologist from Toronto is excellent, but clinical use of a low carbohydrate diet to target the reversal of symptoms of Type 2 Diabetes requires scientific studies.

Enter Phinney and Volek.

Stephen Phinney, MD, PhD is a medical doctor and scientist with 40 years experience and is Professor of Medicine Emeritus at University of California, Davis. Dr. Phinney is an internationally recognized expert on obesity, carbohydrate-restricted diets, diet and performance and essential fatty acid metabolism and has held clinical faculty appointments at MIT, the Universities of Vermont, Minnesota and California at Davis. He has designed, conducted and published data from more than 20 clinical protocols involving diets, exercise, oxidative stress and inflammation and his design of clinical nutrition trials has led to more than 87 peer-reviewed papers and book chapters on clinical nutrition and biochemistry.

Jeff Volek, PhD, RD is a Registered Dietitian with a Doctorate degree and is professor in the Department of Human Sciences at The Ohio State University. Dr. Volek’s work has contributed to the existing science of ketones and ketogenic diets, their use as a therapeutic tool to manage insulin resistance. For the past 20 years, Dr. Volek has researched how humans adapt to diets restricted in carbohydrates, with a focus on both the clinical and performance application of nutritional ketosis. He has published more than 300 peer-reviewed scientific manuscripts and five books.

The Art and Science of Low Carbohydrate Living

In 2011, Phinney and Volek published their fully referenced expert guide titled The Art and Science of Low Carbohydrate Living documenting the clinical benefits of carbohydrate restriction and its practicality as both a sustainable and enjoyable lifestyle. While primarily a book directed towards healthcare professionals and those with a science background, it provides ample scientific evidence behind the use of a low carbohydrate diet to target the reversal of symptoms of Type 2 Diabetes.

In the January-June issue of JMIR Diabetes, Phinney and Volek along with a host of other physicians, Registered Dietitians and nurses published initial 10 week results of a nonrandomized, parallel arm, outpatient intervention using a very low carb diet which induced nutritional ketosis*. Each participant was provided with intensive nutrition and behavioral counseling, digital coaching and education platform and physician-guided medication management.

Nutritional ketosis was defined as a dietary regimen resulting in serum ketone levels of β-hydroxybutyrate between 0.5 and 3.0 mmol·L−1

There were 238 participants in the intervention, all participants had a diagnosis of Type 2 Diabetes (T2D), mean age was 54 years old (with participants ranging in age from 46 – 62 years). The majority were women 67% with 33% menAverage weight was 257 pounds (117 kg) with participants ranging from 200 pounds to 314 pounds (117±26 kg). Average Body Mass Index (BMI) was 41 kg·m-2 (class III obesity) ±9 kg·m-2. Average HbA1c was 7.6% ±1.5%. The majority of participants (89%) were taking at least 1 glycemic control medication.

Each participant received an Individualized Meal Plan for nutritional ketosis, behavioral and social support, biomarker tracking tools, and ongoing care from a health coach with medication management by a physician.

Subjects typically required <30 g·day−1 total dietary carbohydrates. Daily protein intake was targeted to a level of 1.5 g·kg−1 based on ideal body weight and participants were coached to incorporate dietary fats until they were no longer hungry. Other aspects of the diet were individually tailored to ensure safety, effectiveness and satisfaction, including consumption of 3-5 servings of non-starchy vegetables and enough mineral and fluid intake. The blood ketone level of β-hydroxybutyrate was monitored, using a portable, handheld device.

Ten Week Outcomes

Medication Use

At baseline, 89% of participants were taking at least one medication for Diabetes.

At 10 weeks almost 57% had one or more Diabetes medications reduced or eliminated.

64% of insulin, sulfonylurea, SGLT-2 inhibitor, DPP-4 inhibitor and thiazolidinedione prescriptions were eliminated in 10 weeks.

Glycosylated Hemoglobin (HbA1C)

At baseline, the average HbA1c level was 7.6% ±1.5%, with less than 20% having a HbA1c level of <6.5% (with medication usage).

After 10 weeks, HbA1c level was reduced by 1.0% and the percentage of individuals with an HbA1c level of <6.5% increased to more than 56%.

Note: 48% achieved this level while taking only Metformin (n=86) or no Diabetes medications (n=39). That is, >15% achieved this level by diet alone.

Weight Loss

Mean body mass reduction was 7.2% from a baseline average of 117 kg (257.4 pounds) ±26 kg / 57 lbs.


Six month outcomes

After 6 months, 89% of participants were still enrolled in the study. Results indicate that nutritional ketosis was quite effective in improving blood sugar control and weight loss in adults with Type 2 Diabetes, while significantly decreasing medication use.

Glycosylated hemoglobin (HbA1C)

At 6 months, HbA1C was reduced to 6.1% ±0.7% from 7.5% ±1.3% in a sample of 108 participants who elected to test HbA1c at 6 months.

Twenty-two of the 108 started with a HbA1c <6.5%, and at 6 months, 76% reduced their HbA1c below the threshold for diabetes diagnosis (6.5%).

Weight Loss

Patients lost 11.5% (±8.8%) of their body weight with 81% having attained a clinically significant weight loss (more than 5% of their body weight).

Medication Reduction

Most medication eliminations were maintained through 6 months along with reduced HbA1c and weight.

 

 

Participants also experienced a 20% reduction in triglycerides with an average value at follow-up in the healthy range below 1.69 mmol/L (150 mg/dL) [3].

Discussion

Improvements in blood sugar control in adults with Type 2 Diabetes (T2D) have been associated with weight loss of greater than 5% [4], which is why a weight loss component is part of many treatment plans.

