Understand High Blood Sugar & High Cholesterol

INTRODUCTION: All the science in the world isn’t helpful if people can’t understand it.  This is a simple, yet accurate explanation of how we get high blood sugar, fatty liver disease, high triglycerides and high cholesterol. Science made simple.


Most people know that Diabetes is having “high blood sugar” but just how much sugar is actually in the human body?

An adult has 5 liters of blood circulating in their body at any one time.

A healthy person’s body keeps the range of sugar in the blood (called ‘blood glucose’) tightly-controlled between 3.3-5.5 mmol/L (60-100 mg/dl) — that is, when they eat food with carbohydrate the body breaks it down to sugar,  and insulin takes the extra sugar out of the blood and moves it into cells.

Where does it put it?

First, the body makes sure that glycogen stores are sufficient, which is the body’s “emergency supply of energy”. There’s about a day’s worth of energy (2000 calories) in our muscle and liver glycogen. Once the liver and muscle glycogen is full, the rest of the blood sugar is moved to the liver where it is converted into LDL cholesterol and triglycerides and then the rest stored in fat cells. Fat is where the sugar that we make from the food we’ve eaten goes if it is not needed right away. Fat is storage for later.

So how much sugar is there in the blood of a healthy adult?

Doing the math (see illustration below), there are only 5 grams of sugar in the entire adult human body — which is just over one teaspoon of sugar.

That’s it!

One heaping teaspoon of sugar in the entire adult body!

understand sugar in body
The amount of sugar in the blood of a healthy adult

How Do We Understand Diabetes in Terms of Blood Sugar?

How much sugar does someone with Diabetes have in their blood compared to a healthy person?

Someone with a fasting plasma glucose level of 7 mmol/L (126 mg/dL) meets the diagnostic criteria for Diabetes — which is just 6.25 grams of sugar or 1 -1/4 teaspoons.  

That is, the difference between the amount of sugar in the blood of a healthy person and the amount of sugar in the blood of someone with  Diabetes is just a quarter of a teaspoon of sugar

That’s it!

A quarter teaspoon of sugar is such a small amount but it makes the difference between someone who is healthy and someone who has Diabetes

The difference between the amount of sugar in the blood of a healthy person and the amount of sugar in the blood of someone with Diabetes is just a quarter of a teaspoon of sugar.

In a person with Type 2 Diabetes, the once tightly-controlled system that is supposed to keep the range of sugar in the blood between 3.3-5.5 mmol/L  (60-100 mg/dl) is “broken”. When someone with Diabetes eats food with carbohydrate in it, their insulin is unable to take the sugar out of their blood fast enough, so the sugar stays in their blood longer than it should.

Just as with a healthy person, the body of someone with Diabetes takes the sugar that results from the food they’ve eaten and ‘tops up’ their liver and muscle glycogen stores, then the rest is sent to the liver where it is converted into LDL cholesterol and triglycerides, and then the rest is stored in fat cells.

Some people have the ability to store the sugar overload in the form of fat under the skin (called sub-cutaneous fat). In this way, obesity is a way of protecting the body from this sugar overflow.  Eventually though, if the constant flow of carbohydrate continues, the ability of the body to store the excess as sub-cutaneous fat is limited and then fat around the organs (called visceral fat) increases and this is what ends up causing Diabetes and fatty liver disease.

subcutaneous vs visceral fat
Sub-cutaneous fat (LEFT) versus visceral fat (RIGHT) – from Klöting N, Fasshauer M, Dietrich A et al, Insulin-sensitive obesity, Am J Physiol Endocrinol Metab 299: E506–E515, 2010, pg. 5

The problem with all of us (both those that are healthy and those with  Diabetes) is that we never get to access our fat stores because we keep eating significant amounts of carbohydrate every few hours, storing the excess sugar in our fat stores. According to recent statistics, three-quarters of us lead sedentary (inactive) lives and barely get to make a dent in the energy we take in each day.  As a result, we just keep getting fatter and  fatter.

We eat breakfast — maybe a bowl of cereal (30 gms of carbs) or two toast (30 gms of carbs) or if we’re in a rush we grab a croissant breakfast sandwich at our favourite drive-through (30 gms of carb). Each of these contains the equivalent of a bit more than 6 teaspoons of sugar

Mid-morning, maybe we eat a fruit – say, an apple (30 gm of carbs) to hold us together until lunch — and take in another 6+ teaspoons of sugar  in the process. If we didn’t bring a fruit, maybe we go out for coffee and pick up an oat bar at Starbucks® (43 gms of carbs) — the equivalent of almost 10 teaspoons of sugar.

At lunchtime, maybe we’ll have a sandwich (30 gm of carbs) or some leftover pasta from the night before (30 gm of carbs) or we’ll go to the food court and have a small stir-fry over rice (30 gm of carbs) — the equivalent of another 6+ teaspoons of sugar

Maybe we eat another piece of fruit mid-afternoon, this time an orange (30 gms of carb) — and we’ve provided our body with the equivalent of another  6+ teaspoons of sugar

In the scenario above, by mid afternoon (assuming we didn’t eat any fast-food or convenience foods, but only eating the food from home) we’ve eaten the equivalence of 24 teaspoons of sugar!

If we go to MacDonald®’s and eat a Big Mac® (20 g of carbs), large fries (66 g of carbs) and a large soft drink (86 g of carbs) – we’ve eaten a total of 172 g of carbs – which is equivalent to 43 teaspoons of sugar in just one meal!

The body of a healthy person keeps shuttling all this excess sugar off to their liver and keeps making triglyceride and LDL cholesterol out of it and storing the rest as fat. Perhaps on their lab tests, their blood sugar seems normal, but their triglycerides and LDL are not. The origin of the problem is not because they are eating too much fat, but too much carbohydrate.  The body is trying to store it somewhere.  First it stores it in glycogen, then the rest is made into triglyceride and LDL and shipped all over the body, with the rest stored as fat.  The fat cells in the body keep filling up — in the muscle, in and around our organs, and some get “fatty liver disease” and some even get fat cells in their bones if their body needs a place to put it.  Bone is not supposed to have fat cells it in, but the body has to store it somewhere, because the carbohydrates just keep arriving every few hours!

Think of it this way;

Imagine you are at home and you hear the doorbell ring. You go to the door and there’s a package and it’s for you.  You take the package, close the door and head to the kitchen table to open it.  Just as you’re about to open it, the door bell rings again.  You go to the door, and there’s another package — and it’s for you, again.  You take the package and head back to the kitchen and set it down beside the first, when (you guessed it) the doorbell rings again. You take that package and the ones that keep arriving, finding places to put them.  When the kitchen table is full, you put the packages on the floor underneath the table, but then you get a delivery of several packages.  You set those down wherever there’s a spot, just in time to answer the door yet again.  Package after package arrives and before you know it, you look like something out of the TV series Hoarders.  You can barely move for all the boxes, and all of them are unopened.

This is what eating meals and snacks with carbohydrates in them every few hours is like.

We overwhelm our body’s tightly-regulated system that is supposed to maintain our blood sugar level between 3.3 and 5.5 mmol/L (60-100 mg/dl) by continually requiring it to process the equivalent of anywhere from 6 teaspoons of sugar in a bowl of cereal or two toasts to the equivalent of 43 teaspoons of sugar in a fast-food meal. 

This is how the system gets “broken”.

In time, we may get Type 2 Diabetes or fatty liver disease or high triglycerides or high cholesterol or group of symptoms called Metabolic Syndrome. This is the result of the constant strain we put our bodies under by eating a steady diet of foods containing a large percentage of  carbohydrate.

It is easy to see where the high rates of obesity and Diabetes have come from. We have become a nation of “hoarders”.

What’s the solution?

We stop the constant delivery of packages of carbohydrate every few hours.

We feed our body the protein and the nutrients it needs with enough fat to use as fuel (in place of carbs) and allow it to take the extra energy it needs from our “stored fat”.  We finally take the fat out of storage and we do this by following a low carb high fat diet.

Science made simple.

Want to know more?

Please send me a note using the “Contact Me” form above and for a complete summary of my services (pdf format), click here.

 

To our good health!

Joy

 


Reference

Michigan State University, How to convert grams of sugars into teaspoons,  http://msue.anr.msu.edu/news/how_to_convert_grams_of_sugars_into_teaspoons

Klöting N, Fasshauer M, Dietrich A et al, Insulin-sensitive obesity, Am J Physiol Endocrinol Metab 299: E506–E515, 2010 – http://www.physiology.org/doi/10.1152/ajpendo.00586.2009

 


Copyright ©2018 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.

The Role of Protein in the Diet – the problem with carbs

What all low carb diets have in common is that they are low in carbohydrates and high in healthy fats, but they vary with respect to the amount of protein and fat. This is part 1 in a new series titled The Role of Protein in the Diet, and outlines the problem with current carbohydrate intake in terms of the recommended dietary requirements.

This article is based largely on a lecture given by Dr. Donald Layman, PhD - Professor Emeritus from the University of Illinois (Nutrition Forum, June 23, 2013, Vancouver, British Columbia, Canada)

Sometimes, when people debate what is, or isn’t a “high protein diet” they define it in terms of the percentage of calories in the diet but this is really meaningless.

For example, someone may be eating only 56 gm of protein  which was 28% of the 800 calories per day they ate and someone else may be eating 160 gm of protein which is 34% of the 2000 calories they are eating per day.

Both are eating ~30% of calories as protein but there is a big difference between 56 gm of protein and 160 gm of protein.

According to Dr. Donald Layman PhD [1], when we speak of a “high protein diet“, we need to discuss the absolute amount of protein in grams, not as a percentage of calories,  because adequacy in determined on the basis of absolute intake.

The Recommended Daily Allowance (RDA) for Protein

The Recommended Daily Allowance (RDA) for any nutrient is the average  daily dietary intake level that is sufficient to meet the requirements of 97 – 98 % of healthy people. This is not the optimum requirement, but the  absolute minimum. The RDA for Protein, Carbohydrate and Fat are as follows;

Protein: 56 g (224 kcals)
Carbohydrate: 130 g* (520 kcals)
Fat: 30 g (270 kcals)

The RDAs for Carbohydrate[2] is set at 130 g / day, but as established in an earlier article, How Much Carbohydrate is Essential in the Diet, we know that even in the absence of dietary carbohydrate (not recommended!), the minimum amount of glucose needed by the brain of 130 g / day can be made from protein and fat,  provided they are eaten in adequate amounts.

The RDA for Protein is set at 56 gm per day, so whether a person is eating 800 calories a day or 2000 calories per day, their body has an absolute requirement for 56 gm of protein per day.

Recommended Daily Allowance (RDA) for Protein [slide from Dr. Donald Layman, PhD – The Evolving Role of Dietary Protein in Adult Health]
The minimum amount of protein (56 g / day) is calculated based on 0.8 g protein per kg of body weight and the maximum amount of protein (~200 g / day) is calculated based on >2.5 g protein per kg of body weight.

This range from 56 g to 200 g of protein per day is referred to as the range of safe intake[2].

According to Dr. Layman, a high protein diet doesn’t start “until well above 170 g / day“.

There are low carb diets that are higher in protein than others, and to distinguish between the two, the one that is higher in fat than protein (in grams) is referred to as a low carb high fat (LCHF) diet and the one that is higher in protein (in grams) is referred to as a low carb high protein (LCHP) diet - but it really isn't "high protein", but higher protein.

Current Dietary Intakes – the problem with carbs

Protein Intake in the US and in Canada is ~70 g of protein per day in women and in men about 90 g of protein per day (~15-16% of calories). Given the range of safe intake of protein from 56 g to 200 g of protein per day, dietary intake of protein in the US and Canada is very low.

The RDAs of macronutrients, which is the minimum amount required per day is just over 1000 calories per day, as follows;

Protein: 56 g (224 kcals)
Carbohydrate: 130 g (520 kcals)
Fat: 30 g (270 kcals)*
         1017 calories*

RDA minimum diet definition [slide from Dr. Donald Layman, PhD – The Evolving Role of Dietary Protein in Adult Health] — *typo corrected above
But what about current intake?

Current Intake of macronutrients is as follows;

Protein: 70 g (280 kcals)
Carbohydrate: 300 g (1200 kcals)
Fat: 90 g (820 kcals)
         2300 calories

***That means there are between 1000 calories and 1300 calories per day of ‘discretionary calories’ – calories above and beyond the minimum requirements of 97-98% of healthy individuals.***

How should we eat to make the most of these calories?

What is going to give us the best health?

Currently, we are eating 3 times the RDA for carbohydrate (300 g carbohydrate per day!) and very close to the minimum for protein. Is this the right balance?

What evidence is there for this being the ‘right balance’?

Eating Well with Canada’s Food Guide, as with the US Dietary Recommendations emphasizes lots of whole grains and high carb intakes and very low protein intake. For a long time in both countries, we’ve highlighted that the issue is fat. But is this correct?

It was thought that since fat has a high caloric density, reducing fat intake would reduce calorie intake and that’s where the US Food Pyramid and Eating Well with Canada’s Food Guide comes from.

Eating Well with Canada’s Food Guide
USDA Food Guide Pyramid

In both cases, the message is ‘stay away from fats‘, ‘stay away from proteins‘, ‘eat lots of cereal grains‘.

So how did that work out for us?

The Food Guide Pyramid first appeared in the US in 1988– exactly when obesity rates exploded.  It tracks back almost to the date…obesity, Diabetes.

This occurred as we started consuming more and more cereal grains and this, according to Dr. Layman “is the origin of the problem”.

Obesity Trends Among US Adults [slide from Dr. Donald Layman, PhD – The Evolving Role of Dietary Protein in Adult Health]
 What about Canada?

Let’s first look at children;

  • In 1978, only 15% of children and adolescents were overweight or obese.
  • By 2007, that rate had doubled to 29% of children and adolescents being overweight or obese.
  • By 2011, obesity prevalence alone for boys was 15.1% and for girls was at 8.0% in 5 to 17 year olds.

What about adults?

  • The prevalence of obesity [body mass index (BMI) ≥30 kg/m2] in Canadian adults increased from 10% in 1970-72 to 26% in 2009-11
  • Based on waist circumference 37% of adults and 13% of youth are abdominally obese.
  • Looking at these numbers slightly differently, as of 2013, there were approximately 7 million obese adults and 600 000 obese school-aged children in Canada.

What exactly changed in the Dietary Guidelines that caused us to  get fat?

For one, Dr. Layman points out, caloric intake was increased by 300 calories per day and according to the Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010 these extra 300 calories per day came from these 6 categories:

  1. grain based desserts and snacks
  2. yeast bread
  3. pasta
  4. pizza
  5. chicken and chicken products
  6. soda and sports drinks

These are all grain-derived products in excess of our caloric needs. See the pattern? The fifth category includes breaded chicken products, such as chicken fingers and chicken nuggets and even soda and sports drinks, sweetened with high fructose corn syrup are grain derived.

All of these grain-derived products are in excess of our caloric needs. This is only part of the problem with current dietary intake of carbohydrates.

In the next article, I’m going to take a look at our current high intake of dietary carbohydrates in terms of the history of man’s diet and the length of time that we’ve had to adapt to eating them.


References

1 – Layman, Donald, The Evolving Role of Dietary Protein in Adult Health, Nutrition Forum, British Columbia, Canada, June 23, 2013 https://youtu.be/4KlLmxPDTuQ

2 – Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005), pg 275

3 – Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010

Copyright ©2018 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.

Which Low Carb Ketogenic Diet?

There is more than one way to eat a low carb ketogenic diet, in fact there are many variations. In this article I will outline three approaches including (1) a low carb high protein, similar to a Paleo diet as promoted by Dr. Ted Naiman and Dr. Tro Kalayjian (2) a low carb high fat approach, as promoted by Dr. Jason Fung and (3) a higher protein lower fat intake during weight loss, then a moderate protein high fat intake during weight maintenance, as promoted by Dr. Stephen Phinney and Dr. Jeff Volek.

Three Types of “Low Carb” Diets

1 – Low Carb High Protein 

One proponent of a low carb high protein lifestyle is Dr. Ted Naiman, a board-certified family medicine physician who practices in Seattle, Washington. His videos on the subject of insulin resistance filmed at low carb conferences had a profound impact on me when I first adopted a low carb lifestyle in March of last year. This is something he wrote recently on Twitter;

You can’t reduce carbs unless you first target protein so you aren’t hungry. If I tell a patient to stop eating carbs, they are starving and eat a whole box of Oreos—BUT if they eat a pound of steak and eggs, ok now carb reduction is easy!

Dr. Ted Naiman (@tednaiman), Twitter, January 16 2018, 11:06 PM 

On the popular low carb site, Diet Doctor, Dr. Naiman oulines how much fat a person should eat on a ketogenic diet[2], depending on whether they are doing it for weight loss or weight maintenance. For someone seeking fat loss, Dr. Naiman recommends ~120 gm of protein, ~30 gm of net carbs, ~120 gm of ‘whole food fats’ (fat found naturally in food) and ~30 gm of added fat (such as for vegetables, salads and cooking).