As noted by the researchers, it is often assumed that it is the weight loss that leads to the improvements in blood sugar control, but it is possible that improvements in blood sugar control occur simultaneously with- or before significant weight loss is achieved.

In their 10-week outcomes, weight and HbA1c reduction seemed to occur simultaneously, but the researchers noted that there were significant reductions in HbA1c occurring even before the full life cycle of red blood cells (approximately 100 days), in which HbA1C is measured.

The researchers referred to other research which demonstrated that improvements in blood sugar control occur prior to significant weight loss [5]. In that study, patients with Type 2 Diabetes who consumed a very low carbohydrate (ketogenic) diet of 21g of carbohydrate per day had significantly improved insulin sensitivity concurrent with significantly lower plasma glucose and HbA1c, but had only a 5 lb (2kg) weight loss after two weeks ( 1.8%) [5]. This suggests that it is not only the weight loss that was resulting in better insulin sensitivity.

The researchers also referred to other studies which reported that early improvement in blood sugar control is also highlighted by how quickly insulin and some oral anti-diabetic medications must be reduced or eliminated when a very low carbohydrate diet is begun, with most reductions and eliminations occurring in the first 3 weeks [5,6] when there is only a modest reduction in weight.

The researchers noted;

this suggests that weight loss may not be the driver of improved blood sugar control, but may be a positive side effect that is achieved concurrently with a well-formulated, very low carbohydrate diet.”

Medical Involvement

People with Type 2 Diabetes who take medication to lower blood sugar require the involvement of their physician as they follow a low carb- or ketogenic diet, as an adjustment in medication is often needed soon after beginning, due to blood sugar levels coming down. I would consider it prudent that regular daily glucose monitoring take place for (a) fasting blood sugar, at least once (b) just before a meal, and at least once (c) 2 hrs after a meal and again (d) at bedtime.

For those taking medication to lower blood pressure, the involvement of one’s physician is also needed, as blood pressure often drops with– or soon after blood sugar levels come down. The doctor may need to adjust medication dosages several times before attempting to trial eliminating them.

If you are taking medications to lower blood sugar or blood pressure, please speak to your doctor before beginning to eat low carb.

For those with Type 2 Diabetes but not taking any medication to lower blood sugarregular daily glucose monitoring is still necessary, with (a) daily fasting blood sugar and (b) at bedtime and a few times per week (c) just before a meal, and (d) 2 hrs after a meal. This is to be sure that blood sugar levels do not drop too low.

For those whose clinical condition requires use of a very low carbohydrate diet / use of nutritional ketosis, monitoring of ketone levels using urine sticks at first and then blood levels of β-hydroxybutyrate occurs is highly recommended to make sure that steady levels are maintained.

Note: It is not recommended for people with any health or medical conditions to seek to achieve the levels of nutritional ketosis described in the above study, with levels of β-hydroxybutyrate between 0.5 and 3.0 mmol·L−1 without regular medical supervision.

Some final thoughts…

As demonstrated by this intervention study, it is entirely possible for the symptoms of Type 2 Diabetes to go into remission by following a low-carbohydrate lifestyle. After 6 months, >75% of people had HbA1c that was no longer in the Diabetic range (6.5%). This does not mean, however that their Diabetes was “cured”. If those people revert back to eating a high carb intake, they will experience the return of high blood sugar, blood pressure and abnormal lipid profile.

For those wanting to manage and aim to achieve remission of Type 2 Diabetes symptoms, I recommend that people first speak with their doctor about following a low carbohydrate diet with the support of an Registered Dietitian who is experienced using a wide range of low carb diets.

Have questions?

Why not send me a note using the Contact Me form located on the tab above?

References

1. Gordon ES, Goldberg M, Chosy GJ. A New Concept in the Treatment of Obesity, JAMA. 1963;186(1):50–60. doi:10.1001/jama.1963.63710010013014

2. Volek JS, Phinney SD, The Art and Science of Low Carbohydrate Living: An Expert Guide, Beyond Obesity, 2011

3. McKenzie AL, Hallberg SJ, Creighton BC, Volk BM, Link TM, Abner MK, Glon RM, McCarter JP, Volek JS, Phinney SD
A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes, JMIR Diabetes 2017;2(1):e5
URL: http://diabetes.jmir.org/2017/1/e5
DOI: 10.2196/diabetes.6981

4. Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ. Lifestyle Weight-Loss Intervention Outcomes in Overweight and Obese Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Journal of the Academy of Nutrition and Dietetics. 2015;115(9). doi:10.1016/

5. Boden G, Sargrad K, Homko C, Mozzoli M, Stein PT. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. 2005;142(6): 403-411.

6. Bistrian BR, Blackburn GL, Flatt JP, Sizer J, Scrimshaw NS, Sherman M. Nitrogen metabolism and insulin requirements in obese diabetic adults on a protein-sparing modified fast. 1976;25(6):494-504.

Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, 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.

 

What Regulates Body Weight?

Body weight is not under our control as much as we’d like to believe, but is a tightly regulated process that involves a variety hormones with some of the major ones being leptin (a hormone that regulates fat stores by  inhibiting hunger), ghrelin (a hormone that increase hunger when your stomach is empty) and insulin, which plays a very significant role in hunger, eating behavior and fat managementInsulin is one of the major controllers of the body’s “set point”.

What is “set point“?

Think of set point like the thermostat in your house; when the air gets too cold, the thermostat is engaged, and the furnace comes on and when the air gets a little too hot, the thermostat shuts the furnace off. Your body’s set point is maintained by a complex set of hormonal mechanisms that works to maintain your body at its current weight.  If you eat a lot more one day because it’s a special occasion, the next day you won’t feel as hungry as usual, and will eat less. When someone who normally eats a carbohydrate-based diet restricts calories, their body slows its metabolism and lowers the amount of energy (calories) it uses for vital bodily functions in order to ‘save’ the limited calories for use by their brain. In fact, the amount of energy used by your body at rest (called Basal Energy Expenditure) can decrease by as much as 30-50% in order to save those calories!