His summary on Twitter was;

” target protein first (1 g per pound of DESIRED/ideal body weight), keep net carbs low, and eat whole food fats but avoid added fats if you are already fat or trying to get leaner. Nothing else even makes any sense.”

So, assuming someone’s ideal body weight is 120 lbs.  How how much food does one have to eat to get 120 gm of protein? A lot as you’ll see below.


Another proponent of a low carb high protein approach is Dr. Tro Kalayjian, a board certified Internal Medicine physician who currently practices in Greenwich, Connecticut. He lost 145 pounds over a two-year period following a low carb high protein diet and like Dr. Naiman does a great deal of high intensity interval training (HIIT) and resistance training (RT).

When asked recently on Twitter whether he followed a high fat or high protein diet, he replied;

I’d say my only focus is to hit my protein target. I shoot for 200-350 g depending, especially if I do RT. With regards to fat, I eat plenty. I trim meats and don’t eat skin, but i eat variety of nuts from time to time and use olive/avocado oil.

Dr. Tro Kalayjian (@Dr.T), Twitter, January 15, 2018, 7:03  PM

Note: this is Dr. Kalayjian's plan for himself and not necessarily what he'd recommend for everyone. He does ~10 hours of HIIT and RT training a week, with a goal of increasing muscle mass (hypertrophy) and re-composition. 

What Dr. Kalayjian would recommend to others depends on (1) what their goal is, (2) what their current medical/metabolic status is and (3) any lifestyle details that will impact dietary requirements.

How much actual protein is in what we call ‘protein foods’?  Here are some examples;

Egg (1 large) – 6.3 grams
Sausage, pork link (14 gm / 0.5 oz each) – 2.5 grams
American cheese (28 gm / 1 oz.) – 7 grams
Cottage cheese (250 ml / 1 cup) – 28.1 grams
Salmon (170 gm / 6 oz.) – 33.6 grams
Ham (170 gm / 6 oz.) – 35.4 grams
Tuna (170 gm / 6 oz.) – 40.1 grams
Chicken, breast (170 gm / 6 oz.) – 37.8 grams
Broiled Beef steak (170 gm / 6 oz.) – 38.6 grams
Hamburger (170 gm /  6 oz.) – 48.6 grams
Turkey, dark meat (170 gm / 6 oz.) – 48.6 grams
Pork Chop (170 gm / 6 oz.) 49 grams
Beef (170 gm / 6 oz.) – 54 grams

So, what would Dr. Kalayjian’s daily intake of 200-350 gm. of protein look like in terms of food? Let’s look at how much food one would need to eat  meet only 200 gm of protein per day, which is the ‘low end’ of Dr. Kalayjian’s intake;

Three eggs at breakfast would only supply less than 19 gm of protein.
Four pork link sausages would supply another 10 gms of protein.
He’d only have eaten less than 30 gms of protein.

Eating a 340 gm (12 oz) broiled beef steak at lunch-time would add another 77 gms of protein.

After these two meals, he would have eaten 106 gms of protein and be only a little over half-way to his minimum protein goal and less than a third the way to his upper range of protein.

Let’s say he decided to eat 1/2 a large salmon i.e. 340 gm (12 oz) for supper, that would add 67 grams of protein.

Adding up all the protein so far, he would have only eaten 173 gms of protein, so he’d have to fry up 4 more eggs to make his 200 gm of protein to meet his minimum protein requirement.

Looking back to Dr. Naiman’s “pound of steak and eggs“, let’s break that up over a day. Three eggs for breakfast would supply <20 gm of protein and eating 227 gm (8 oz) of beef at lunch would provide 50 gm of protein, so the person would need to eat another 227 gm (8 oz) of beef at supper just to make their 120 gm of protein for the day. Now, remember, this is for an individual whose ideal body weight is only 120 pounds! That is a lot of meat and eggs.

This approach may be appealing to some but is eating high protein (i.e. 120 gm per day) appropriate for everyone?

As I will develop in a future article, the Recommended Daily Intake (RDA) for protein is only 56 gms per day – which represents the minimum requirement that individuals need for health.  People in both Canada and the US are eating only 70 gms of protein per day (barely over the minimum requirement) but is this optimum?  Some very prestigious nutrition experts think not.  More on that in an upcoming article.

2 – Low Carb High Fat

One of the popular proponents of a high fat approach is Dr. Jason Fung, a Toronto-area nephrologist (kidney specialist). His approach is reflected in the blogs he has been writing since 2013 as part of the Institute of Kidney Lifescience Technologies (www.kidneylifescience.ca), which have since  become the basis for his Intensive Dietary Management (IDM) Program, based out of Toronto[4].

From what I gleaned back from my early days reading all of his first two years of his blogs (Aug 2013- May 2015) and many since, Fung promotes a diet which is a maximum of 20-30 gm of net carbohydrate (gross carbohydrate content minus fiber) per day, a maximum of 75 gm of protein per day (~20 gm of protein at each meal), with the remainder of intake as a variety of fats. Fung does not promote the use of “fat bombs” popularized with the “Bulletproof Diet” written by layman “biohacker” Dave Asprey, but encourages the eating of fat that comes naturally in food; such as the skin on poultry, the visible fat on meat and the yolk of eggs plus a total of 70 gm of added fat per day for satiety (feeling full).

Dr. Fung’s recommendations seem to be roughly 5-10% net carbohydrate with about 75% fat and 20% protein.

Fundamental to Fung’s approach is the use of Intermittent Fasting to restore insulin sensitivity, which ultimately also has the effect of decreasing overall intake. This is how he defines fasting windows;

  1. a 16-hour fast begins from the end of supper the previous night, until lunch the following day. That is, only breakfast isn’t eaten.
  2. 24-hour fast begins from the end of supper the previous night, until supper the following day (i.e. one meal).
  3. 36-hour fast begins from the end of supper the previous night and no breakfast, lunch or dinner is eaten the following day, with the fast broken at breakfast the next day.
  4. 42-hour fast is like the 36-hour fast, except people fast until lunch on the day following the fast.

Fung’s “fasts” are not water-only fasts, but allow the drinking of ‘bone broth’* during fasting periods, amongst other beverages.

*NOTE: An article on making a 18 hour bone broth along with nutritional analysis is pending. I require my clients who wish to do a 24 hour fast to discuss it with their doctors first. If medically approved, I encourage people to drink as many cups of 18 hour bone broth as they would like during a 24 hour fast, as it provides ~9 gm of protein per 250 ml / 8 oz cup. In my practice, fasts longer than 24 hours require medical supervision.

Commercial 'bone broths' generally contain much less protein than a homemade 18 hour bone broth.

3 – Higher Protein Lower Fat followed by Moderate Protein High Fat

Dr. Stephen Phinney MD, PhD, a medical doctor and Dr. Jeff Volek, RD, PhD a Registered Dietitian have decades of combined scientific and clinic  research  experience in the area of low carb diets and in 2011 published their expert guide titled The Art and Science of Low Carbohydrate Living [2]  documenting the clinical benefits of carbohydrate restriction.

They promote a low carbohydrate diet that is higher protein during the weight loss phase only, but the level of protein they recommend is nothing near the levels that Dr. Naiman and Dr. Kalayjian encourage, but still as I will outline below, it still requires a large quantity of protein foods to be eat daily.

In the induction and weight loss phase using Phinney and Volek’s approach, protein is ~30% of caloric intake but decreases to ~21% of caloric intake  following weight loss, during weight maintenance. Fat is 60% of calories  during the weight loss phase and 65-72% during weight maintenance. Carbohydrate intake is kept very low (7.5-10% of calories for men, 2.5-6.5% of calories for women) and this induces nutritional ketosis.

The amount of mathematical calculations required for the average individual to follow Phinney and Volek’s method is, at the very least, daunting. The amount of fat in grams and carbohydrate in grams needs to be calculated initially during induction and recalculated for weight loss, then recalculated again during pre-maintenance and maintenance.  In addition, as the person’s weight decreases, the number of grams of fat and carbohydrate also needs to be recalculated. The amount of protein that must be eaten on an ongoing basis is another challenge to their approach.

What does 100-150 grams of protein look like in terms of actual food [3]?

Two eggs at breakfast would only supply less than 13 gm of protein. Eating 170 gm (6 oz) of salmon at lunch-time would only supply less than 34 gm.

A woman would need to eat 2 additional hamburger patties (170 gm / 6 oz, cooked), or 170 gm / 6 oz of turkey or pork or beef in order to meet her daily protein requirement. A man would need to eat double that to meet his daily protein requirement.

Human Protein Tolerance

Ironically, even though Phinney and Volek encourage eating more protein than fat during weight loss, they write about “human protein tolerance“, including the “lethargy and malaise” that occurs when more protein than fat is eaten on a regular basis, along with the feeling of being “sick to the stomach” [3, pg. 210]. They also point out that there seems to be a physiological upper limit of protein intake of 20-25 gms per meal, after which skeletal muscle is no longer synthesized with additional intake.

Another reason Phinney and Volek recommend avoiding eating too much protein is that it lowers ketone production;

“it [protein] has a moderate insulin stimulating effect that reduces ketone production. While this effect is much less gram-for-gram- than carbohydrate, higher protein intakes reduce one’s keto-adaptation and thus the metabolic benefits of the diet.”

Phinney SD, Volek JS, The Art and Science of Low Carbohydrate Living: An Expert Guide, Beyond Obesity, 2011, page 210.

This Dietitian’s Approach

For the most part, my starting approach (for those without hereditary cholesterol or triglyceride issues) is closer to Dr. Fung’s approach than to either of the others, with several modifications.

One the modifications is around the types of fat that are central in the diet. Like Fung, I encourage people to eat fat that naturally comes with food (egg yolk, for example) but I don’t encourage the amount of saturated fat that his blogs reflect. I am fine with people eating eggs a few times a week (again, provide there are no clinical reasons not to), but I encourage my clients to consider rich sources of monounsaturated fats such as avocado, nuts and seeds and their oils as their primary fat source, with omega-3 poly-unsaturated fat from fatty fish such as salmon, tuna, mackerel and sardine, a close second.

Another modification that I have made is that I encourage my clients to eat some cheese as it supplies a good source of calcium, that doesn’t have the anti-nutrients such as oxalates and phytates that are found in many calcium-rich vegetables.

As I continue to read though the literature on the topic, I am tending to a higher protein and lower fat ratio than Dr. Fung – closer to 30% protein and 65% fat, with 5% net carbs – but as I said above, everybody’s needs are different.

I also support those who would like to eat more protein during the weight loss phase (provided there is no clinical reason not to) and as Phinney and Volek, we can adjust the protein intake downward (~21-23% of caloric intake) after weight loss has occurred.

Some people, when they eat considerably more protein than fat feel nauseated.  This finding of feeling “sick to the stomach” was referred to by Phinney and Volek and came from a study of prolonged meat diets in the early 1930’s.  It is also supported from the traditional indigenous diets of the Inuit which Phinney and Volek pointed out “keep their protein intake moderate to avoid the lethargy and malaise that would occur if they ate more protein than fat” [3].

There is no one “right” way to eat a low carb, ketogenic diet.  What is appropriate for each individual depends on their clinical factors, as well as their personal preferences. There is no “one-size-fits-all” low carb approach.

Keep in mind as well, that no Meal Plan is ‘carved in stone’.  Sometimes a client may start out with a higher fat approach but as they get closer to their goal weight, may reduce the amount of fat intake, so that they can take off the remainder of the weight. The flip side is true as well.  Sometimes people start out with a higher protein intake and then as they reach their goal weight, they drop their protein intake down and increase their added monounsaturated fats.

In any case, I make the process easy.

After conducting a thorough assessment, I do the math required to design their Meal Plan, calculating their protein requirement based on their physiological needs and preferences and then distribute their fat and carbohydrate intake around that.

Have questions?

Please send me a note using the “Contact Me” form above.


References

1. Mark’s Daily Apple, How to Eat Enough Protein, April 3, 2008 URL: www.marksdailyapple.com

2 – How Much Fat for a Ketogenic Diet; maintenance versus fat loss, https://www.dietdoctor.com/much-fat-eat-ketogenic-diet

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

4. Fung, Jason,  Institute of Kidney Lifescience Technologies (www.kidneylifescience.ca) & Intensive Dietary Management (IDM) Program (www.intensivedietarymanagement.com)

 

 

 

Your 2018 Health and Weight Loss Goals

It’s halfway through the first week of 2018 so, how are you doing with accomplishing your New Year’s goals?

According to two University of Scranton studies, by the end of the first week 50% of people who made health and weight loss resolutions will have already given up.

By the end of January, that number will rise to 83%.

In fact, only 8% of people are successful in achieving their health and fitness resolutions on their own – perhaps because it takes ~66 days for a new behaviour to become a habit (Lally et al, 2010).

That’s more than 2 months. 

Having the professional support of a Registered Dietitian during this critical time can make all the difference!

I can help.

Perhaps you’ve lost weight before by cutting portion sizes, going to the gym and eating ‘low fat’. You ate cottage cheese, skimmed milk and celery sticks until it was coming out of your ears and while the weight did come off, you were hungry, grumpy and cold.

What if I told you there’s a much better and easier way to lose weight, where you eat real food that’s easy to prepare and tastes great? There is no weighing  and measuring food portions and there are no special products to buy.

I not only teach others how to do this, I eat this way myself.

There are many benefits to eating this way in addition to losing weight, including the ability to reverse symptoms of Type 2 Diabetes and prediabetes, lower high blood pressure and high triglycerides and improve cholesterol.

Want to know more?

Please send me a note using the “Contact Me” form on the tab above to find out how I can help you be successful at achieving your weight loss and health goals for 2018.

Let’s do this together!


References

Lally, P., van Jaarsveld, C. H. M., Potts, H. W. W. and Wardle, J. (2010), How are habits formed: Modelling habit formation in the real world. Eur. J. Soc. Psychol., 40: 998–1009.

Norcross, JC et al, Auld lang syne: success predictors, change processes, and self-reported outcomes of New Year’s resolvers and nonresolvers. J Clin Psychol. 2002 Apr;58(4):397-405

New Year’s Resolutions for 2013 – Changeology, Dr. John C. Norcross

How Much and Which Types of Fat?

I often get asked ‘how much fat should people on a low carb high fat diet eat’ and ‘which types of fat’? In this article I answer both questions.

As mentioned in previous blogs, there are many types of “low carb diets” -ranging from moderately low carb diets (~130 g carbs) such as the one the American Diabetes Association recommends for weight loss in those with Type 2 Diabetes, to ketogenic low carb diets (5-10% net carbs), and everything in between.

In any low carb diet, carbs (5-10% net carbs) are supplied in foods such as non-starchy vegetables, nuts and seeds, and certain fruit.

In a moderately low carb diet, ~25% of calories come from carbs found in the same foods as with a keto low carb diet, along with the addition of milk and yogurt, legumes, and small amounts of grain products.

What low carb diets have in common is that they provide adequate but not excess protein (~75-120 gms total protein), varying amounts of  carbs  (35-40 gm in a ketogenic diet, 130 gm in a moderately low carb diet), with the remaining calories coming from healthy fats.

What kinds of fat?

Some types of low carb diets (e.g. Paleo diets, Dr. Atkins diet, etc.) include large amounts of red meat, including processed meat such as bacon and sausage, and an abundance of cream and butter. While there is nothing inherently ‘bad’ about saturated fat for healthy people (covered in a previous article), there are some individuals with specific risk factors or disease conditions that might benefit by taking a more conservative approach with regards to the total amount they eat of these types of fats.

Unless required for clinical reasons, the low carb diets I teach include the saturated fat found naturally in the protein foods for the day, as well as butter for cooking or seasoning vegetables, mayo for canned fish or eggs,  and a dollop of sour cream with a meal or cream in coffee. If, for example people love the crispy skin on a barbecued chicken and there is no compelling reason to remove it, then they can by all means enjoy it. Same for the visible fat around the outside of a rib steak.

That said, I see no justifiable reason for adding “fat bombs” to the diet or drinking “bullet proof coffee” made with added butter and coconut oil – especially for individuals who have been overweight or obese and have leptin resistance (covered in an earlier article), that accompanies insulin resistance.

Most of the fats that I recommend people eating should be a natural part of  meals and come from mono-unsaturated fruits, such as avocado and olives, from a wide variety of nuts and seeds (as well as from the oils from these foods), from coconut oil used for cooking, as well as from omega 3 fats found abundantly in certain kinds of fish, such as salmon, mackerel and tuna.

It is important to keep in mind as covered in earlier articles, that if one is limiting carbohydrates then sufficient fat is required from which the body will make ketones for fuel, as well as for one of the sources (along with protein) from which it can synthesize the small amount of glucose (130 g / day) that it needs for brain function. Of course, when a person is completely fasting (religious reasons, medically supervised, etc.) the 130 g / day of glucose needed by the brain can be made from fat stores.