This saving of calories for essential functions is why when people who are used to eating carbs ‘fast’ or limit the number of calories they eat, they feel cold, tired and find it hard to focus.  This is the body ‘saving’ the few calories for essential body functions, such as for their brain and organs. This doesn’t happen to someone who is fat-adapted, because they use their own fat stores to maintain blood and brain glucose, and for other energy needs.

Equally part of maintaining the body’s set point, when an overweight person takes in too many calories, their body will try to get rid of them by increasing its Basal Energy Expenditure and speeding up breathing rate (respiration), increasing heart rate and generating more body heat.

So, whether we are overweight or underweight, the body will adjust its processes to maintain its ‘set point’.

This is why the so-called calorie in, calorie out model, doesn’t work – because it is not simply a matter of “eating less and moving more“. When people who are carb-dependent restrict their calories, their metabolism slows and so they burn way less calories!

Calories in and calories out are not independent of each other but inter-dependent on each other; when one is lowered (calories in), so is the other (calories out, metabolism).  When one is increased (calories in), so is the other (calories out, respiration, heat generation).

It’s really not as simple as “eating less and moving more” to lose weight, because when we both restrict calories and increase our exercise, our body responds by increasing hungerincreasing craving (especially for foods such as simple carbs that can be broken down quickly for glucose for your blood) and by decreasing the amount of energy it uses. Using the thermostat analogy, our body turns the thermostat down.

Wouldn’t you think that if it were really as simple as “eating less and moving more” that more people would be slim!

Restricting calories doesn’t work for long term weight loss because the body compensates by lowering its energy expenditure. It’s not about how many calories we take in, but about what changes ‘set point’.

It’s mainly about insulin. We have to reduce insulin.

Low-carbohydrate diets and increasing the amount of time between meals (called “intermittent fasting”) are two ways to lower insulin.

Lowering insulin, will in turn will lower blood sugar and when this lifestyle is maintained, over time, it has even shown by researchers to be able to reverse the symptoms of Diabetes. That doesn’t mean people aren’t Diabetic anymore – they are but the symptoms of Diabetes, namely high blood sugar (reflected in high fasting blood glucose and HbA1C) are in remission. Other added benefits include a lowering of blood pressure (which is closely tied to insulin), gradual, sustainable weight loss and a normalizing of triglycerides as well as some cholesterol markers.

When people are ‘fat-adapted‘, they have a ready supply of fuel for their bodies (their own fat stores!), and so their metabolism doesn’t slow down when they eat this way. Their bodies continue to burn calories at the usual rate!

Furthermore, they aren’t cold, tired and hungry because they have excess fat stores to serve as a constant supply of fuel for their brain, blood and muscles. Fat is broken down for ketone bodies which can be used for most body processes, and the essential glucose needed by our blood and brain is easily synthesized by the breaking down of fats. 

Want to know more about how I can help you?

Why not send me a note using the Contact Us form above and I will reply shortly.

To our good health!

Joy


Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, 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.

A Dietitian’s Journey – before and since

INTRO: “Before” and “after” photos are often the source of encouragement, as I progress on my journey.  This “before and since” photo serves as some Monday-morning motivation.

Yesterday, after ten days on crutches and a brace due to a torn MCL tendon, I had finally progressed to a cane and just had to get out for a bit.  With a break in the rain, one of my sons and I headed for Indian Arm, an ocean inset nearby. It was mild and humid and I really didn’t want to wear a long sleeve jacket, so I reached for a down-filled vest that I bought a number of years ago that never zipped or snapped up, and headed out.  When we arrived, there was a breeze off the salt water and instinctively, I zipped up the vest and snapped the outer snaps. Only in hindsight did I realize this was the first time I ever did that – and with a little room to spare.

We walked (actually, I hobbled on my cane) along the coast path and down to the pier and took in the fresh air and beautiful view. As we were leaving, I remembered the photo that was taken of me 2 1/2 years ago on the same pier, around the time I first learned about eating low carb high fat (LCHF) and asked my son to snap a photo of me on my phone, so I could compare them. In both photos, I was dressed in comfortable clothes, with no makeup and my hair however it was.

When we returned home, I dug out the old photo and here they are, side by side.  Even with my puffy down-filled vest and knee brace, the difference is noticeable, even though it has only been 6 months that I have been “practicing what I preach” and eating low carb, myself. Since I am very much ‘in progress’ with my weight loss and achieving my health goals, I refer to this as before and since rather than before and after.

Me – summer 2015 (left), me fall 2017 (right)

It will be interesting to take an updated photo this time next year to see the progress.

Encouragement in our health journeys come in many forms; a number on the scale, new lab results, readings on a glucometer, or photos over time.

Today I celebrate this mid-point progress in this Dietitian’s Journey and I encourage you to celebrate yours!

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.

American Diabetes Association Approves Low Carb Diets for Weight Loss

In December 2008, the American Diabetes Association (ADA) issued its Clinical Practice Recommendations which included the option for Diabetics to follow low-carbohydrate diets as a weight-loss option. While this is obviously not ‘news’, it is important to note that the Canadian Diabetes Association – now called Diabetes Canada, does not as yet make the same recommendation.

Why is that?

Is there something inherently different about Diabetics in Canada than Diabetics in the United States?