Remember too, that when limiting carbohydrates, eating adequate amounts of healthy fat along with sufficient protein will keep you from getting hungry between meals by increasing satiety (the feeling of ‘fullness’ that fat provides), so when you are planning your meals, be sure to include a variety of types of fat in sufficient quantity.

If you are following a low carb high fat approach, feel free to add olives on top of a Greek salad and drizzle it with a beautiful extra virgin olive oil.

Enjoy homemade guacamole with blackened fish or a salad sprinkled with nuts or seeds and topped with a macadamia nut balsamic vinaigrette.  These are just some of the delicious ways to enjoy added fat.

Want to know which kind of low carb high fat diet might be best for you?

Please send me a note using the “Contact Me” form on this web site.

To our good health!

Joy


Note: There is no one-size-fits-all approach to following a Low Carb High Fat lifestyle since everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor.

Copyright ©2018 – 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.

 

 

 

 

Working on Health Goals?

The holidays have come and gone but what about your resolve that this would be the year you’d achieve your health goals. You want to, of course – but it all seems so overwhelming. Perhaps the weight has crept up over the years – and with it higher blood sugar, blood pressure and LDL  cholesterol and triglycerides, too.  I know.  I was “there” this time last year.

If I was honest with myself (which I wasn’t!), last New Years I was 60 pounds overweight. It had been far too long since I had taken my blood sugar and I was already Diabetic and the last time I had lab work done two years earlier, my ‘bad’ cholesterol was already higher than it should be.  I was in denial. Reality was, I was an overweight, unwell Dietitian.

It took two of my girlfriends dying within months of each other – both of preventable, natural causes, for me to seriously consider “doing something”.   But when?

March 5, 2017 I didn’t feel very well and decided to take my blood pressure. It was dangerously high. That was the day that “one day” became “day one“.  That was the day I overcame my own resistance to change – when the pain of remaining the same was greater than the pain of changing.

It is 10 months later and much has changed for me.  While I am only half way to my goal weight, my blood sugar, blood pressure, cholesterol and triglycerides are well within normal range, with some in the  ‘ideal’ range. It isn’t a “quick fix”, but it is a “lasting fix” and it is entirely  sustainable over the long term.

After two and a half years teaching my clients the “how-to’s” of a low carb lifestyle, I finally had become my own client. I eat the way I’ve taught others to do since 2015 -practicing what I preach, and loving how I feel.

What about you?

Has New Years come and gone and still you don’t have a concrete plan to achieve your health and nutrition goals? Today can be “day one”.

Drop me a note using the “Contact Me” form to find out how I can help.

To your good health,

Joy

 

Top New Years Resolutions

Have you made any New Years Resolutions? According to two University of Scranton studies done ten years apart, two of the top New Years Resolutions are to lose weight and eat healthier. The study also found that those who made New Years Resolutions were 10 times more successful at changing their behavior in the short run than those who wanted to change their behavior but didn’t actually making a resolution. The bad news was that only a week into the New Year, 50% had already given up and by the end of January, that number had risen to 83%.

Unfortunately, only 8% of people are successful in achieving these types of New Years Resolutions on their own.

The reality is that it takes approximately 66 days to create a new habit (Lally et al, 2010). That’s more than 2 months. Having the professional support of a Registered Dietitian during this critical time can make all the difference!

Like many of my clients, you have probably lost weight before — perhaps by cutting portion sizes, going to the gym or eating ‘low fat’. You dutifully ate rabbit food, cottage cheese and skimmed milk and while the weight came off, you were probably hungry, grumpy and cold, but determinedly you pressed on. Or maybe you didn’t.

What if I told you there’s a much better, and easier way to lose weight and as importantly, bring blood sugar levels and blood pressure levels down and lower high triglycerides?

There is.

I not only teach it, I am doing it.

If you want 2018 to be the year you achieve your weight loss and health goals, then let’s do this together.

Please send me a note using the “Contact Me” form on this web page to find out more.

All the best of health and happiness to you and yours in 2018!

Joy


References

Lally, P., van Jaarsveld, C. H. M., Potts, H. W. W. and Wardle, J. (2010), How are habits formed: Modelling habit formation in the real world. Eur. J. Soc. Psychol., 40: 998–1009.

Norcross, JC et al, Auld lang syne: success predictors, change processes, and self-reported outcomes of New Year’s resolvers and nonresolvers. J Clin Psychol. 2002 Apr;58(4):397-405

New Year’s Resolutions for 2013 – Changeology, Dr. John C. Norcross

What is Ideal Protein®?

Recently, there has been a lot of buzz about a weight-loss program called Ideal Protein® which is often talked about as being a “low carb diet” so I decided to look into what this system is, and how it works. A local pharmacy is participating in this program, so I was able to obtain information directly from the pharmacist.

Ideal Protein®, in it’s weight-loss phase (called “Phase 1”) is both low carb and low fat diet – and is most significantly a calorie-restricted diet promoted for weight loss.

Pharmacy-based

“Lifestyle Clinics”,  many of which are located at participating pharmacies are supervised by a pharmacist (or a nurse) who oversees the promotion of the Ideal Protein® line of products required for the diet, as well as the Natura® vitamin and mineral supplements and “Ideal Salt®“, which clients are instructed to use daily.

The designated pharmacist (or nurse) reviews the sign up, but “Ideal Protein® weight loss “coaches” are the ones who review weekly “food journals” that clients are required to keep, as well as records client’s weight, body measurements and fat % readings at their weekly “check-ins”.

Restricted Foods

In addition to limiting both carbs and fats, many foods are not permitted to be eaten by those on the Ideal Protein® diet until clients achieve 100% of their weight-loss goals.

For example, no cheese or dairy is permitted during the weight loss phase, except for 30 ml (1 oz) of regular milk in coffee or tea at breakfast. Natura® supplements are prescribed to clients to ensure adequate intake of calcium and magnesium.

The only vegetables permitted during the weight-loss phase of the Ideal Protein® diet during lunch and dinner are what are called “selected vegetables”  – which exclude green and wax beans, Brussels sprouts, eggplant, heart of palm, rutabaga, snow peas, tomatillo, and tomatoes. These are considered “occasional vegetables” and are allowed to a maximum of 4 cups per week.

*NOTE: I have been advised from a pharmacist that sells these products that these vegetables have “extra carbohydrates” and “slightly higher GI (glycemic index) for the most part“,  which is the reason they are limited.

Glycemic Index (GI) is a measure of the effect of carbohydrates on a person's blood sugar. I am more interested in a food's Insulin Index (II) which is a measure of the effect of a carbohydrate on a person's insulin levels.

Permitted “selected vegetables” are alfalfa, asparagus, bamboo shoots, bean sprouts, bell peppers, broccoli, cabbage, cauliflower, celeriac, celery,  chayote, chicory, collards, cucumbers, dill pickles, fennel, Chinese broccoli, green onions, jicama, kale, kohlrabi, mushrooms, okra, onions (raw only), hot peppers, radish, rhubarb, sauerkraut, spinach, Swiss chard, turnip, and zucchini / yellow summer squash.

Only unlimited “raw vegetables and lettuce” in the list below are permitted during the weight-loss phase (and only during lunch and dinner). These are arugula, bibb lettuce, Boston lettuce, celery, chicory lettuce, cucumber, endives, escarole lettuce, frisée lettuce, green and red leaf lettuce, iceberg lettuce, mushroom, radicchio, radish, romaine lettuce, spinach and watercress lettuce. All others raw vegetables and lettuce are prohibited.

Even in Phase 2, clients are instructed to only “eat the vegetables permitted” and to “continue to omit cheese and other dairy with the exception of 30 ml (1 oz.) of milk in coffee or tea only“.

Ideal Protein® “Meals”

During the weight loss phase (Phase 1), clients are instructed to have meals as follows;

BREAKFAST: 1 Ideal Protein® diet food product, with the option of having coffee or tea with 1 oz. (30 ml) milk, plus Natura® vitamin and mineral supplements.

LUNCH:Ideal Protein® diet food product, with 2 cups of “selected vegetables” and unlimited “raw vegetables and lettuce” from the above list.

DINNER: clients can eat 8 oz (225g) of lean fish / seafood, lean beef, skinless poultry, lean cuts of pork, veal or wild game meat and 2 cups of “selected vegetables” and unlimited “raw vegetables and lettuce” from the above list plus Natura® vitamin and mineral supplements and omega 3 plus.

SNACK: For a snack, clients eat another Ideal Protein® diet food product and more Natura® vitamin and mineral supplements.

In “Phase 2”, which occurs after 100% of weight loss goals have been achieved, the number of Ideal Protein® diet food products required to be consumed is reduced to 2 and clients can eat the protein choice they wish from the approved list at both lunch and dinner, for 2 weeks. The “selected vegetables” and unlimited “raw vegetables and lettuce” remains the same.

In “Phase 3”,  the number of Ideal Protein® diet food products required to be consumed is reduced to 1 and clients can continue to eat the protein choice they wish from the approved list at both lunch and dinner, for 2 weeks. The “selected vegetables” and unlimited “raw vegetables and lettuce” remains the same.

It is only in “Phase 4”, the maintenance phase” of the Ideal Protein® weight loss system where clients are allowed to eat “all whole foods, including protein and fats, and do not need to eat the Ideal Protein®  products”.

Additional Instructions

Clients are instructed to follow the strict carbohydrate and fat restriction until they achieved “100% of their weight loss goals” and to “eat no more / no less” than the amount of food listed for each meal and snack. That is, “Phase 1” last as long as necessary until a person loses all the weight they planned.

They are cautioned that during Phase 1 and possibly beyond that, six symptoms may occur – especially if they “don’t follow the weight loss method as prescribed”. These symptoms are hunger, headache, nausea, fatigue, constipation and bad breath.

Restricted Calories

Ideal Protein® provides only 850-1000 calories per day, which makes it a calorie-restricted diet.

Low Carb

The Ideal Protein meal replacement packets provide ~20 gm net carbs per day and the “selected vegetables” and “raw vegetables and lettuce“provide ~ 20 gm net carbs per day. Total net carbs are ~40 gm / day.

High Protein

In the Ideal Protein® system,   the meal supplements contain ~15-20 gm protein each and 3 of those are to be eaten each day, along with 8 oz of lean animal protein per day. From the ‘meal packets’, there are 60-80 gms of protein and anywhere from 56 gm of protein (lean ground beef) to 72 gms of protein  (chicken breast).  In total, the Ideal Protein system has people eating between 120 gm – 152 gm of protein per day.

According to Statistics Canada (www.statcan.gc.ca/daily-quotidien/170620/dq170620b-eng.htm), the average protein intake for an adult is 16.5% to 17.0%. Based on Ideal Protein® system having a caloric intake of 850-1000 kcals/day, and the 3 meal supplement packets providing 15-20 gm of protein each, plus the 8 oz of lean protein (another 56-72 gms of protein), the Ideal Protein® system supplies 53 – 67.5% of calories as protein. 

Costs

In terms of cost, it is ~ $500 to sign up to begin the Ideal Protein® diet, which includes a ‘coaching fee’, first round of supplements and 2 weeks worth of meal replacement and meal supplement sample products.

After sign up, the cost works out to ~$100 a week to purchase the Ideal Protein® products, plus supplements  i.e. each box of 7 Ideal Protein® “meal replacements” or diet food product (required to be eaten for meals and snacks) costs ~$30 and for weight loss, 3 boxes a week are required.

Each additional month is another ~$400.

Ideal Protein® – the company 

The Ideal Protein® company is headed by Dr. Randall Wilkenson MD, who has 20 years experience specializing in allergy and environmental medicine and who now works with his son Denver Wilkenson, whose experience is in managing a weight-loss clinic in Idaho for 3 years.

Ami-Higbee, RN serves  as Clinic Director and Mike Ciell, RPh, a registered pharmacist certified in geriatric pharmacy, is VP of Clinic Operations.

At the time of writing, no Registered Dietitians are listed on the team, but they do have a ‘chef’ from Quebec who designs their recipes, almost all of which include ingredients from their Ideal Protein® product list.

According to a local pharmacist that I spoke with, Ideal Protein® has over 4000 of these “Lifestyle Clinics” worldwide.


A few thoughts…

This diet is very popular, but it is not a “low carb diet” but is a “low carb, low fat, calorie restricted diet”.

It’s easy because people don’t need to think what to to eat and can buy meal replacement products to satisfy breakfast and the protein component of lunch.  For supper, clients are provided with recipes that use the special branded products that they already purchase to make cooking easy. A snack (deemed necessary, I presume) is another food replacement product. There is limited food preparation required.

The diet system promotes fast weight loss — where both carbohydrates and fats are limited.

Since it is overseen by a pharmacist or a nurse, it has the image of being healthy. But is it “ideal”?

As discussed in an earlier article, our bodies have an absolute requirement for specific essential nutrients; nutrients that we must take in our diet because we can’t synthesize them. These are listed in several volumes called the Dietary Reference Intakes (DRIs), published by National Academies Press. There are essential amino acids, fatty acids, vitamins and minerals – and it is necessary to take in adequate protein and fat, when carbohydrate is restricted.

In the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) it reads;

The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed

… however, Ideal Protein® diet restricts both carbs and fats.

It restricts calories.

It restricts cheese and all dairy except for one ounce of milk per day.

It restricts which non-starchy vegetables can be consumed.

It allows no fruit.

It allows no nuts or seeds.

It offers vitamin and mineral supplements and food replacements in place of those real foods.

In the Ideal Protein® system, people are required to eat 4 times a day with carbs contained in the branded meal supplements on each occasion. Research supports that to begin to lower insulin release in insulin-resistant people requires periods of at least a 12 hour where no food is eaten, which naturally occurs after dinner before the first meal of the day breakfast). Having people eat a ‘snack’ would appear to be self-defeating.

Eating a low carb high healthy fat with 3 meals per day, with nothing between supper and breakfast supports the lowering of insulin release, improving the cells insulin sensitivity, in time.  Adding to this periods of intermittent fasting (which is not a total fast, but has no carbohydrates or significant amounts of protein) allows insulin levels to fall even further, which is often the goal of eating a low carb diet.

In the Ideal Protein® system, the meal supplements contain ~15-20 gm protein each and there are 3 of those per day and there is also 8 oz of lean animal protein per day. From the ‘meal packets’, there are 45-60 gms of protein and anywhere from 56 gm of protein (lean ground beef) to 72 gms of protein (chicken breast). In total, the Ideal Protein®  system supplies between 100 gm – 132 gm of protein per day. While carb intake in the Ideal Protein®  system is low, the body would synthesize glucose from the excess protein (called gluconeogenesis) resulting in insulin release. From my understanding, this appears to be self-defeating if the goal is to lower insulin release.

It would seem that the increased gluconeogenesis from the high protein intake in the Ideal Protein® system would not support increased insulin sensitivity as much as a low-carb-high-fat moderate protein diet, even without intermittent fasting.

Another factor is the $500 start-up cost for the first month, plus another  $400+ for each additional month to eat ‘meals’ comprised of largely of meal replacements and supplements, along with some real food.

Ideal Protein® makes it easy and promotes rapid weight loss, but is it really “ideal” for people who have made poor eating choices in the past — when they don’t learn how to make healthy meal choices while achieving weight loss? Weight loss may be quick, but weight loss also has to be sustainable.

Also, is it really “ideal” for people who are insulin resistant when it has them eating food with carbohydrate and protein 4 times per day?

I encourage my clients to eat a wide variety of real foods – foods such as dairy products including cheese,  domesticated and wild meat, poultry and fish, especially fatty fish that are rich in omega 3 fats, low-carb fruit and a vast array of low-carb vegetables. There are fats from all sources, including some healthy saturated fat, with most fat coming from healthy monounsaturated sources such as olives avocadosnuts and seeds. There are no food diaries to keep and no mandatory “weigh-ins” or “check-ins”.  My clients eat real food when they are hungry and don’t eat if they are not hungry.  Most significantly, they learn to make healthy food choices with whole, real food as they lose weight.

Each person needs to evaluate for themselves whether use of the Ideal Protein® system makes sense for them.

As I always do, I recommend that people consult with their own doctor before beginning any weight-loss program.

To your 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.

 

How Much Carbohydrate is Essential in the Diet?

INTRODUCTION: I was asked a question recently on social media as to what is our body’s essential daily requirement for carbohydrate. This is a very good question – so much so, that I decided to answer it in the form of a short article. If you are considering a low carb high fat lifestyle, this is important to understand.


Our body has an absolute requirement for specific essential nutrients; nutrients that we must take in our diet because we can’t synthesize them. What these nutrients are and how much we require depends on our age and stage of life, our gender and other factors and are listed in several volumes called the Dietary Reference Intakes (DRIs), published by National Academies Press.

There are Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005), Dietary Reference Intakes for Calcium and Vitamin D (2011), Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000), Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997), Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005), Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998), Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001).

In these texts are listed the essential amino acids (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine) that must be supplied in the different kinds of protein that we eat.

These texts also establish that there are two essential fatty acids, linoleic (an omega 6 fat) and alpha-linolenic (an omega 3 fat) that can’t be synthesized by the body and must be obtained in the diet.

There are 13 essential vitamins (vitamin A, vitamin B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyrodoxine), B12 (cyanocobalamine), biotin, vitamin C (ascorbic acid), choline, vitamin D (cholecalciferol), vitamin E (tocopherol) and  folate) listed and essential minerals, including major minerals (calcium, phosphorus, potassium, sodium, chloride and magnesium) and minor minerals (chromium, cobalt, copper, fluorine, iodine, iron, manganese, molybdenum, selenium, silicon, sulfur and zinc).

But is there “essential carbohydrate?

In Chapter 6 of the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) is the chapter titled “Dietary Carbohydrates: Sugars and Starches” (pg. 265), which indicates that the  Recommended Dietary Allowance (RDA) for carbohydrate,  considered to be the average minimum amount of glucose needed by the brain, is set at 130 g / day for adults and children.

Recommended Dietary Allowance (RDA) for carbohydrate

It is important to note that the Recommended Dietary Allowance (RDA) for carbohydrate is at 130 g / day based on the average minimum amount of glucose needed by the brain – with no consideration that the body can manufacture this glucose from both FAT and PROTEIN.

Just 10 pages later, in the same chapter of the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) it reads;

The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed. 

The lower limit of dietary carbohydrate

That is, there is no essential need for dietary carbohydrate, provided that “adequate amounts of protein and fat are consumed”.

The text goes on to say that there are traditional civilizations such as the Masai, the Greenland and Alaskan Inuit and Pampas indigenous people that survive on a “minimal amount of carbohydrate for extended periods of time with no apparent effect on health or longevity“, and that white people (Caucasians) eating an essentially carbohydrate-free diet resembling that of the Greenland natives were able to do so for a year, without issue.

That is, the minimum amount of dietary carbohydrate required is zero provided that adequate amounts of protein and fat are consumed. Phrased another way, the “minimum amount of glucose needed by the brain of 130 g / day is made by the body from protein and fat provided they are eaten in adequate amounts.

In the absence of carbohydrate, de novo synthesis of glucose

On the next page (pg. 276) of the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) it explains the process;

“In the absence of dietary carbohydrate, de novo synthesis of glucose requires amino acids derived from the hydrolysis of endogenous or dietary protein or glycerol derived from fat. Therefore, the marginal amount of carbohydrate required in the diet in an energy-balanced state is conditional and dependent upon the remaining composition of the diet.”

That is, even when minimal amounts of carbohydrate is eaten (not something I promote), the body will synthesize the glucose needed by the brain from the protein taken in through the diet (provided it is in adequate amounts) or from glycerol which is formed when fat is broken down. If the protein in the diet (exogenous protein) is inadequate however, the body’s own protein (endogenous protein) will be used.

So, no, there isn’t any “essential carbohydrate” requirement.

Even when a person is completely fasting (religious reasons, medically supervised, etc.) the 130 g / day of glucose needed by the brain is made from endogenous protein and fat.

When people are “fasting” the 12 hour period from the end of supper the night before until breakfast (“break the fast”) the next day, their brain is supplied with essential glucose! Otherwise, sleeping could be dangerous.

In previous articles reviewing long-term studies of low carbohydrate diets, safety and efficacy has been established with intakes as low as 20 gm of carbs for 12 weeks and 35 gm of carbohydrate per day for extended periods of time, provided adequate protein and fat is eaten.

I am of the opinion that in order to have a diet with the essential vitaminsminerals, amino acids and fatty acids, that a wide range of healthy foods with some carbohydrate content is required.  I encourage people to consume low carb fruit and dairy products and nuts and seeds, along with a wide range of meat, fish and poultry, eggs and even tofu, if desired. I design each person’s Meal Plan to meet their individual requirements, lifestyle as well as the foods they like and take into consideration whether they like to cook or prefer meals with the minimum of preparation required.

Have questions?

Please send me a note using the “Contact Me” located on the tab above and I will reply soon.

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.

 

 

Low Fat Calorie Restricted Diet versus Low Carbohydrate Diet – a two year study

INTRODUCTION: To date, there have been 3 long-term clinical trials (2 years) published over the past 10 years involving “low carb diets”. In this post I review the third study which compares the effects of a low fat calorie restricted diet compared with a low carbohydrate diet and finding significantly better lipids at 1 year, before carbs were liberalized.


Purpose and Overview of the Study

The purpose of this randomized, controlled trial was to evaluate the long-term (2-year) effects of treatment with either a low-carbohydrate or low-fat, calorie-restricted diet on weight, cardiovascular risk factors, and bone mineral density — with the primary outcome being weight loss at 2 years.

All participants received comprehensive behavioral treatment to enhance weight loss associated with both diets and assessments were conducted at baseline, 3 months, 6 months, 12 and 24 months.

Inclusion Criteria

Primary inclusion criteria were age of 18 to 65 years, Body Mass Index (BMI) of 30 to 40 kg/ (m) x (m) and body weight less than 136 kg (300 pounds).

Exclusion Criteria

Exclusion criteria were participants with serious medical illnesses such as Type 2 Diabetes, lipid-lowering medications for dyspidemia, medications that affect body weight (including anti-obesity agents), blood pressures of 140/90 mm Hg or more (regardless of whether it was treated), and  pregnancy  or lactation.

Participants

A total of 307 adults (208 women and 99 men) with a mean age of 45.5 years and a mean Body Mass Index of 36.1 kg /(m) x (m) participated in this study.

Most (74.9%) participants were white; 22.1% were African American and 3% were of other race or ethnicity.

After a scripted phone screening, eligible participants attended an in-person screening during which the study’s purpose and requirements were discussed, eligibility confirmed and written informed consent was obtained.

Using a random-number generator, researchers randomly assigned participants (within each of 3 sites) to either a low carbohydrate treatment for 2 years, or a low fat calorie restricted diet for 2 years.

All participants completed a comprehensive medical examination and routine blood tests. There were no statistically significant differences between the two diet groups in any baseline variables.

The study, including recruitment and enrollment took place from March 2003 to June 2007.

Low Carbohydrate Diet

Approximately half of the participants (n = 153) were assigned to a low carbohydrate diet, which limited carbohydrate intake but allowed unrestricted consumption of fat and protein.

First 12 weeks of treatment

During the first 12 weeks of treatment, participants were instructed to limit carbohydrate intake to 20 g / day in the form of low–glycemic index vegetables.

After 12 weeks on very low carbohydrates

After the first 12 weeks, participants gradually increased carbohydrate intake each week by 5 g / day per week by consuming more vegetables, a limited amount of fruits, small quantities of whole grains and dairy products, until a stable and desired weight was achieved.

Subjects followed the guidelines outlined in Dr. Atkins’ New Diet Revolution, but were not provided with a copy of the book.

Participants were instructed to focus on limiting carbohydrate intake and to eat foods rich in fat and protein until they were satisfied.

The primary behavioral target was to limit carbohydrate intake.

Low-Fat Calorie Restricted Diet

Approximately half of the participants (n= 154) were assigned to eat a low fat diet which limited energy to 1200 to 1500 kcal / day for women and 1500 to 1800 kcal / day for men.

Approximately 55% of calories came from carbohydrate, 30% from fat and 15% from protein (comparable to the recommendations of Canada’s Food Guide for Healthy Living).

Participants were instructed to limit calorie intake, with a focus on decreasing fat intake, however limiting overall energy intake (kcal / day) was the primary behavioral target.

Group Behaviour Treatment

All participants received comprehensive, in-person group behavioral treatment weekly for 20 weeks, every other week for 20 weeks and then every other month for the remainder of the 2-year study period.

Each treatment session lasted 75 to 90 minutes.

Topics included self-monitoring, stimulus control and relapse management.

Group sessions reviewed participants’ completion of their eating and activity records, as well as other skill builders.

Participants in both groups were instructed to take a daily multivitamin supplement (provided by the study).

Physical Activity

All participants were prescribed the same level of physical activity (mainly walking), beginning at week 4, with four sessions of 20 minutes each and progressing by week 19 to four sessions of 50 minutes each.

Outcomes and Measurements

Body Weight— measured at each treatment visit on calibrated scales while participants wore light clothing and no shoes. The primary outcome was weight at 2 years.

Height — measured by a stadiometer at baseline.

The following measurements were collected at baseline and at 3, 6, 12 and 24 months:

Serum Lipoproteins — measured plasma high-density lipoprotein (HDL) cholesterol and triglyceride levels. Very-low-density lipoprotein (VLDL) cholesterol and low-density
lipoprotein (LDL) cholesterol concentrations were directly measured by β-quantification. Blood samples were obtained after participants fasted overnight (12 hours).

Blood Pressure— assessed after participants were sitting quietly for 5 minutes and using automated instruments with cuff sizes based on measured arm circumference.  Two readings of blood
pressure were obtained, separated by a 1-minute rest period with the average of the two readings used.

Urine Ketones— Bayer Ketostix were used to measure fasting urinary ketones and were characterized as negative (0 mg/dL) or positive (trace, 5 mg/dL; small, 15 mg/dL; moderate, 40 mg/dL; or large, 80 to 160 mg/dL).

Bone Mineral Density and Body Composition (percentage of body fat)—assessed using dual-energy x-ray absorptiometry at baseline and at 6, 12 and 24 months.

Attrition—There were no statistically significant differences between the two groups in terms of attrition; defined as not undergoing an assessment at a specific time point, independent of the reason.

Results

Body Weight— participants in both groups lost approximately 11% of initial weight at 6 and 12 months, with subsequent weight regain to a 7% weight loss at 2 years . There was no statistically significant differences in weight loss at any time point between the low carbohydrate and low-fat calorie restricted groups, although there was a strong trend for greater weight loss in the low-carbohydrate group at 3 months.

Urinary Ketones—percentage of participants who had positive test results for urinary ketones was greater in the low carbohydrate than in the low fat calorie restricted group at 3 months (63% vs. 20%) and at 6 months (28% vs. 9%). Researchers found no statistically significant differences between groups after 6 months and they noted that the decrease from 3 to 24 months is consistent with liberalization of carbohydrate intake over time, as part of the study protocol.

Blood Pressure—Systolic blood pressure decreased with weight loss in both diet groups relative to baseline and did not significantly differ between groups at any time.  Reductions in diastolic pressure were significantly greater (2 to 3 mm Hg) in the low carbohydrate than in the low-fat group at 3 and 6 months with a strong trend at 24 months.

Plasma Lipid Concentrations—Most of the differences in plasma lipid concentrations between the two groups were observed during the first 6 months of the diets.

LDL cholesterol: Researchers found a significantly greater decrease in LDL cholesterol levels at 3 and 6 months in the low-fat calorie restricted group than in the low carbohydrate group, but this difference did not persist at 12 or 24 months. There may be reasons for this, discussed below.

Triglyceride levels: Decreases in triglyceride levels were greater in the low-carbohydrate group than in the low-fat calorie restricted group at 3 and 6 months, but not at 12 or 24 months.

VLDL cholesterol: Decreases in VLDL cholesterol levels were significantly greater in the low-carbohydrate group than in the low-fat calorie restricted group at 3, 6, and 12 months but not at 24 months.

HDL cholesterol: Increases in HDL cholesterol levels were significantly greater in the low-carbohydrate group than in the low-fat calorie restricted group at 3, 6, 12 and 24 months.

Total-cholesterol : HDL cholesterol: The ratio of total-cholesterol to HDL cholesterol levels decreased significantly in both groups through 24 months but did not significantly differ between groups at any time. There was a trend for greater reductions in the low-carbohydrate group at 6 months and 12 months.

Summary: The only effect on plasma lipid concentrations that persisted at 2 years was the significantly greater increases in HDL cholesterol levels among low-carbohydrate participants.

Bone Mineral Density and Body Composition— researchers found no differences between the two groups in changes in bone mineral density or body composition over 2 years.

Findings

  1. Neither dietary fat nor carbohydrate intake influenced
    weight loss when combined with a comprehensive lifestyle intervention.  That is, participants had similar and clinically significant weight losses with either a low carbohydrate or low-fat calorie restricted diet at 1 year (11%) and 2 years (7%). Researchers concluded that this demonstrates that either diet
    can be used to achieve successful long-term weight loss. if coupled with behavioral treatment.
  2. Researchers concluded that because both diet groups achieved nearly identical weight loss, a low-carbohydrate diet has greater beneficial long-term effects on HDL cholesterol concentrations
    than a low-fat calorie restricted diet.
  3. While researchers found a significantly greater decrease in LDL cholesterol levels at 3 and 6 months in the low-fat calorie restricted group than in the low-carbohydrate group, this difference did not persist at 12 or 24 months. Researchers  concluded that since assessment of LDL cholesterol concentration was without information on LDL particle size, no information was obtained in terms of coronary heart disease risk (small, dense LDL particles are more atherogenic than large LDL particles).
  4. The low-carbohydrate diet caused a decrease in plasma triglyceride concentration that was more than double the reduction observed with a low-fat calorie restricted diet at 3, 6, and 12 months however plasma triglyceride concentration returned toward baseline in the low-carbohydrate
    group, such that the two groups did not differ significantly at 2 years.
    [Note: The rise in triglycerides after desired weight was achieved may have been the result of the liberalization of the low carbohydrate diet by the inclusion of fruit, dairy and small amounts of whole grains which may have been responsible for driving triglyceride levels up.]
  5. The greater decline in directly measured VLDL cholesterol concentration in the low-carbohydrate at 3, 6, and 12 months was not sustained at 2 years. Researchers found no significant differences between the two groups in VLDL cholesterol. Researchers concluded that the close relationship and tracking  between fasting plasma triglyceride concentrations (which are primarily contained within VLDL) and VLDL cholesterol  concentrations supports a model in which during the first year of the study the low-carbohydrate diet (a) decreased hepatic VLDL secretion, (b) enhanced VLDL clearance, or both when compared with the low-fat calorie restricted diet.
    [Note: Again, the liberalization of the low carbohydrate diet after  desired weight was reached and the inclusion of fruit, dairy and small amounts of whole grains into the diet may have been responsible.]
  6. Plasma HDL cholesterol concentration increased by approximately 20% at 6 months in the low-carbohydrate diet group, which persisted throughout the study and was more than twice the increase observed in the low-fat calorie restricted diet group. Researchers concluded that the magnitude of the change observed in the low-carbohydrate diet group approximates that obtained with the maximal doses of nicotinic acid (niacin), the most
    effective HDL-raising pharmacologic intervention that was available at the time of the study (2010).

Conclusion

This 2-year, randomized control study of more than 300 participants found that both diet groups achieved clinically significant and nearly identical weight loss (11% at 6 months and 7% at 24 months) and that people who ate the low-carbohydrate diet had greater 24-month increases in HDL-cholesterol concentrations than those who ate a low-fat calorie restricted diet.

As well, an significant finding of this study was a very favourable lowering of LDL for the first 6 months and lowering of both TG and VLDL for the first year. It is unknown whether these results would have persisted and been sustained had the low carb group not been permitted to liberalize their diet by the inclusion of fruit, dairy and small amounts of grain products, once they achieved their desired weight loss.

These long-term data certainly provide evidence that a low-carbohydrate diet is both a safe and effective option for weight loss and that this style of eating has a prolonged, positive effect on lipid profiles – certainly while intake of carb-containing foods are restricted.

References

Foster GD, Wyatt HR, Hill JO et al, Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial, Ann Intern Med. 2010 Aug 3;153(3):147-57

Part II- Understanding Low Carb High Fat – the solution

INTRODUCTION – In Part I of this two-part series, I explained how the current dietary recommendations and popular beliefs about weight gain have inadvertently contributed to many of the health problems we now face.  If you haven’t yet read the first part, you can read it here and then follow the link back to continue reading this article.

In this post, I point to some previously written articles posted on this site to explain what a Low Carb High Fat style of eating is and how it serves as a solution to the problems outlined in the previous article.

Part II – Understanding Low Carb High Fat – the solution

Low Carb High Healthy Fat – food categories (acknowledgements: adapted from an illustration by Dr. Ted Naiman)

What exactly is a Low Carb High Fat Diet?  This article explains the fundamental information people want to know about which food categories they can eat, such as  non-starchy vegetables, plant fat, low sugar fruit, meat fish poultry and seafood, animal fat and unsweetened beverages).

There is also a simple illustration of the food categories in a low carb lifestyle, indicating the types of food in each category. This dispels the myth that eating LCHF is in anyway a ‘restricted diet’.

This post also explains what macronutrients are and what the ratios of protein, fat and carbohydrate are on a LCHF diet. It is a basic primer about the Low Carb High Fat lifestyle.