For the last 9 years the American Diabetes Association has given people the option of following what they call a “moderate carbohydrate diet by (a) omitting some of the carb-containing foods on their standard meal plan or (b) substituting them for much lower carb alternatives. They also (c) provide Americans with the option of following a low carb diet for weight loss.

Let’s take a look at the American dietary recommendations compared with the Canadian ones.

Dietary Recommendations of the American Diabetes Association

On their web page, the American Diabetes Association states that their standard Meal Plans that are “moderate” in carbohydrates provide  ~45% of calories from carbs, but they add;

Your healthcare provider may ask you to limit carbohydrate  more than our meal plan suggests. This means you should cut back on the carbohydrate foods that you eat throughout the day. To keep your calorie intake about the same, substitute sources of lean protein or healthy fats for those higher carbohydrate foods.

Then they give some examples of how people can lower carbohydrate intake by making some adjustments to the posted meal plan, such as;

  • omitting the slice of whole wheat toast at breakfast
  • replacing the whole wheat wrap for a lettuce wrap at lunch
  • skipping the serving of brown rice at dinner and adding another non-starchy vegetable instead.

For the last 9 years (2008), Diabetics in the US have also been given the option by the American Diabetes Association to follow a low carb diet in order to lose weight. The 2008 Summary of Revisions for the Clinical Practice Recommendations was changed to include the following;

The “Medical Nutrition Therapy” section has been revised; updates to this section include the following revised recommendations for weight loss:

For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short-term (up to 1 year).

For patients on low-carbohydrate diets, monitor lipid profiles, renal function and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed.

What the last sentence means is that doctors should monitor the  cholesterol and triglyceride levels of their patients on low-carb diets and adjust the dosage of the medication prescribed to control blood sugar levels. 

As has been the experience of physicians that prescribe a low carb high fat diet to their patients, as blood sugar levels drop – they need to reduce their patient’s medications dosages and in time, these medications are often discontinued entirely.

What are the dietary recommendations given to Diabetics in Canada?

Dietary Recommendations of Diabetes Canada

Diabetes Canada basic meal planning information advises people to;

“Choose starchy foods such as whole grain breads and cereals, rice, noodles, or potatoes at every meal. Starchy foods are broken down into glucose, which your body needs for energy.”

The sample meal plan for small appetites on the Diabetes Canada website recommends that people consume 193 g of carbohydrates per day which is approximately 13 servings* of carb-containing food per day (based on the Diabetic exchanges, where 1 serving is 15 g of carbohydrate).

Diabetic Sample Meal Plan (for small appetites) from Diabetes Canada

The Diabetic Sample Meal Plan for larger appetites is the same as above, but also includes an afternoon snack with a medium apple or small banana (+ 25 g carbohydrates), plus a medium pear at supper (+29 g carbohydrates) and another glass of milk with the above evening snack (+12 g carbohydrates), amounting to 259 g of carbohydrates per day, which is almost 17 servings* of carb containing foods.

Diabetics in Canada are advised to eat 45 – 60 g of carbs at each of 3 meals, plus 15 – 30 grams of carbs at each of 1-2 snacks

This is a lot of carbohydrate for someone whose body isn’t handling carbohydrates well.

The Diabetes Canada webpage, under Healthy Living Resources, there is a section titled Diet and Nutrition.  Under this are the organizations recommendations concerning Carbohydrates. They encourage carbohydrate counting which “focuses on foods that contain carbohydrate as these raise your blood glucose (sugar) the most.

They encourage Canadian Diabetics to “follow these steps to count carbohydrates and help manage your blood glucose levels“.

What are those steps?

  • Step 1: Make healthy food choices
  • Step 2: Focus on carbohydrate
  • Step 3: Set carbohydrate goals
  • Step 4: Determine carbohydrate content
  • Step 5: Monitor effect on blood glucose level

Diabetes Canada recommends that Diabetics eat ~ 1/2 of their calories as carbohydrate while at the same time advising people that “foods that contain carbohydrate … raise your blood glucose (sugar) the most”. 

So, when Diabetics eat the large percentage of their diet as carbs and their blood sugar is raised, what should they do?

Well, the Diabetes Canada webpage goes onto explain under Step 5 that they should “monitor the effect (of carbohydrates) on blood glucose level and

Work with your healthcare team to correct blood glucose levels  that are too high or too low.

I had to read this several times to make sure I wasn’t misreading it.

Diabetics in Canada are being told;

  1. carbs raise their blood sugar the most
  2. that they are to take in ~1/2 of their calories as carbs
  3. when their blood sugars get too high, they need to have their medication adjusted to handle the load.

Could this be why Diabetes is said to be “a chronic, progressive disease”?

Change in the American Diabetes Association Postion

In 2007, a year before the revised recommendations came out approving either a low-carb diet or a low calorie restricted diet, the American Diabetes Association recommendations stated that ‘low carb diets were not recommended for the treatment of overweight or obesity—even in the short term, because their long-term effects were unknown and they did not seem to provide better maintenance of weight loss than low-fat diets over the long term’.

However, in a press release with the release of the 2008 recommendations the American Diabetes Association reversed its position saying;

“there is now evidence that the most important determinant of weight loss is not the composition of the diet, but whether the person can stick with it, and that some individuals are more likely to adhere to a low carbohydrate diet while others may find a low fat calorie-restricted diet easier to follow.”

Furthermore, in the same press release, the American Diabetes Association President of Health Care & Education at the time, Registered Dietitian Ann Albright, PhD, RD, said;

“We’re not endorsing either of these weight-loss plans over any other method of losing weight.”

Albright added that it was ‘more important that people with Diabetes choose a weight-loss plan that works for them and that their healthcare team supports their efforts and monitors their health accordingly‘.