People sometimes refer to a “low carb diet” as if it were a single entity, but there are many types of low carb diets ranging from moderate low carb (130 g carbs) to ketogenic diets (5-10% net carbs). Even amongst low carb or ketogenic diets, there are low carb high fat diets,  low carb high protein diets as well as Low Carb High Protein in weight loss and High Carb High fat in maintenance.


This article titled American Diabetes Association Approves Low Carb Diets for Weight Loss explains the basics of a moderate low carb diets (130 g carbs) which is approved by the American Diabetic Association as a weight-loss option for Diabetics.


Many people believe that saturated fat is “bad” for them but few realize that our bodies actually manufacture it. This article titled The “Skinny” on Fats explains the principles of fats while explaining the chemistry in simple terms that those with a non-science background can understand.  These ‘basics’ enable people to understand the controversy around saturated fat and to be able to talk about them with family members, friends, and their healthcare professionals.


People are used to thinking about food in terms of its ability to provide energy for their body but many don’t realize that their bodies can be fuelled by either carbohydrates or fat.  This article titled Humans – the perfect hybrid machine explains how in times past it was perfectly normal for us to experience a cycle of “feasting” and “fasting” – running on our own fat stores during the times between eating and how currently, we rarely are able to access our own fat stores, because of the constant supply of carbohydrate-rich food.


This article, titled Evidence for Remission of Type 2 Diabetes Symptoms using LCHF begins with a brief history of the Low Carb Diet and its role the primary approach to managing Diabetes prior to the discovery of insulin. It also talks about its role in managing seizure disorder and outlines how a Low Carb approach was central to the very first weight loss diet book written ~150 years ago.  It mentions the “Atkins Diet” which first came on the scene in the early 1970s and then introduces the research of Stephen Phinney (a medical doctor and PhD research scientist) and Jeff Volek, a Registered Dietitian with PhD whose work centers on using a low carb diet as a therapeutic tool for managing insulin resistance.  It presents the findings of Phinney and Volek’s most recent study which demonstrates that after 6 months following a low carb diet >75% of people in this study had HbA1c that was no longer in the Diabetic range (6.5%). It provides some evidence that yes, the symptoms of Type 2 Diabetes can to go into remission by following a Low Carb lifestyle.


Finally, the last article titled Are Low Carbohydrate Diets Safe and Effective provides compelling evidence from a two-year study which found that compared to a Mediterranean Diet and Low Fat diet, weight loss was greatest in those that followed a Low Carb diet. Of significance, subjects in in the LCHF group in this study also had lower fasting plasma glucose, lower HbA1C, significantly lower triglycerides, significantly higher HDL and lower C-reactive protein .


More Info

Want to know how I can help you adopt a low carb lifestyle?

I provide LCHF in-person services to those in the Greater Vancouver BC area and LCHF Distance Consultation services to those living elsewhere in the province, or from other provinces and territories in Canada. Please have a look at the “My Services” tab above for a list of the LCHF services that I provide.

Have questions? Please send me a note using the “Contact Me” form located on the tab above.

 

 

 

Part I – Understanding Low Carb High Fat – the problem

INTRODUCTION – If you are one of those that is considering adopting a low carb high fat lifestyle and want to understand the reasons behind ‘why’, this post is for you. It will guide you through a handful of previously written articles on this site so that you’ll understand how the current dietary recommendations and popular beliefs about weight gain have inadvertently contributed to many of the health problems we now face.

As in anything, before considering a solution to a problem, we first need to understand the problem.

Part I – Understanding Low Carb High Fat – the problem

In 1977, the US and Canada changed their Dietary Recommendations  encouraging us to eat 45-65% of daily calories as carbohydrate and to limit all kinds of fat to 20-35%. Of relevance, in the early 1970s, prior to these changes only ~8% of men and ~12% of women were obese – and now almost 22% of men and 19% of women are obese.

The article titled Obesity Rates in Canada and Changes to Canada’s Food Guide will walk you through the changing recommendations of Canada’s Food Guide (CFG) over the years, as well as the corresponding and  simultaneous increase in the rates of overweight and obesity.


Unfortunately the dietary changes of 1977 have given us 40 years of data showing ever-increasing rates of obesity, overweight and Diabetes. It is quite literally an “epidemiological* experiment gone wrong”.  This article titled Canada’s Food Guide – an Epidemiological Experiment Gone Terribly Wrong will help you understand some of the shortcomings of the guide, as it stands now.

*Epidemiology is the study and analysis of the patterns, causes, and effects of health and disease in populations.

We’ve been told for years that the problem is that we “just need to eat less and exercise more“.  If it were really that simple then 4.7 million adults in Canada wouldn’t be classified as obese and more than 40% of men and 27% of women classified as overweight.  This article titled Why do we Gain Weight – the Myth of “Calories in, Calories out” will explain why this model doesn’t work.


We’ve also been told that people are overweight because “they lack self control” but this article titled Weight Gain as a Hormone Imbalance not a Calorie Imbalance explains how body weight is regulated automatically under the influence of hormones – hormones that signal us to eat and indicate when we are satiated. These hormones also signal our bodies to increase energy expenditure and when calories are restricted, they will slow energy expenditure. It’s not a matter of people “trying harder” but eating in such a way as to regulate these hormones.


In Part II titled Understanding Low Carb High Fat – the solution, I explain what a Low Carb High Fat style of eating is and how it serves as a solution to the health problems we now face.

 

Four Diets over Two Years – long term findings

INTRODUCTION: To date, there have been 3 long-term clinical trials (2 years) published over the past 10 years involving “low carb diets”.

The first long-term study that was presented in the previous article (which can be read here) clearly demonstrated that a low carb non–calorie-restricted diet was both safe and effective and produced the greatest weight loss, lower FBS and HbA1C, the most significantly lower TG and higher HDL and lower C-reactive protein (when compared with a low-fat calorie-restricted diet and a Mediterranean calorie-restricted diet).

In this, the second of the three long term studies, researchers looked at the effectiveness of four dietary interventions with different composition of fat, protein and carbohydrate – including one “low carb” diet..

Did this study demonstrate that a “low carb” diet was safe and effective to result in weight loss?

Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates

Participants

This study involved over 800 overweight and obese subjects, of which 40% were men. Subjects were between the ages of 30 and 70 years and had a Body Mass Index (BMI) of 25-40, where BMI is the weight in kilograms divided by the square of the height in meters.

BMI =25.0-29.9 is considered overweight
BMI = 30.0-34.9 is Class I obesity
BMI = 35.0-39.9 is Class II obesity
BMI ≥ 40.0 is Class III obesity

Major criteria for exclusion from this study were the presence of Diabetes or unstable cardiovascular disease, the use of medications that affect body    weight and insufficient motivation as assessed by interview and questionnaire.

Of the 811 subjects that began the study, at the end of two years, 645 subjects remained enrolled. Approximately 80% of the participants were white, 15% black, 4% Hispanic and the remaining 1% Asian.

The Four Diets – high/low fat, high/low protein

The 811 overweight adults were randomly assigned to one of four diets:

  1. Low Fat, Average Protein: fat: 20%, protein: 15%, carbohydrate: 65% (202 subjects)
  2. Low Fat, High Protein: fat: 20%, protein: 25%, carbohydrate: 55% (202 subjects)
  3. High Fat, Average Protein: fat: 40%, protein: 15%, carbohydrate: 45% (204 subjects)
  4. High Fat, High Protein: fat: 40%, protein: 25%, carbohydrate: 35% (201 subjects)
Two Diets were Low Fat but Two were not High-Fat Diets

The researchers stated that “two diets were low-fat and two were high-fat”, but it is important to note that none of the diets were “low carb high fat”/ ketogenic diets, which are ≥ 65% fat (not 40% fat). Two of the diets were higher in fat than the recommended dietary intake (in both the US and Canada).

Two Diets were Average Protein but not High Protein

The researchers said that “two diets were average protein and two were high protein” and while the ‘average protein intake’ in the US in 2008 was ~15%  (16.1% for men and 15.6% for women), diets such as two of the ones in this study that have only 25% protein are really at the very lowest range of what are considered high-protein diets – which normally contain between  27 – 68 % protein. Also important to note, a “low carb high fat”/ ketogenic diet usually has ~20% protein (considered ‘moderate protein’) and are not high protein diets.

Two Diets were High Carb and One Diet was Moderate Carb

The first and second dietary interventions would both be considered high carb, as they fall within the range of the dietary recommendations in both  Canada and the USA, 45-65% carbohydrate, with one being higher protein and one being average protein.

The third diet would be consider “moderate carb” according to Diabetes Canada’s standards, at 45 % carbohydrate, and higher fat and higher protein.

One Diet was Low Carb but not Ketogenic – and not Low Carb High Fat

The fourth diet could be considered ‘low-carb’ at 35% carbohydrate, but it is not a ketogenic diet, as the percent of carbohydrate is too high. A ketogenic diet has between 5-10% carbohydrate.  It was not a “high fat diet”, as the fat is only 40%, not ≥ 65% fat.

None of the dietary interventions in this study was 'low-carb high fat' or ketogenic, however one diet was "low carb".
Other Study Goals and Information

Other goals for all the dietary interventions were that the diets had;
– 8% or less of saturated fat
20 g or more of dietary fiber
150 mg or less of cholesterol per 1000 kcal

Each participant’s calories represented a deficit of 750 kcal per day
from baseline, as calculated from the person’s resting energy expenditure and activity level (which should have promoted a weight loss of ~ 1.5 pounds per week).

Blinding between the groups was maintained by the use of similar foods in each of the dietary interventions.

Staff as well as participants were taught that each diet adhered to principles of a “healthful diet” and that each had been recommended for “long-term weight loss”.

Group dietary counselling sessions were held once a week, 3 of every 4 weeks during the first 6 months and 2 of every 4 weeks from 6 months to 2 years; individual sessions were held every 8 weeks for the entire 2 years. Behavioral counseling was integrated into the group and individual sessions to promote adherence to the assigned dietary intervention.

Participants were instructed to record their food and beverage intake in a daily food diary and in a web-based self-monitoring tool that provided information on how closely their daily food intake met their dietary intervention’s goals for macronutrients and calories.

The goal for physical activity was 90 minutes of moderate exercise per week. Participation in exercise was monitored by questionnaire and by
the online self-monitoring tool.

Measurements

Body weight and waist circumference were measured in the morning before breakfast on 2 days at baseline, 6 months, and 2 years, and on a single
day at 12 and 18 months.

Levels of serum lipids, glucose, insulin, and glycated hemoglobin (HbA1C) were measured via fasting blood samples, and 24-hour urine samples, and measurement of resting metabolic rate were obtained on 1 day, and blood-pressure measurement on 2 days, at baseline, 6 months and 2 years.

Results

Weight loss and Waist Circumference

The amount of weight loss after 2 years was similar in participants assigned to a diet with 25% protein and those assigned to a diet with 15% protein.

Weight loss was the same in those assigned to a diet with 40% fat and those assigned to a diet with 20% fat.

There was no effect on weight loss of carbohydrate level through the target range of 35 to 65%.

Most of the weight loss occurred in the first 6 months, however 23% of the participants continued to lose weight from 6 months to 2 years.

The change in waist circumference did not differ significantly among the diet groups.

At 2 years, 31 to 37% of the participants had lost at least 5% of their initial body weight, 14 to 15% of the participants in each diet group had lost at least 10% of their initial weight, and 2 to 4% had lost 20 kg or more.

Risk Factors for Cardiovascular Disease and Diabetes

All the diets reduced risk factors for cardiovascular disease and Diabetes at 6 months and 2 years.

At 2 years, the two low-fat diets and the highest-carbohydrate diet decreased low-density lipoprotein (LDL) cholesterol levels more than did the high-fat diets or the lowest-carbohydrate diet, 5% vs 1%. And at 2 years, the highest carbohydrate decreased LDL more (6%) versus the lowest carbohydrate diet (1%).

The lowest-carbohydrate diet increased HDL cholesterol levels more (9%) compared with the highest-carbohydrate diet (6%).

All the diets decreased triglyceride (TG) levels similarly, by 12 to 17%.

All the diets except the one with the highest carbohydrate content decreased fasting serum insulin levels by 6 to 12% – and the decrease was larger with
the high-protein diet than with the average-protein diet (10% vs. 4%).

Blood pressure decreased from baseline by 1 to 2 mm Hg, with no significant differences among the groups.

The metabolic syndrome (defined as elevated fasting blood glucose, elevated blood pressure and abnormal triglycerides or cholesterol levels) was present in 32% of the participants at baseline, and the percentage at 2 years ranged from 19 to 22% in the four diet groups.

Diet Adherence

Mean reported intakes at 6 months and at 2 years were not at the target levels for macronutrients (fat, protein and carbohydrate). This limits the applicability of the data.

In the Low Fat, Average Protein group (fat: 20%, protein: 15%, carbohydrate: 65%), carbohydrate intake decreased from baseline by 12.8% and by 9.3% from baseline at 2 years and fat intake decreased from baseline by 11.8% at 6 months and 12.0% at two years. As it should have, protein intake hardly changed at 6 months (0.2%) but by 2 years it had increased by 2.1% to 19.6%.

In the Low Fat, High Protein group (fat: 20%, protein: 25%, carbohydrate: 55%) at 6 months carbohydrate intake decreased from baseline by 7.4% and at 2 years, it decreased from baseline by 6.8%. Protein intake increased from baseline by 3.9% at 2 years it had increased by 2.5% – but it is important to note that such a modest increase meant that this group did not consume a diet of 25% protein (but slightly less than 19% at 6 months and 17.5% at 2 years). Fat intake decreased from baseline by 11.8% at 6 months and 12.0% at two years.

In the High Fat, Average Protein group (fat: 40%, protein: 15% carbohydrate: 45%), at 6 months carbohydrate intake  decreased from baseline by 5.0% and at 2 years, it decreased from baseline by 2.4%. Protein intake hardly increased from baseline at 6 months (0.5%), but at 2 years it had increased from baseline by 2.1%. Fat intake in this group was supposed to have increased, but actually decreased from baseline by 3.8% at 6 months and decreased from baseline by 2.1% at two years.

In the High Fat, High Protein group (fat: 40%, protein: 25%, carbohydrate: 35%) – which was the only intervention that was “low carb”, at 6 months carbohydrate intake only decreased from baseline by 0.2% and at 2 years, it decreased from baseline by 0.4%. In fact, carbohydrate remained at ~ 43% the entire time. Protein intake was supposed to increase substantially, but only increased from baseline by 4.3%, and at 2 years it had had only increased from baseline by 3.4%. It is important to note that such a modest increase in protein meant that this group did not consume a diet of 25% protein but ~19.3 % at 6 months and ~18.4% at 2 years. Fat intake in this group was supposed to have increased, but actually decreased from baseline by 3.7% at 6 months and decreased from baseline by 3.4% at two years.

Neither of the "high protein" groups achieved anywhere near 25% of daily calories as protein.

Despite the intensive behavioral counseling in this study, participants did not achieve the goals for macronutrient intake of their assigned group and while some data in this study is helpful, the one group that was supposed to be “low carb” (high fat, high protein) was none of those!

Researcher’s Conclusion

The researchers concluded;

“we did not confirm previous findings that low-carbohydrate or high protein diets caused increased weight loss at 6 months”

High Protein Diet “Fail”

The reason that this study failed to confirm whether a high protein diet causes increased weight loss at 6 months is because neither of the two “high protein” diet groups in this study ate anywhere near the target protein level of 25%, but rather ate between 17.5%-19% protein,  which is remarkably close to the average protein intake of 15%  (16.1% for men and 15.6% for women). Subjects also ate no where near the lower limits of a “high protein” diet, which is 27-68% of daily calories as protein.

Low Carbohydrate Diet “Fail”

The reason that this study failed to confirm that a low carbohydrate diet causes increased weight loss is because the one group of the four diet interventions that was supposed to eat what the researchers defined as “low carb” (35% of calories as carbohydrate) ate ~43% of calories as carbohydrate the entire duration of the study. This as a moderate carb diet, not a low carb diet.

Final Thoughts

In this long term study, researchers set out to look at the effectiveness of four dietary interventions including a “low carb” diet group, however poor study design failed to produce even one of the four groups that ate low carb.

References

Sacks FM, Bray GA, Carey VJ et al, Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates, N Engl J Med. 2009 Feb 26;360(9):859-73

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?

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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.

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

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.

Food as Medicine to Lower Blood Glucose – scientific support

In two recent A Dietitian’s Journey posts, I wrote about the positive impact certain foods, such as apple cider vinegar, ginger and turmeric root have had on my blood sugar levels and more recently, about kombucha and kimchi. In this article I touch on the science to support the use of these foods to lower blood glucose levels.

Apple Cider Vinegar

Apple cider vinegar has long been popular as a folk remedy for high blood sugar and a 1988 study demonstrated that vinegar lowered both blood glucose levels and insulin following the eating of complex carbohydrates (starch) and simple carbohydrates (sucrose). It is now known that vinegar acts by a similar mechanism as the Diabetes medication Metformin® and increases fat burning, increases glucose movement into cells and increases insulin sensitivity. This may account for the effectiveness of vinegar in lowering blood glucose that has been know historically and has now been demonstrated in human clinical trials.

2004 study

A 2004 study, looked at the effectiveness of apple cider vinegar in reducing blood glucose levels after a meal (postprandial) as well as insulin levels in subjects with varying degrees of insulin resistance. The small study included both non-Diabetic subjects and those with Type 2 Diabetes. The non-Diabetic subjects were either insulin sensitive (n=8) or insulin resistant (n = 11) and there were 10 subjects with Type 2 Diabetes.

Fasting subjects were randomly assigned to either drink (1) 20 g apple cider vinegar with 40 g water and 1 tsp saccharine to sweeten it or (2) a placebo (water) drink. After a week of testing, subjects switched groups, so if they previously drank the placebo, they now took the apple cider vinegar.

After a 2-minute delay, subjects ate a white bagel, butter and orange juice (87 g total carbohydrates) and blood samples measuring blood glucose  and insulin levels were taken 30 minutes and 60 minutes after eating the test meal.

As would be anticipated, fasting blood glucose was higher in ∼55% of subjects with Type 2 Diabetes compared with the non-Diabetic insulin sensitive and non-Diabetic insulin resistant groups and fasting insulin  was 95–115% higher in both the subjects with Type 2 Diabetes and the non-Diabetic insulin resistant group

Compared with the placebo, the insulin resistant subjects that drank the apple cider vinegar had 34% higher whole-body insulin sensitivity 60 minutes after the high carbohydrate test meal and the subjects with Type 2 Diabetes had 19% higher whole-body insulin sensitivity.

This study demonstrated that apple cider vinegar taken before a meal containing carbohydrate can significantly improve insulin sensitivity in insulin-resistant subjects – both those with Type 2 Diabetes and those with ‘pre-Diabetes’ (i.e. insulin resistant, non-Diabetic).

2015 study

A 2015 study looked at the effect of vinegar on glucose metabolism in muscle, as it is considered the most important tissue for insulin-stimulated glucose disposal.

Subjects with Type 2 Diabetes drank either (1) 30 mL vinegar (6% acetic acid) and 20 mL water or (2) a placebo drink (water) before a mixed meal of bread, cheese, turkey ham, orange juice, butter and a cereal bar (with a total of 75 g carbohydrates, 26 g protein and 17 g fat).

Blood glucose, and insulin levels were measured in the subject’s forearm at 30 minutes and 60 minutes before the meal and 300 min after the meal was eaten and compared to placebo, vinegar increased forearm glucose uptake and decreased plasma glucose and decreased plasma insulin.

Researchers concluded that vinegar’s effect on carbohydrate metabolism may be partly accounted for by an increase in glucose uptake, demonstrating an improvement in insulin action in skeletal muscle.

NOTE: The amount of apple cider vinegar taken before meals in these two studies were 1.5 Tbsp. (20 mL) or 2 Tbsp. (30 mL).

Mechanism of Action

When taken with or just before meals, it is believed that vinegar slows gastric emptying, delays the uptake of glucose and slows the rise in blood sugar following a meal (2 hours postprandial).

Vinegar also stimulates an enzyme called AMP-activated protein kinase (AMPK) that increases fat oxidation, improves glucose uptake and insulin sensitivity and lowers glucose production (gluconeogenesis) in the liver.  This is similar to how the diabetic medication Metformin works (see Zhou et al, 2001).

NOTE: This article is not proposing that foods such as vinegar are substitutes for medication prescribed by a doctor.

Activation of AMPK by vinegar has been demonstrated in the liver of vinegar fed rats and in human endothelial cells in vitro (see Kondo et al 2009, Sakakibara et al 2006, 2010, Li et al 2013) and this may account for the effectiveness of vinegar in lowering blood glucose that has been demonstrated in the human clinical trials, above.

Taking vinegar at meals has also been reported to significantly lower the glucose response after a meal (postprandial) – presumably by slowing the absorption of starch or polysaccharides (see Johnson 2009, 2010, Ostman et al 2005).

Ginger

Ginger was shown to have blood glucose lowering activity in a 2004 study that found that pre-meal treatment with ginger lowered induced high blood glucose levels (hyperglycemia).

A 2015 study evaluated the effects of a ginger powder supplement on  fasting blood glucose levels and hemoglobin A1c (HbA1c) in Type 2 Diabetics. To be included, subjects needed to have been diagnosed as T2D for at least 2 years, have a HbA1c level of 6-8%, as well as taking no antioxidant supplements for at least 3 months prior to the study, and no smoking and drinking. Subjects that took insulin before or during the study were excluded, as were those that had a change in the type or dose of medication, changes in diet or any illnesses during the study.

The fifty subjects of both genders were divided randomly into and experimental and control group, with 25 subjects in each and received either a ginger-containing capsule or a placebo capsule twice a day for 12 weeks. All subjects took their usual medications for T2D and were stable on their dose.

Of 50 patients that began the study, 41 subjects completed the study (22 in the ginger group and 19 in the control group).

Fasting blood glucose levels after the intervention study were 19.4% lower in the ginger supplemented group than in the placebo group and HbA1C was .77% lower in the ginger supplemented group than in the placebo group. It was concluded that a study with more subjects and a longer study period were needed for a better observation of the effects of ginger in improving blood glucose in those with Type 2 Diabetes.

Turmeric Root

Turmeric root (Curcuma longa) is a rhizome of the ginger family that gives curry powder (which is a mixture of several spices) its characteristic yellow colour. Turmeric has been used in both Ayurvedic and traditional Chinese medicine to lower blood sugar levels. The active component of turmeric, is curcumin.

An extensive literature review of studies on curcumin was conducted and published in 2013 with more than 200 publications retrieved using the search term “curcumin and diabetes” from the MEDLINE database, with the earliest being a case study from 1972 and curcumin has since been extensively studied in animal models of Diabetes and in a few clinical trials with subjects with Type 2 Diabetes. The conclusion of the literature review was that there is ample evidence in the scientific literature regarding the use of curcumin as a potential treatment for Diabetes as well as its associated complications.

Note: when using turmeric, be sure to add a few grinds of black pepper as it increases the bioavailability of the curcumin by ~2000 times.

Fermented Foods – Kombucha, Kimchi and Jun

Kimchi

Fermented foods, such as kombucha and kimchi are popular as probiotics for enhancing the microbiota of our intestine.  Research in the field has focused on what role this complex bacterial community plays in health and disease in people, and how we can alter the microbiota through the foods and beverages we consume. The benefit of eating foods and drinking beverages with these probiotics has been demonstrated in studies and include improvement of constipation, diarrhea, irritable bowel syndrome (IBS), intestinal inflammatory conditions such as Crohn’s and colitis, as well as an improvement in immune function.

homemade kimchi

Lactic acid bacteria are the most widely used strains used to ferment foods; from sauerkraut, kosher dill pickles to kimchi, a staple of the Korean diet.  For lactic acid bacteria to benefit the microbiota of the human intestines however, they first must be able to survive the hostile environment of digestion, which include extreme acidity, and digestive enzymes, and bile acids – not to mention low oxygen availability, and regulated temperature. It has been demonstrated in studies that they do.

2014 meta-analysis

A meta-analysis published in 2014 examined the effect of probiotics on glucose metabolism in patients with Type 2 Diabetes Mellitus of randomised-controlled studies where fasting blood glucose, glycosylated hemoglobin (HbA1c), insulin concentration or homeostasis model assessment of insulin resistance (HOMA-IR) changes were reported for the intervention and control groups.

Seven trials met the search criteria and results indicated that probiotic consumption significantly changed fasting plasma glucose by –0.9 mmol/L (-15.92 mg/dL). The duration of intervention for ≥8 weeks resulted in a significant reduction in fasting blood glucose of 1.2 mmol/dL (-20.34 mg/dl). HbA1C was significantly reduced by -0.54% compared with control groups. The results also showed that probiotic therapy significantly decreased homeostasis model assessment of insulin resistance (HOMA-IR) by -1.08 and insulin concentration by –1.35 mIU/L.

This meta-analysis suggests that eating or drinking foods containing probiotics may improve glucose metabolism with a potentially greater effect when the duration of intervention is ≥8 weeks, or multiple species of probiotics are consumed.

2016 meta-analysis

A meta-analysis published in 2016 examined the effect of probiotics on glucose and glycemic factors in Type 2 Diabetes of randomised-controlled studies published in English between January 2000 to June 2015. The main outcomes of interest were mean changes in glucose, HbA1c, insulin and homoeostasis model assessment-estimated insulin resistance (HOMA-IR).

A total of 11 studies with 614 subjects were included. It was found that there was a statistically significant difference between the probiotic consuming groups and the placebo-controlled groups on the reduction of blood glucose of -0.52 mmol/L (10 mg/dl).

Analysis identified that probiotics significantly reduced fasting blood glucose, HbA1c, insulin and HOMA-IR in participants with Type 2 Dabetes.

Kombucha and Jun
Raspberry kombucha

Kombucha is a beverage made by fermenting black tea and sugar with some “starter” from a previous batch, called the ‘mother’ or ‘SCOBY’ (symbiotic culture of bacteria and yeast). This is sometimes referred to as the ‘tea mushroom’ or ‘tea fungus’.

After ~ a week or 10 days, a second fermentation takes place with approximately 1 part fruit to about 10 parts fermented tea. This remains in sealed containers where it yields a lightly carbonated, mildly acidic and fruity flavoured beverage, which is the final product. In the photo to the left, this is my first batch.

Left: Kombucha (first fermentation) Right: Jun (first fermentation)

Green tea and honey can also be used to make a fermented product using a very similar process, but using a different kind of SCOBY (one that is adapted to metabolize these substrates) and the resulting product is called Jun.

The taste of jun is considerably different than kombucha, as is the alcohol content.  Kombucha is typically ~1.50% alcohol whereas Jun ranges from 3-7% alcohol.

With some investigation, I was able to determine that kombucha is essentially a symbiotic growth of acetic acid bacteria and osmophilic (water-loving) yeasts in a cellulose mat that the culture makes.

The main bacteria are (1) Acetobacter acetic acid bacteria that are able to convert the ethanol (alcohol) that is initially produced in the fermentation process to acetic acid, in the presence of oxygen and (2) Gluconobacter – acetic acid bacteria that prefer sugar-rich environments.

This is the same species that converts the ethanol (alcohol) in apple cider, to apple cider vinegar. Hence, it seems reasonable to surmise that it is the acetic acid content of kombucha and jun, which give it its characteristic tart taste, that also provide the same glucose lowering effect as apple cider vinegar.

Some final thoughts…

Given that there is scientific evidence that apple cider vinegar, ginger root, turmeric root, kimchi, kombucha & jun play a role in lowering blood glucose and other markers, these foods should be considered – along with a low carbohydrate diet and intermittent fasting (extending the time between meals) when addressing the problem of high blood glucose levels resulting from insulin resistance.

Food, and the temporary absence of it, as medicine.

NOTE: These foods should not be consumed without first consulting with your doctor, especially if you are on medication for Type 2 Diabetes as they can have a potent blood effect on blood sugar levels.

References

Akhani SP, Vishwakarma SL, Goyal RK. Anti-diabetic activity of Zingiber officinale in Streptozotocin-induced type I diabetic rats. J. Pharm. Pharmacol. 2004;6:101–105.

Ebihara K, Nakajima A: Effect of acetic acid and vinegar on blood glucose and insulin responses to orally administered sucrose and starch. Agric Biol Chem 52:1311–1312, 1988

Jayabalan R, Malbaša R, Lončar ES, et al: A Review on Kombucha Tea—Microbiology, Composition, Fermentation, Beneficial Effects, Toxicity, and Tea Fungus. Comprehensive Reviews in Food Science and Food Safety 13(4): 1541-4337

Johnston CS, Kim C, Buller AJ, Vinegar Improves Insulin Sensitivity to a High-Carbohydrate Meal in Subjects With Insulin Resistance or Type 2 Diabetes, Diabetes Care 2004 Jan; 27(1): 281-282.

Johnston CS, White AM, Kent SM. Preliminary evidence that regular vinegar ingestion favorably influences hemoglobin A1c values in individuals with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2009 May; 84(2):e15-7

Johnston CS, Steplewska I, Long CA, Harris LN, Ryals RH. Examination of the antiglycemic properties of vinegar in healthy adults. Ann Nutr Metab. 2010; 56(1):74-9.

Khandouzi N, Shidfar F, Rajab A, Rahideh T, Hosseini P, Mir Taheri M. The Effects of Ginger on Fasting Blood Sugar, Hemoglobin A1c, Apolipoprotein B, Apolipoprotein A-I and Malondialdehyde in Type 2 Diabetic Patients. Iranian Journal of Pharmaceutical Research : IJPR. 2015;14(1):131-140.

Kondo T, Kishi M, Fushimi T, Kaga T (2009b) Acetic acid upregulates the expression of genes for fatty acid oxidation enzymes in liver to suppress body fat accumulation. J Agric Food Chem 57(13):5982–5986

Kim NH, et al. (2008). Lipid profile lowering effect of Soypro fermented with lactic acid bacteria isolated from kimchi in high-fat diet-induced obese rats. BioFactors 33(1):49-60. PMID 19276536

Li X, Chen H, Guan Y, Li X, Lei L, Liu J, Yin L, Liu G, Wang Z. Acetic acid activates the AMP-activated protein kinase signaling pathway to regulate lipid metabolism in bovine hepatocytes.
PLoS One. 2013; 8(7):e67880.

Mitrou P, Petsiou E, Papakonstantinou E, et al. Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes. Journal of Diabetes Research. 2015;2015:175204. doi:10.1155/2015/175204.

Ostman E, Granfeldt Y, Persson L, Björck I. Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. Eur J Clin Nutr. 2005 Sep; 59(9):983-8.

Sakakibara S, Yamauchi T, Oshima Y, Tsukamoto Y, Kadowaki T, Acetic acid activates hepatic AMPK and reduces hyperglycemia in diabetic KK-A(y) mice. Biochem Biophys Res Commun. 2006 Jun 2; 344(2):597-604.

Shang Q, Wu Y, Fei X, Effect of probiotics on glucose metabolism in patients with Type 2 Diabetes Mellitus: A meta-analysis of randomized
controlled trials. Medicina 52 (2016) 28-34.  doi:10.1016/j.medici.2015.11.008

Sun J, Buys NJ, Glucose- and glycaemic factor-lowering effects of probiotics on diabetes: a meta-analysis of randomised placebo-controlled trials. British Journal of Nutrition, 2016; 115(7):1167-1177

Yusoff et al, Aqueous Extract of Nypa fruticans Wurmb. Vinegar Alleviates Postprandial Hyperglycemia in Normoglycemic Rats, Nutrients 2015, 7(8), 7012-7026

Zhang D, Fu M, Gao S-H, Liu J-L. Curcumin and Diabetes: A Systematic Review. Evidence-based Complementary and Alternative Medicine : eCAM. 2013;2013:636053. doi:10.1155/2013/636053.

Zhou et al, Role of AMP-activated Protein Kinase in Mechanism of Metformin action. Journal of Clinical Investigation 2001 Oct 15; 108(8): 1167–1174

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.

 

Cheat Days and Eating LCHF

I often get asked what I recommend people do when it is a special occasion, or a holiday. Are we allowed a “cheat day”.  This is how I answer the question.

It may seem like a strange thing for a Dietitian to say, but when it comes to weight loss, or targeting lower blood sugars, or pressure or cholesterol, I don’t believe in “diets”. The way I look at it is, if people go on a diet,  then at some point, they go off of it. I prefer to think of what we eat in terms of “everyday foods” and “sometimes foods“.

Eating a low carb high fat (LCHF) diet is a choice, just like becoming a vegetarian. People become vegetarian for different reasons; sometimes it is for religion reasons or ethical reasons and sometimes it is for the perceived health benefits. It’s the same with the reason people start eating LCHF. For some, it is to lower insulin resistance, for others it’s to address high blood sugar or to lose weight.  Some decide to eat this way because it was the diet of our ancient ancestors.  Since the reasons people start eating LCHF are different, the reasons people might give to eat a high carbohydrate food also differ.

As far as an idea of a “cheat day”, I don’t find the idea of being “allowed” or “not allowed” foods, helpful.  It implies that there are rules that we are somehow ‘breaking’ – and this comes with baggage all its own. Restricting  calories or restricting food and weighing and measuring every bite that we put in our mouths is not a paradigm that has served most people well – and this type of obsession and attention to “how much” can, in theory, feed a predisposition to disordered eating.

I encourage people to learn to follow a LCHF style of eating and to become adapted to burning fat, rather than just carbohydrate.  Then I advise them to eat when they are hungry and stop eating when they are no longer hungry.  It sounds simple, but there is some physiology behind it. Without constantly high insulin levels driving food craving, eating a diet rich in healthy fats enables people to stop eating when they are no longer hungry.