Canadian Recommendations

The Canadian Clinical Practice Guidelines recommends that people with Diabetes receive nutrition counselling from a Registered Dietitian. They recommend that those who are overweight or obese reduce caloric intake to achieve and maintain a healthier body weight and state that it is consistency in carbohydrate intake and in spacing and eating regular meals that may help control blood glucose levels and weight.

From the 2017 Guidelines:

People with diabetes should receive nutrition counselling by a registered dietitian.

Reduced caloric intake to achieve and maintain a healthier body weight should be a treatment goal for people with diabetes who are overweight or obese.

The macronutrient distribution is flexible within recommended ranges and will depend on individual treatment goals and preferences.

Replacing high glycemic index carbohydrates with low glycemic index carbohydrates in mixed meals has a clinically significant benefit for glycemic control in people with type 1 and type 2 diabetes.

Intensive lifestyle interventions in people with type 2 diabetes can produce improvements in weight management, fitness, glycemic control and cardiovascular risk factors.

A variety of dietary patterns and specific foods have been shown to be of benefit in people with type 2 diabetes.

Consistency in carbohydrate intake and in spacing and regularity in meal consumption may help control blood glucose and weight.

Final Thoughts…

Why are Diabetics in the US recommended to lose weight by following  either a low-carb diet or a low calorie restricted diet, yet Diabetics in Canada are recommended to eat 13-17 servings of carb-containing foods per day, with 45 – 60 g of carbs at each of 3 meals, plus 15 – 30 grams of carbs at each of 1-2 snacks? That’s a good question.

Many physicians report that Diabetics following LCHF diets have their medications reduced and in many cases discontinued entirely. As a Dietitian this seems preferable as a first approach, than recommending that Diabetics eat half of their calories as carbs, which would necessitate having their medication adjusted upwards when their blood sugars get too high, and having people’s Diabetes continue to worsen in time.

Why should Canadians with Diabetes not be provided with choice?


Copyright ©2017 BetterByDesign Nutrition Ltd.  

All illustrations and text content contained on this web page are the intellectual property of The Low Carb High Fat 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.


References

American Diabetes Association, Adjusting the Meal Plan, http://www.diabetes.org/mfa-recipes/2017-07-adjusting-the-meal-plan.html

Dairman T., Diabetes Self-Management, ADA’s New Guidelines OK Low-Carb Diets for Weight Loss, 2008 Jan 7,  www.diabetesselfmanagement.com/blog/adas-new-guidelines-ok-low-carb-diets-for-weight-loss/

Dworatzek PD, Arcudi K, Gougeon R, Husein N, Sievenpiper JL, Williams SL. Nutrition Therapy, Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, http://guidelines.diabetes.ca/browse/chapter11

New York Style Chocolate Cheesecake – less carbs than a slice of bread

Some people think of Dietitians as the healthcare professional that is going to take all the fun out of life. We’re going to advise you to eat carrots, when everyone else is eating cheesecake. That is not how I practice. Even when I taught a higher carb style of eating, I always believed there were “everyday foods” and “sometimes foods” and never believed in forbidding any food (unless serious food allergies were involved). For me it’s always been about how much and how often we eat something.

If you’ve been following my blogs for a while, you know that I don’t believe in eating unlimited amounts of any type of foods or restricting any food groups. Yes, I recommend people eat carbs in vegetables, nuts and seeds, certain dairy and some fruit. Protein is adequate, but not in excess because excess protein will go to the liver and synthesize glucose which would otherwise been made from our fat stores.  I encourage eating a wide range of healthy fat, including that found in the protein sources, as well as monounsaturated fats such as olive oil and avocado oil, as well as using coconut oil to raise the smoke point of those, when heating them to higher temperatures.

But what about sweets? Where do they fit in?

I do think there are times where celebrating a special occasion warrants making something special that contains carbs, fat and protein beyond what we usually eat.  I am not the Grinch of holidays or celebrations!

I encourage people to plan for eating the treats by knowing the  macronutrient content in it (amount of protein, fat and carbs in grams) and subtracting that from their Meal Plan ahead of time.  This rarely necessitates people eating more than they usually do because the foods themselves, if well planned, can take the place of a meal. If it means that someone eats “Pumpkin Pie without the Pie” (crust-less low carb pumpkin custard) instead of supper, so be it!  The net carbs from the pumpkin itself minus the fiber aren’t that high, and the eggs and cream inside the custard filling serve as the protein source for the meal, and the rest is fat.  So? What’s wrong with that?

Tonight is one of those occasions that a special treat was warranted. One of my sons has been wanting New York style cheesecake since he began eating low carb high healthy fat with me, 7 months ago and today I baked him one!  It is creamy and rich with all the mouth-feel one expects from New York Cheesecake from the cream cheese, egg and egg yolks.  It has real Swiss dark chocolate and homemade vanilla extract, made from real vanilla beans soaked in Russian vodka. It has a little hint of sweet, because after all, it is for a special occasion!  Should he choose to (or rather if he were even able to) he could eat the entire 8 1/2″ cheese cake and not exceed his daily 100 g of carbs!  I can assure you, he will try! And who could blame him?

Low Carb New York Style Cheesecake

Ingredients

  • Five 250 g (8 oz) pkgs cream cheese, room temperature
  • 1/2 cup of berry sugar (extra fine castor sugar)
  • 1/4 tsp salt
  • 1/2 tsp sea salt
  • 1/2 tsp real vanilla
  • 5 lg eggs plus two egg yolks, room temperature
  • 100 gm (3.5 oz.) 85% cocoa Swiss dark chocolate, melted in a double boiler

Instructions

Preheat the oven to 500 F.