Eating or not eating high carbohydrate foods comes with an opportunity cost. The questions I encourage people to ask themselves is “what will the results or conssequences be if I eat the specific food(s) I have in mind, and in what quantities?”

“What will the consequences be if I eat 2 oz of this saffron-raisin egg bread? Or 4 oz? Or more?

For example, if a person that normally eats ~100g of carbohydrate a day wants to eat a few slices of pizza, the physiological consequences will be different than a woman that normally eats 35g of carbohydrate, or a man that normally eats 50g of carbs per day. If either of them is insulin resistant or Diabetic, it will certainly impact their blood sugars (the symptom), but how long will it have an effect on their insulin levels?  That is the more important question.

“What will my blood sugars be tomorrow, if I eat 1/2 cup of this noodle pudding with dried fruit?”

For people who are in ketosis, eating foods very high in carbohydrates will cause that to cease for a time, and it might take several days of eating LCHF again until they are again in fat-burning mode.  Likely there will be a few days of being hungry through the day.  Are they okay with this?

I want people to have a healthy relationship with food – and that means that they can eat anything – but how much and how often?

The last time I made this bread for company, I gave them the remaining loaves to take home. I ate a small amount and really enjoyed it.

Everyday (i.e. “everyday foods”), I choose to eat LCHF, but sometimes (i.e. “sometimes foods”) I will take a taste of something yummy – and I encourage my clients to feel free to do so too.  A bite of an ice cream or cake, in the grand scheme of things, won’t make a huge difference, in fact, I calculate the number of carbs that are in the food I am considering, and decide beforehand, if it is worth it for me.

Tonight I will be having my family over for a special dinner and I have decided in advance that I will have 2 oz of the bread, a spoonful of the noodle pudding and a 2″ x 1″ piece of the honey cake.  Sure I can have more, if I wanted, but I’ve come to realize that whether I eat 2 oz of the saffron honey egg bread or 10 oz of it, it will taste exactly the same!  Why eat more? I’ve never been a big fan of the noodle dish, so a small taste is fine with me, and the honey cake is only made once a year on this occasion, and it’s my mother’s recipe from 1954, so yes I am going to eat a bigger piece and enjoy every bite. So what am I going to eat?

Roasted chicken with saffron, honey and hazelnuts

Chicken! …and some red butter lettuce salad with raspberries on top and drowned in olive oil.  Oh! And an apple slice, dipped in honey, for a sweet year.

Eating LCHF is a choice, and a lifestyle and as such, we can choose to eat other things.  How much, how often and which things is up to us. If our goal is to lower our insulin levels, we will know (or need to learn) how much of something won’t have a large, lasting impact.

So eat! Enjoy!

Note: I am a "sample-set of 1" - meaning that how I implement a low carb diet may differ from others who follow a similar lifestyle. 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.


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.

 

Why I am the Low Carb High Fat Dietitian

This article provides the references for the text which appears on the front of my webpage.A low carb diet isn't new. In fact this was the standard recommendation prior to the discovery of insulin.

Several years ago, I began to ask myself how it is that 2/3 of men and ~1/2 of women in Canada are either overweight or obese. In the early 1970s, only ~8% of men and ~12% of women were obese and now almost 22% of men and 19% of women are obese- even though statistics show we are eating much less fat, drinking way less pop and eating more fish than ever before. I wondered if the increase in overweight and obesity might be related to the changes in the Dietary Recommendations that began in 1977 and which encourage us to eat 45-65% of daily calories as carbohydrate and to limit all kinds of fat to 20-35%.

In early 2015, after scouring the scientific literature and reading about the clinical use of a Low Carb High Fat (LCHF) diet, I came to the understanding that those who are insulin resistant or have Type 2 Diabetes or have other indicators that they are not tolerating large amounts of carbohydrate well could improve their symptoms significantly by following a lower carb style of eating, with the oversight of their doctors.  Such an adjustment in lifestyle seemed like a small price to pay for the potential of significantly improving – and in some cases reversing symptoms of these conditions, especially when compared with the reality that at best these symptoms will stay the same and very likely will get worse over time.

Many scientific studies as well as physician’s clinical experience indicate that a lower carb style of eating combined with extending the time between meals lowers insulin resistance (which is the underlying cause of high blood sugar). When insulin levels are lowered, blood pressure comes down and triglycerides and some other lipid ratios normalize.

Physicians across Canada, the US, the UK and Australia that prescribe a LCHF Diet to their patients have found that they experience a significant improvement in the symptoms of insulin resistance, Type 2 Diabetes, high blood pressure, high triglycerides and that a natural reversal of many symptoms is possible. Such improvements often enable these doctors to reduce- and sometimes discontinue medications that were previously prescribed to their patients for these conditions. While the American Diabetes Association enables Type 2 Diabetics to choose to follow either  moderate low carb diet (130g carbohydrate) or a low fat calorie restricted diet for up to a year for weight loss, as of yet this approach is not approved by Diabetes Canada.

A low carb diet isn’t new. In fact this was the standard recommendation prior to the discovery of insulin.

It seems to me that a lower carbohydrate intake resulting in improved symptoms and lab results as overseen by one’s own doctor is preferable to living with chronic disease symptoms and taking increasing numbers of medications in an effort to manage symptoms, but each person needs to evaluate the alternative and make their own choice.

For those who want to aim to improve or reverse the symptoms of these chronic diseases, I offer services as the LCHF-Dietitian. 

References

1942-2015 Canada Food Guides: https://www.canada.ca/en/health-canada/services/food-nutrition/canada-food-guide/background-food-guide/canada-food-guides-1942-1992.html

Canadian Medical Association Journal, Early Releases (May 11, 2015), Food Guide Under Fire at Obesity Summit:  www.cmaj.ca/site/earlyreleases/11may15_food-guide-under-fire-at-obesity-summit.xhtml

2015 Acceptable Macronutrient Distribution Ranges:  https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/eating-well-canada-food-guide-resource-educators-communicators-2007.html#a9

1970-1972 Obesity Rates:  https://lop.parl.ca/content/lop/ResearchPublications/prb0511-e.htm

2014 Obesity Rates, Statistic Canada – Overweight and obese adults (self-reported), 2014 http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14185-eng.htm

Janssen I, The Public Health Burden of Obesity in Canada, Canadian Journal of Diabetes, 37 (2013), pg. 90-96

from the Public Health Collaborative, Summary Table of Randomized-Controlled Trials Comparing Low Carb to Low-Fat Diets – https://phcuk.org/:

[1] A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on
Body Weight and Cardiovascular Risk Factors in Healthy Women. Brehm et al.
http://press.endocrine.org/doi/full/10.1210/jc.2002-021480

[2] A Randomized Trial of a Low-Carbohydrate Diet for Obesity. Foster et al.
http://www.nejm.org/doi/full/10.1056/NEJMoa022207

[3] A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. Samaha et al.
http://www.nejm.org/doi/full/10.1056/NEJMoa022637

[4] Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents.
Sondike et al. http://www.sciencedirect.com/science/article/pii/S0022347602402065

[5] The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein
and Monounsaturated Fat A Randomized Trial. Aude et al. http://archinte.jamanetwork.com/article.aspx?
articleid=217514

[6] A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia: A
Randomized, Controlled Trial. Yancy et al. http://annals.org/article.aspx?articleid=717451

[7] Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body
composition in overweight men and women. Volek et al.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC538279/

[8] Comparison of a Low-Fat Diet to a Low-Carbohydrate Diet on Weight Loss, Body Composition, and Risk
Factors for Diabetes and Cardiovascular Disease in Free-Living, Overweight Men and Women. Meckling et
al. http://press.endocrine.org/doi/full/10.1210/jc.2003-031606

[9] Lack of suppression of circulating free fatty acids and hypercholesterolemia during weight loss on a highfat,
low-carbohydrate diet. Hernandez et al. http://ajcn.nutrition.org/content/91/3/578.long

[10] Perceived Hunger Is Lower and Weight Loss Is Greater in Overweight Premenopausal Women
Consuming a Low-Carbohydrate/High-Protein vs High-Carbohydrate/Low-Fat Diet. Nickols-Richardson et al.
http://www.sciencedirect.com/science/article/pii/S000282230501151X/

[11] Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes—a randomized
controlled trial. Daly et al. http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2005.01760.x/abstract

[12] Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Krauss et
al. http://ajcn.nutrition.org/content/83/5/1025.full

[13] Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk
Factors Among Overweight Premenopausal Women The A TO Z Weight Loss Study: A Randomized Trial.
Gardner et al. http://jama.jamanetwork.com/article.aspx?articleid=205916

[14] Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive
performance. Halyburton et al. http://ajcn.nutrition.org/content/86/3/580.long

[15] A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic
and non-diabetic subjects. Dyson et al. http://onlinelibrary.wiley.com/doi/10.1111/j.1464-
5491.2007.02290.x/full

[16] The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in
type 2 diabetes mellitus. Westman et al. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633336/

[17] Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. Shai et al.
http://www.nejm.org/doi/full/10.1056/NEJMoa0708681

[18] Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of
cardiovascular disease risk in subjects with abdominal obesity. Keogh et al.
http://ajcn.nutrition.org/content/87/3/567.long
www.PublicHealthCollaboration.org

[19] Metabolic Effects of Weight Loss on a Very-Low-Carbohydrate Diet Compared With an Isocaloric HighCarbohydrate
Diet in Abdominally Obese Subjects. Tay et al.
http://www.sciencedirect.com/science/article/pii/S0735109707032597

[20] Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet.
Volek et al. http://link.springer.com/article/10.1007/s11745-008-3274-2

[21] Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet
after 12 mo. Brinkworth et al. http://ajcn.nutrition.org/content/90/1/23.long

[22] Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese
Adolescents. Krebs et al. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892194/

[23] In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves
glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Guldbrand et
al. http://link.springer.com/article/10.1007/s00125-012-2567-4/fulltext.html

[24] A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet
in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or Prediabetes. Saslow et al.
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0091027

[25] Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial. Bazzano et al.
http://annals.org/article.aspx?articleid=1900694

[26] The Role of Energy Expenditure in the Differential Weight Loss in Obese Women on Low-Fat and Low Carbohydrate
Diets. Brehm et al. http://press.endocrine.org/doi/full/10.1210/jc.2004-1540

[27] Effects of a Low Carbohydrate Weight Loss Diet on Exercise Capacity and Tolerance in Obese Subjects.
Brinkworth et al. http://onlinelibrary.wiley.com/doi/10.1038/oby.2009.134/full

[28] Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a
Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes. Davis et al.
http://care.diabetesjournals.org/content/32/7/1147

[29] Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet: A
Randomized Trial. Foster et al. http://annals.org/article.aspx?articleid=745937

[30] Effects of a Low-intensity Intervention That Prescribed a Low-carbohydrate vs. a Low-fat Diet in Obese,
Diabetic Participants. Iqbal et al. http://onlinelibrary.wiley.com/doi/10.1038/oby.2009.460/full

[31] Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and
raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects. Ruth et al.
http://www.metabolismjournal.com/article/S0026-0495(13)00223-0/abstract

[32] Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated
fat diets on body composition and cardiovascular risk. Noakes et al.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1368980/

[33] Long-term Effects of a Very Low-Carbohydrate Diet and a Low-Fat Diet on Mood and Cognitive
Function. Brinkworth et al. http://archinte.jamanetwork.com/article.aspx?articleid=1108558

[34] The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year
follow-up of a randomized trial. Stern et al. http://www.ncbi.nlm.nih.gov/pubmed/15148064

[35] A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss. Yancy
et al. 2010. http://www.ncbi.nlm.nih.gov/pubmed/20101008

[36] A randomized controlled trial of low carbohydrate and low fat/high fiber diets for weight loss. Baron et al.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1646726/

[37] A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial. Tay
et al. http://www.ncbi.nlm.nih.gov/pubmed/25071075

[38] Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from
the BBC “diet trials”. Truby et al. http://www.bmj.com/content/332/7553/1309
www.PublicHealthCollaboration.org

[39] Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease
Risk Reduction:A Randomized Trial. Dansinger et al. http://jama.jamanetwork.com/article.aspx?
articleid=200094

[40] Very Low-Carbohydrate and Low-Fat Diets Affect Fasting Lipids and Postprandial Lipemia Differently in
Overweight Men. Sharman et al. http://jn.nutrition.org/content/134/4/880.long

[41] Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese
women. McAuley et al. http://link.springer.com/article/10.1007/s00125-004-1603-4/fulltext.html

[42] Diet-Induced Weight Loss Is Associated with Decreases in Plasma Serum Amyloid A and C-Reactive
Protein Independent of Dietary Macronutrient Composition in Obese Subjects. O’Brien et al.
http://press.endocrine.org/doi/10.1210/jc.2004-1011

[43] Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2
diabetes compared with advice to follow a low-fat diet. Jonasson et al.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025600/

[44] A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type
2 diabetes. Yamada et al. http://www.ncbi.nlm.nih.gov/pubmed/24390522

[45] Low-Fat Versus Low-Carbohydrate Weight Reduction Diets Effects on Weight Loss, Insulin Resistance,
and Cardiovascular Risk: A Randomized Control Trial. Bradley et al.
http://diabetes.diabetesjournals.org/content/58/12/2741.long

[46] Weight loss with high and low carbohydrate 1200 kcal diets in free living women. Lean et al.
http://www.nature.com/ejcn/journal/v51/n4/abs/1600391a.html

[47] Evaluation of weight loss and adipocytokines levels after two hypocaloric diets with different
macronutrient distribution in obese subjects with rs9939609 gene variant. De Luis et al.
http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2323/abstract

[48] Enhanced weight loss with protein-enriched meal replacements in subjects with the metabolic syndrome.
Flechtner-Mors et al. http://onlinelibrary.wiley.com/doi/10.1002/dmrr.1097/abstract

[49] Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a nointervention
control. Lim et al. http://www.nmcd-journal.com/article/S0939-4753(09)00124-0/abstract

[50] A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on
lipoprotein subfractions and C-reactive protein levels in patients with severe obesity. Seshadri et al.
http://www.amjmed.com/article/S0002-9343(04)00344-4/abstract

[51] Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial.
Tay et al. http://ajcn.nutrition.org/content/early/2015/07/29/ajcn.115.112581.abstract

[52] Weight loss on low-fat vs. low-carbohydrate diets by insulin resistance status among overweight adults
and adults with obesity: A randomized pilot trial. Gardner et al.
http://onlinelibrary.wiley.com/doi/10.1002/oby.21331/abstract

[53] Metabolic impact of a ketogenic diet compared to a hypocaloric diet in obese children and adolescents.
Partsalaki et al. http://www.ncbi.nlm.nih.gov/pubmed/23155696

[54] A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic
control. Sato et al. http://www.clinicalnutritionjournal.com/article/S0261-5614(16)30169-8/pdf

[55] Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss
program versus hypocaloric diet in patients with type 2 diabetes mellitus. Goday et al.
http://www.nature.com/nutd/journal/v6/n9/full/nutd201636a.html

[56] Visceral adiposity and metabolic syndrome after very high–fat and low-fat isocaloric diets: a randomized
controlled trial. Veum et al. http://ajcn.nutrition.org/content/early/2016/11/30/ajcn.115.123463.abstract

[57] An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle
Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A
Randomized Controlled Trial. Saslow et al. https://www.ncbi.nlm.nih.gov/pubmed/28193599

Fact and Fallacy of a Low Carb High Fat (LCHF) Diet

It bothers me when people make negative comments about a Low Carb High Fat (LCHF) style of eating, without really understanding what it is – and what it isn’t. This article addresses a few of the common misconceptions about a Low Carb lifestyle that were presented in a recent French-language newspaper article.

FALLACY: “The LCHF diet targets a very low carbohydrate and high-fat diet, aimed at rapid weight loss.

FACT 1: Firstly, there is no single LCHF diet.

The Atkins Diet is one kind of LCHF diet, so is a Paleo Diet, and these are substantially different from each other. There are LCHF diets written by non-healthcare professionals such as the “Bulletproof Diet”, as well as those from Dr. Jason Fung, a Nephrologist (kidney specialist) from Toronto and from Dr. Eric Westman of Duke University. Referring to “the” LCHF diet fails to take this huge range into account.

FACT 2: There is no one “goal” of LCHF diets.

From my experience, most of the well-designed LCHF diets written by healthcare professionals and researchers are aimed at lowering insulin resistance (IR), which underlies the symptom of high blood sugar and Type 2 Diabetes. Weight loss is a natural byproduct of eating in such a way as to lower IR.

FACT 3: LCHF diets that focus on weight management rarely aim for “rapid weight loss”.  

LCHF diets designed by healthcare professionals with a weight management goal generally aim for consistent weight loss and/or inches lost, and reducing abdominal obesity. Morbidly obese people or those with a great deal of weight to lose and who begin eating low-carb will lose weight rapidly at first, firstly from water-loss and then from fat loss. That is not the aim, but the result.