Prepare an 8 1/2 ” spring-form pan by lining with parchment paper and spraying well with an oil spray.

 

In the bowl of a stand mixer using the flat paddle or by hand, beat the cream cheese until very well blended and add the eggs one at a time, continuing to blend.  Add the egg yolks, then the salt, berry sugar (castor sugar) and real vanilla.

Remove the bowl from the stand mixer and fold in the melted, cooled chocolate.

 

Bake at 500 F for 12 minutes, then lower the heat to 200 F and make for another 45 minutes.

Turn off the heat of the oven and open the door, but leave the cheesecake inside for 30 minutes until partially cooled.

Then move it to a draught-free location to completely cool.

Enjoy!


Based on 1/12 of the cheesecake, the macronutrient content is as follows;

  • Carbohydrates: 12.6 g*
  • Protein: 17 g
  • Fat: 46 g

* a slice of bread has 15 g of carbs

A Dietitian’s Journey – Progress not perfection, 7 months in

It’s been 7 months since I’ve been seriously adhering to a low carb high heathy fat (LCHF) lifestyle, but like anybody else it’s easy for me to get frustrated when I don’t reach goals as quickly as I would like. I have to stop and remind myself that I didn’t become obese and Diabetic overnight and it’s going to take time to reverse these symptoms. These updates help me take stock of my progress, because after all it’s about progress, not perfection.

Joy – class 2 obesity

At my highest weight, my Body Mass Index (BMI) put me well into the Class 2 Obesity category. I felt terrible, looked terrible and was desperately unhealthy.  Losing weight seemed impossible – or if not impossible, too difficult.

 

September 20 2015

This is what I looked like 2 1/2 years ago, when I first heard about following a low carb high healthy fat lifestyle from a retired physician-friend. At this point, I had already lost about 25 pounds by cutting portion sizes and exercising, but my weight was always fluctuating by 10 or 12 pounds and with it, my blood sugar, cholesterol and blood pressure. I was in denial about how very unwell I had become.

The sudden death of two girlfriends my own age was certainly a ‘wake up call’, but it was my blood pressure that had become dangerously high that was the final impetus for me to change. I knew that if I did nothing, I was at very high risk of having a stroke or heart attack. My choice was (1) to go on medication for high blood sugar, high cholesterol and high blood pressure or (b) change the way I ate. It was, as they say, a “no brainer”.

March 5, 2017 was the day I made the decision to change and there has been no looking back.

Change only happens when the pain of staying the same is greater than the pain of changing.

March 16 2017 – the beginning of the journey

This is what I looked like when I started.  Based on my BMI, I was well into the Class I Obesity category.

My blood pressure ranged between Stage 2 Hypertension and Stage 1 Hypertension – dangerously high.

My morning fasting blood sugar was averaging ± 12 mmol/L (216 mg/dl) and my HbA1C was likely ~ 9.5%.

My triglycerides were high and my LDL cholesterol (“bad cholesterol”) was well above what it should have been for someone who was Type 2 Diabetic and had family risk factors.

I was determined to reverse the symptoms of Diabetes, high triglycerides and high blood pressure by changing how I ate.

Progress, not perfection

Blood Glucose

When I began this journey at the beginning of March, my fasting blood glucose was averaging 12 mmol/L . My HbA1C was likely ~9.5%. Four months into eating low carb high fat, my fasting blood sugar was averaging 8.5 mmol/L and my HbA1C was 7.5% – still above the ≤ 7.0% therapeutic target for those with Type 2 Diabetes.

This week, 3 months later, my HbA1C reached the 7.0% therapeutic target for those with Type 2 Diabetes, but that is still not good enough. My goal is to get it at or below 6.0 % – below the Diabetic cutoff range. My challenge remains that my blood sugar is frequently high in the morning  when I am fasted, yet is significantly lower in the late afternoon when I have been intermittent fasting for the same length of time. I continue to suspect that cortisol remains a factor as cortisol production naturally begins to climb around midnight and reaches and is highest level between 6 am to 8 am.  

This higher blood sugar in the morning is something called “Dawn Phenomenon” which I had for a good 5 years before becoming Type 2 Diabetic. When I track my blood sugar from 10 pm until 8 am, it starts going up in the wee hours of the morning and keep rising until 6:30 or 7 am so it’s evident that my fasting blood sugar is rising with the daily fluctuations in cortisol. When I am intermittent fasting for the same amount of time during the day, my fasting blood glucose is always < 5.0 mmol/L and many times less than 4.0 mmol/L – which is usually my signal to eat something. Under the effect of cortisol combined with my liver still being insulin resistant, the glucose has no where to go and just sits in my blood.

I am going to try to get back to incorporating some form of daily activity to lower stress, which kind of fell off the radar and add some short duration, high-strength / high muscle-use exercise such as squats which can help move blood glucose into the muscle.

Blood Pressure

I continue on my low very low dose of Ramipril (Altace) and my blood pressure is averaging 127/74 mmHg. When I stop the meds for a day or two to measure my blood pressure, it is still averaging 145/82 mmHg which is still too high to discontinue the medication, but it is far better than the 160/90 mmHg that it was 3 months ago.

Weight and Body Measurements
LEFT: March 16 2017, RIGHT: October 11 2017

I’ve lost 20 lbs so far but its the change in my body and face shape that is most noticible!

In terms of “inches”, I’ve lost;

  • 1″ off my upper arms
  • 2.5″ off my neck (which really shows!)
  •  1″ off my thighs
  • 4 1/2″ off my waist (which feels amazing!)

Facial lines are more visible, but when I look in the mirror I actually recognize the face looking back.

I am now below the high end of the overweight category based on BMI and am continuing to lose weight steadily.

At the beginning of this journey, I planned to lose ~30 lbs, but I realize that to attain an ideal waist circumference that is 1/2 my height, I likely have another 30 pounds to lose now which means I am not quite half-way there, but I am making progress!

…and that is the goal; progress, not perfection.

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.

Is Low Carb eating really not sustainable?

For the umpteenth time in as many weeks, I had a client tell me that they were told that “low carb eating is not sustainable” – and this was in the same breath as the decision to increase the second of two medications they are prescribed for Type 2 Diabetes.

What frustrates me is that their physician did not even want this person to try a lower carbohydrate approach.

The client was reminded soberly that “Diabetes is a chronic progressive disease” and that it is “expected” that over time the dosage of both of those medications will increase until they can’t be any more, and that they will eventually be insulin-dependent. I think that for many, this becomes a self-fulfilling statement and believing it to be ‘inevitable’, people are resigned that there is ‘nothing they can do’.

But is this true? Does it have to be a chronic, progressive disease?

Medical professionals across Canada, the United States, Australia and Europe have clinical experience demonstrating that the symptoms of Type 2 Diabetes can be put into remission and that most are able to the majority of their patients off many, if not all of their medications by following a low carbohydrate diet.

What about the claim that “low carb eating is not sustainable“?

Certainly, people who adopt a low carb lifestyle eat differently than they did before – but so do people who choose to be vegetarians. How often are those who choose not to eat meat for ethical or moral reasons told that “a vegetarian diet is not sustainable“? I don’t know of any.

Following a low carb lifestyle is no more or less sustainable than choosing not to eat meat.

For heaven’s sake, for the last 40 years people have been advised to eat a low-fat diet and I don’t recall anyone being told that “a low fat diet is not sustainable“.

I like to think of adopting a low carb lifestyle in terms of someone who has been diagnosed with a food allergy or food intolerance. Someone who’s been diagnosed as Celiac is intolerant to gluten and they make the choice to avoid gluten for health reasons. People with nut allergies also face food restrictions that guide their choices. Do we ever hear Celiacs being told that “eating a gluten restricted diet is not sustainable” or that “eating a nut-free diet is not sustainable“?

No.

People are advised by their doctors, or who have consulted with their doctors to follow these dietary restrictions for health reasons should not view this style of eating as any more or less restrictive or limiting than any other dietary restriction made for heath reasons.

Many people who adopt a low carb lifestyle do so to reduce the risks associated with health conditions such as Type 2 Diabetes, high blood pressure and high triglycerides / cholesterol. People who have seen friends or family members live through or die from complications from these conditions are likely to be highly motivated to make dietary changes and to stick with them. As with any other dietary restriction, a low carb lifestyle is a dietary choice and the willingness to continue with it is tied to the strength of the motivation to make that dietary change in the first place.

Note: The American Diabetes Association gives Type 2 Diabetics the option of following either a moderate low carb diet (130g carbohydrate) or a low calorie calorie restricted diet for up to a year, for weight loss. At the present time, Diabetes Canada does not yet approve this approach.

Once people start eating lower carb, how much better they feel provides the self-motivating to continue!  They report that they are no longer driven by food cravings, that they sleep better, have more energy and mental clarity and focus.  Many people with joint stiffness and pain find it improves considerably and of course, they lose weight naturally and almost effortlessly, without being hungry.

There is such a sharp contrast between how they feel after adopting a low carb lifestyle to how they felt before, that this serves to reinforce their initial reason for adopting this change. Why would they want to go back to feeling overstuffed, lethargic, hungry and tired? So they continue in their lower carb lifestyle.

What if when a person is faced with the preconceived conclusion that “low carb eating is not sustainable” they responded by suggesting adopting it for 3 months and re-running the blood work, along with the commitment to monitor their own blood glucose levels and blood pressure daily, and returning immediately if there are any issues? People could get “buy in” from their doctors in order to improve their own health using dietary changes – in much the same manner as dietary changes are used to manage other conditions. This is what I ask my clients to do before they begin a low carb diet; to discuss the approach with their doctors beforehand and have them follow them over time.

Maybe to change the ‘status quo’ is simply a matter of each of us advocating for change in managing our own “chronic, progressive diseases” – especially those that need not be either chronic, nor progressive.


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.

Turkey or Chicken Low Carb Lasagne – great for leftovers

It’s the day after Canadian Thanksgiving and many people are wondering what to do with leftover turkey.  Well, here’s an almost no-carb idea for a delicious LCHF Lasagne! It can also be made with sliced cooked BBQ chicken breast, as well.

Almost no-carb turkey or chicken lasagne

INSTRUCTIONS

Grease an 8″ x 10″ ceramic or glass baking dish liberally with butter or a high quality fat of your choice.

In a bowl, place 500 ml (2 cups) plain tomato sauce and season with salt, freshly ground black pepper, fresh squeezed garlic, rubbed oregano and extra virgin olive oil and set aside.

In another bowl, beat 3 eggs and add enough whipping cream to bring the volume up to 500 ml (2 cups).  Season with salt and freshly ground black pepper and add 100 gm (3 oz) grated Parmesan (or Asiago) cheese. Grate a bit of fresh nutmeg into the mixture, and set aside.

In the microwave, cook 2 pkg. of chopped, frozen spinach until defrosted, but not cooked.  Place in a sieve and press out water with the back of a large spoon.  With clean hands or a cheesecloth (if you prefer), squeeze out the excess water and leave in sieve while preparing the rest of the ingredients.  In a small bowl, beat 3 eggs and season with salt and freshly ground black pepper to taste and then add the well-drained spinach.  Add a touch of whipping cream to increase volume / adjust texture, if desired.

Slice the turkey or chicken breast to 3 mm slices (not to thin as it won’t have the correct texture when baked).

Now you are ready to assemble the lasagne, but while you are doing that, preheat the oven to 450° F.

In the bottom of the greased baking dish, layer 1/2 the tomato sauce mixture.  Add one layer of sliced turkey (or chicken) – about 1/3 of the total quantity, being sure to leave no gaps between pieces.  Spread the sliced poultry with a layer of the spinach mixture and top that with 1/2 the cream mixture. Add the second layer of poultry and on top of that, spread the rest of the spinach mixture and top that with the remainder of the cream mixture.  Finish with the remainder of the sliced poultry and top with the rest of the seasoned tomato sauce and cover the top well with shredded Parmesan cheese, or a mixture of Parmesan or Asiago cheese mixed with shredded mozzarella.

Bake at 450° F until bubbly and hot and slightly browned on top.

Enjoy!

ACV Gingeraid Recipe with Variations – food as medicine

In both a recent A Dietitian’s Journey entry (Food as Medicine – dramatically lower blood sugar) and an academic article (Food as Medicine to Lower Blood Glucose – scientific support), I discussed the use of- and scientific basis for consuming beverages containing apple cider vinegar, ginger, turmeric root, and kombucha in lowering blood sugar levels.  In this post, I provide the recipe for “ACV Gingeraid” along with the different variations mentioned in the above-mentioned articles.

These beverages are most effective in lowering blood glucose when drunk immediately after a meal containing carbohydrates and nightly, before bed.

NOTE: Given the possibility of these ordinary foods resulting in a dramatic drop in blood sugar, if you are taking any medication, especially for controlling high blood sugar, check with your doctor before adding any of these foods to your diet.

ACV Gingeraid – basic recipe

1 litre water, carbonated (or use Club Soda/Seltzer) 
2 tsp apple cider vinegar, unpasteurized, unfiltered
1 tsp ginger root, washed, peeled, freshly grated

In a 1 litre of carbonated water (Club Soda/Seltzer), add 2 tsp of unpasteurized, unfiltered apple cider vinegar such as Braggs®. Allen’s® also makes one, but read the labels carefully, as their regular apple cider vinegar is pasteurized and hence does not contain the “mother”, or culture. Using a very fine grater, grate a 1″ x 1″ knob of washed and peeled ginger root and add it to the acidulated water. Cover tightly and chill if desired, before drinking or drink at room temperature.


Turmeric ACV Gingeraid

 1 litre water, carbonated (or use Club Soda/Seltzer) 
2 tsp apple cider vinegar, unpasteurized, unfiltered
1 tsp ginger root, washed, peeled, freshly grated
1/2 tsp turmeric root, peeled, freshly grated
1/8 tsp black pepper corns, freshly ground

In a 1 litre of carbonated water (Club Soda/Seltzer), add 2 tsp of unpasteurized, unfiltered apple cider vinegar such as Braggs® or  Allen’s® unpasteurized. Using a very fine grater, grate a 1″ x 1″ knob of washed and peeled ginger root and add it to the acidulated water. Using a polyethylene kitchen glove or plastic sandwich bag on the hand holding the turmeric root, on the same grater, grate a 1/2″ by 1/2″ piece of turmeric root and add it to the Gingeraid. Add a few grindings of freshly ground black pepper (increases bioavailability of turmeric, due to it containing piperine). Cover tightly and chill if desired, before drinking or drink at room temperature.


Kombucha – ACV Gingeraid

1/2 litre water, carbonated (or use Club Soda/Seltzer) 
1/2 liter Kombucha
2 tsp apple cider vinegar, unpasteurized, unfiltered
1 tsp ginger root, washed, peeled, freshly grated
In a 1 litre bottle suitable for carbonated drinks, add the carbonated water (Club Soda/Seltzer) and Kombucha (any flavour). Be sure to choose brands with as few carbohydrates as possible, or brew your own using a low sugar recipe.
To this mixture, add 2 tsp of unpasteurized, unfiltered apple cider vinegar such as Braggs® or  Allen’s® unpasteurized.
Using a very fine grater, grate a 1″ x 1″ knob of washed and peeled ginger root and add it to the acidulated water.
Cover tightly and chill if desired, before drinking or drink at room temperature.
By changing the fruit that the second fermentation of Kombucha is made with, the flavour changes substantially.  The fructose in the fruit is largely consumed by the acetic acid bacteria during the second fermentation.

Turmeric Kombucha – ACV Gingeraid

1/2 litre water, carbonated (or use Club Soda/Seltzer) 
1/2 liter Kombucha
2 tsp apple cider vinegar, unpasteurized, unfiltered
1 tsp ginger root, washed, peeled, freshly grated
1/2 tsp turmeric root, peeled, freshly grated
1/8 tsp black pepper corns, freshly ground
In a 1 litre bottle suitable for carbonated drinks, add the carbonated water (Club Soda/Seltzer) and Kombucha (any flavour). Be sure to choose brands with as few carbohydrates as possible, or brew your own using a low sugar recipe.
To this mixture, add 2 tsp of unpasteurized, unfiltered apple cider vinegar such as Braggs® or  Allen’s® unpasteurized.
Using a very fine grater, grate a 1″ x 1″ knob of washed and peeled ginger root and add it to the acidulated water. Using a polyethylene kitchen glove or plastic sandwich bag on the hand holding the turmeric root, on the same grater, grate a 1/2″ by 1/2″ piece of turmeric root and add it to the Gingeraid. Add a few grindings of freshly ground black pepper (for the piperine, see above)
Cover tightly and chill if desired, before drinking or drink at room temperature.
Enjoy!

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