FALLACY: “this diet is so restrictive”…

FACT 4: this diet…”

Which LCHF diet? As mentioned above, there are many different LCHF-style diets and they differ substantially from each other.

Fact 5: The term “restrictive” is not defined, so this statement really has no meaning.

What are all LCHF diets “restrictive” in?

Foods that are not included on an Atkins Diet are very different from what is not included on a Paleo Diet.  Dr. Fung’s recommendations differ from Dr. Westman’s. For example, Dr. Fung does not limit any fats, and Dr. Westman does.

Which LCHF-diet is “restrictive” and in what foods or nutrients?

FALLACY:this diet is so restrictive that the likelihood that the people who adopt it will drop it in the short or medium term is high.

FACT 6: Which LCHF diet is restrictive and what is it restrictive in? Is there evidence to support that people that stop eating those foods regularly are unable to continue to do so in the short- or medium term?

FALLACY: “There is a difference between processed high-carbohydrate foods such as juice, sweetened beverages, white bread, pastries and sweets, and whole foods high in unprocessed carbohydrates such as brown rice, whole wheat, vegetables, fruits, legumes , which are associated with good health and the prevention of the risk of diabetes, cardiovascular disease and obesity.“.

FACT: 7: all carbohydrates (whether from juice, fruit, pastry, brown rice or whole wheat) are broken down and supply the blood with glucose.

FACT 8: how quickly all carbohydrates are broken down to glucose varies.

FACT 9: how much insulin is released in response to all of these different carbohydrates is what most well-designed LCHF diets endeavor to address.

FALLACY: “Whenever an attempt is made to isolate a nutrient (carbohydrates, proteins or lipids) and make it responsible for all ills, it is wrong. The reality is that we need these three nutrients for the health and enjoyment of eating.

FACT 10: Well-designed LCHF-diets have all three macronutrients in them; carbohydrates, protein and fat.

The major difference is LCHF diets are low in carbohydrate and high in fat. Which carbohydrates are eaten on different LCHF diets vary. Paleo diets for example eat starchy vegetables that ketogenic-style LCHF diets don’t. In addition, which fats are promoted in the different styles of LCHF diets also differs.  Paleo diets are known for promoting lots of red meat, including processed meat such as bacon and sausage and lots of full-fat cream and butter.

LCHF diets, such as the one I teach, include the saturated fat found naturally in foods, such as in steak or in cheese but encourage the “high fat” part of the diet to come from mono-unsaturated fruits such as avocado and olives, from a wide variety of nuts and seeds, as well as from the oils from these foods as well as from omega 3 fats found in fish. It also includes the carbohydrates found in an abundance of non-starchy vegetables, specific fruit, nuts and seeds. A look at just a few of the recipe ideas posted on this web site, certainly do not indicate a “restrictive diet”.

FACT 11: The Dietary Guidelines in Canada (and the US) have “attempted to isolate a nutrient – fat, and make it responsible for all ills”. 

In 1977, the Dietary Guidelines in both countries were first changed to restrict fat intake from all sources, especially saturated fat, in the belief that eating fat contributed to heart disease (see previous articles).

While it is now known that dietary fats do not cause heart disease, and even the Canadian Heart and Stroke Foundation changed their recommendations in this regard, it is my conviction that it was this vilification of fat and the corresponding promotion of diets very high in carbohydrates (45-65% of daily calories as carbs) that contributed to the dual obesity- and Diabetes epidemics that we now have.

Some final thoughts…

A LCHF-style of eating can be done safely, with slow yet consistent weight loss, while being overseen by one’s doctor and monitoring blood glucose and lab work.

It certainly doesn’t have to be restrictive, as one can eat meat, fish, seafood, poultry, cheese and other dairy, vegetables and fruit, nuts and seeds. It can provide a nutritionally adequate diet – certainly no less adequate that the average Canadian eats, following Eating Well with Canada’s Food Guide [see Do Canadian Adults Meet Their Nutrient Requirements Through Food Intake Alone? Health Canada, 2012, Cat. No.: H164-112/3-2012E-PDF].

References

Le Soleil (07 septembre 2017 17h50, “Nutrition : des raccourcis absurdes et dangereux” (“Nutrition: absurd and dangerous shortcuts”)

Do Canadian Adults Meet Their Nutrient Requirements Through Food Intake Alone? Health Canada, 2012, Cat. No.: H164-112/3-2012E-PDF

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.


 

Surprising ways to get adequate fiber eating LCHF

When people think of getting enough “fiber” they often imagine foods like “bran” and prunes – foods not usually eaten when one is following a LCHF style of eating. But what is fiber and how do we get enough when we don’t generally eat grains or legumes?

Fiber – soluble and insoluble

There are two kinds of fiber, insoluble and soluble.

Insoluble fiber is what most people think about when they think of “roughage” needed to form stool and prevent constipation. It helps form the bulk of the stool. Insoluble fiber is naturally present in the outside of grains, such as whole grain wheat, un-milled brown rice and the outside of oats. It is also found in fruit, legumes (or pulses) such as dried beans, lentils, or peas, some vegetables and in nuts and seeds.

Soluble fiber forms a ‘gel’ in the intestine and binds with fatty acids. It slows stomach emptying and helps to make people feel fuller for longer, as well as slow the rate that blood sugar rises, after eating. Soluble fiber absorbs water in the gut, and helps to form a pliable stool. Soluble fiber is found on the inside of certain grains, such as oats, chia seeds or psyillium, as well as the inside of certain kinds of fruit such as apple and pear.

Dietary Recommendations for dietary fiber intake varies with age and gender. Men under the age of 50 years are recommended to take in 38 gm / day of dietary fiber, and men over 50 years to take in 30 gm / day. Women under 50 years old are recommended to take in 25 gm of fiber per day and over 50 years, 21 gm per day.

[Reference: Government of Canada, nutrients in food, https://www.canada.ca/en/health-canada/services/nutrients/fibre.html]

Both kinds of fiber are needed and most Canadians eating a conventional diet are getting half of what is recommended.

For those eating a Low Carb High Fat Diet, even though grains and legumes are generally not eaten, getting enough fiber is not that difficult.

Avocado – Surprisingly, avocado which is an excellent source of vegetable fat, is also high in fiber, having more than 10 gm fiber per cup (250 ml). Avocado grown in Florida which are the bright green, smooth-skinned variety have more insoluble fiber than California avocado, which are the smaller, darker green, dimpled variety.

Berries – Berries such as blackberries and raspberries are fruit that I encourage people to use sprinkled on salads, as they are an excellent source of antioxidants, but also have 8 gm fiber per cup (250 ml).

Coconut – Fresh coconut meat has 6 gm of net carbs per 100 grams of coconut, but also packs a whopping 9 gms of fiber and is a very rich source of fat (33 gms per 100 gm coconut). It can be purchased peeled, grated and sold frozen in many ethnic stores or in the ethnic section of regular grocery stores.

Artichoke – Artichoke is a low-carbohydrate vegetable that is delicious boiled and it’s leaves dipped in seasoned butter. Surprisingly, one medium artichoke has over 10 gm of fiber.

Okra – Okra, or ‘lady fingers’ is a staple vegetable in the South Asian diet and is commonly eaten in the Southern US. Just one cup of okra contains more than 8 gm of fiber.

Brussel Sprouts – These low-carb cruciferous vegetables are not just for Thanksgiving and Christmas dinner.  Split and grilled on the BBQ with garlic, they are a sweet, nutty addition to any meal, packing almost 8 gm of fiber per cup.

Turnip – Turnip, the small white vegetable with a hint of purple is not to be confused with the pale beige, larger rutabaga. Turnip contains almost 10 gm of fiber per cup. It is delicious pickled with a single beet, and eaten with Middle Eastern foods.

Constipation

Even though passing stool is as natural a part of the process as eating is, most feel awkward discussing it. Many don’t know what “normal” is in that regard, or even if there is such a thing. Is once every few days okay, is it detrimental if it is only once a week?  Should it be every day and if so, is more than once a day too much? Does texture matter or is it only frequency?

Frequency and Texture

Many physicians consider normal bowel movement (BM) frequency from 3/day to every 3 days whereas I tend to lean towards daily to every two days as preferable. Even if BM frequency is in this range, hard, painful to pass stools are problematic and would be categorized as constipation.

Since the mid-1990s there is a standardized method to classify the texture of stools, called the Bristol Stool Chart based on research which indicated that stool is a useful surrogate measure of how long feces (stool) takes to go through the large intestine (called “colon transit time”).

Bristol Stool Chart

While Type 3-7 are considered valid for diagnosing diarrhea, Type 1 and Type 2 stool can have normal “transit time”, but be compact and hard due to lack of fluid / water.

The fact is, many, if not most people either have a lack of fiber or a lack of sufficient fluid or both and are constipated to a greater or lesser degree. They eat every day, but they don’t pass stool often and when they do, it is hard and compact. Their bodily waste sits in their colon for several days before finally being eliminated – and when it is, it is hard, dry and compact and often painful to pass.

Constipation is usually due to two factors;

(1) not taking in foods with enough fiber and

(2) not drinking enough water

Sometimes, despite eating the foods mentioned above, people find it isn’t sufficient. This is where what I have dubbed “birdseed” comes in.  Of course, I don’t mean actual birdseed!

What I call “birdseed” is a mixture of 1 tbsp. freshly ground whole flax seed (3 gm fiber per tbsp.) to which 1 tbsp. of chia seed is added (5.5 gm fiber per tbsp.).

 

The chia seeds are ground a little bit with the previously ground flax seed, and then the two ground seeds are placed in a small bowl.

An added portion of psyllium husk (1 tbsp.) is optional.

 

Drinking “Birdseed”

To drink this mixture, diluted coconut milk can be added, the mixture briefly stirred and then drunk quickly, followed by a good amount of water (I recommend at least 2 cups (500 ml).

 

Eating “birdseed”

For even more fiber and a delicious taste, 2 tbsp. of tahini (ground sesame paste) can be added and the mixture eaten with a spoon.

Tahini has 0 net carbs, and almost 4 gm of fiber for 2 tbsp.

 

 

Note: people often ask if they can make "chia pudding" to which they add ground flax seed, but the idea here is to have the flax and chia seeds do their magic in the intestines, not in a container, beforehand.

Water – how much is sufficient?

Dehydration is another factor that contributes to constipation. Often people simply don’t drink enough water to form a bulky, pliable stool.

The Reference Daily Intake (RDI) for water for men over 18 years is 3.7 liters per day and for women over 18 years, 2.7 liters per day and this is from all water, including that contained in beverages.

Fiber and water together

Drinking one liter of water or club soda / seltzer with each batch of “birdseed” is a good idea, because the last thing we want is to have all this insoluble and soluble fiber this in our intestines, with insufficient water. In the worse case scenario, this can result in an intestinal blockage, so be sure to drink sufficient water when taking “birdseed”.

I usually recommend that people start off with having 1 tbsp of flax seed and 1 tbsp of chia seed once a day – increasing after a few days if needed to twice (or if needed, three times) a day – making sure to drink a liter of water immediately afterwards.

What about carbs in “birdseed”?

While flax seed, chia seed and psyllium are grains, they have very few net carbs.

1 tsp of whole flax seed (3.4 gm) is so high in fiber that it has no net carbs.

1 tsp of whole chia seed has only .3 gm of net carbs.

Even if you add 1 tsp of psyllium husk, that adds only 1 gram of carbs.

“Birdseed” can be drunk as described above, eaten with sesame paste (also very high in fiber and a good source of healthy fat), or sprinkled on salads or omelettes.

…and remember to drink a liter or so of water each time you take “birdseed”, so that passing stools daily, just like eating daily, will be the norm.

To your good health!

Joy

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/

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.


 

Caffeine Substantially Increases Plasma Ketones in Healthy Adults

INTRODUCTION: This recent Canadian study reports that the caffeine contained in 1  1/2 to 3 cups of unsweetened coffee is sufficient to increase plasma levels of ketones, including β-hydroxybuterate, for several hours.


A pilot Canadian study conducted at the Université de Sherbrooke in Sherbrooke, Quebec and published in the Canadian Journal of Physiology and Pharmacology on November 25, 2016 evaluated the effect of caffeine on the production of ketones in healthy adults. Researchers were interested in caffeine as a ketogenic agent based on its ability to increase lypolysis (the breaking down of fat for fuel).

Method of the Study

Two different doses of caffeine were administered to 10 healthy adults who had fasted for 12 hours and who then ate a breakfast that containing 85 gm carbohydrate, 9.5 gm fat and 14 gm of protein.

Subjects were either given;

(1) no caffeine

(2) a cup and a half of regular drip coffee

(3) three cups of regular drip coffee 

The subjects plasma caffeine levels were measured over the next 4 hours and it was found that those that drank 1  1/2 cups of coffee had~ 2.5 mg caffeine per kilogram of body weight and those that drank 3 cups of coffee had ~ 5.0 mg caffeine per kilogram of body weight. 

Plasma caffeine over time

Results – the effect of caffeine on ketone production

Subjects that had 1  1/2 cups of coffee (2.5 mg of caffeine per kilogram)  had 88% higher ketone production than subjects that had no caffeine.

Subjects that drank 3 cups of coffee (5.0 mg caffeine per kilogram of body weight) had 116% higher ketone production over subjects that had no caffeine. 

β-hydroxybuterate per hour

Expressed as the amount of βhydroxybuterate in μmol/L, it is evident that this ketone rises significantly in response to caffeine, and rises in a dose-dependent manner. That is, the more caffeine consumed the more βhydroxybuterate was produced.

Amount of β-hydroxybuterate produced in response to caffeine dose

Researchers reported that the level of ketones found in the blood after 3 cups of coffee was approximately twice that produced after an overnight fast.

This increase in plasma ketones obtained with these doses of caffeine could, at least in the short term (a few hours) contribute to ~5-6% of brain energy needs.

Mechanism

The increase in free fatty acids as well as β-hydroxybuterate is explained by caffeine blocking phosphodiesterase (PDE), preventing the inactivation of cyclic adenosine monophosphate (cAMP) – with increased caffeine leading to higher levels of cAMP.

Cyclic adenosine monophosphate (cAMP) is a cellular messenger that is involved with transferring hormones such as glucogon, which is the main catabolic hormone of the body and which functions to raise both the concentration of glucose and fat in the bloodstream and has the opposite effect of insulin).

Glucagon needs cAMP in order to pass through the plasma membrane, so as a result cAMP serves to regulate glucose, fats and glycogen.

cAMP activates hormone sensitive lipase, an enzyme which breaks down fat (lypolysis). This increased breaking down of fat, increases free fatty acids (FFAs), which can then be converted in the liver to the ketones acetoacetate and β-hydroxybuterate.

Final Thoughts…

While this is a small study, the data supports that a few cups of regular, unsweetened coffee (without any butter or coconut oil added) increases the amount of ketones produced for several hours.

If you are following a low carb diet and are monitoring your blood or urine ketones, be aware that having coffee can increase the amount of ketones your body is producing.


Here is a recipe for delicious carb-free cappuccino or latte that you can have the barista at your favourite coffee house make for you:

http://www.lchf-rd.com/2017/08/21/bullet-less-low-carb-cappuccino-and-latte/


References

Vandenberghe C, St-Pierre V, Courchesne-Loye A, et al, Caffeine intake increases plasma ketones: an acute metabolic study in humans, Canadian Journal of Physiology and Pharmacology, 2017, Vol. 95, No. 4 : pp. 455-458 
Dr. David Perlmutter, MD (www.drperlmutter.com/caffeine-ketosis-friend-or-foe)

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.

Increasing the Time Between Meals: Intermittent Fasting

When people think of “fasting” what comes to mind is an almost-intolerable short period of time without food, and with nothing to drink (except maybe water) and where people usually spend most of the time counting until they can eat again. This is the case when we are used to burning carbs as our fuel source and then just stop eating. Our body slows its metabolism in response to the severe calorie restriction in an effort to spare energy.  We feel cold, tired, lethargic and we find it difficult to concentrate because our body is in starvation mode.

When we are fat-adapted, we use the fat in our diet (dietary fat) and our own fat stores (endogenous fat) as our fuel source. When we “fast”, we stop supplying our body with dietary fat, so our body relies solely on our fat stores to supply its energy needs.  Most of us who are following a low carb high fat diet have plenty of endogenous fat, so when we aren’t eating, we don’t feel hungry, tired or cold because our body has a plentiful source of energy! Our basal metabolism doesn’t drop.  Rather than feeling cold and tired and finding it difficult to think, we are able to think clearly using ketones produced from fat to fuel our body, rather than glucose.

Intermittent fasting” is simply increasing the amount of time between meals.  Fasting is not eating or rather, not eating now. It’s different than “starving” because our basal metabolic rate is being maintained through our fat stores. When we are in starvation mode, our basal metabolism drops significantly in order to spare energy – that’s why we feel cold and tired, because our body is saving calories for our brain and our heart to function. Fasting also doesn’t mean that we can’t consume anything! There are plenty of things we can have during the delay before our next meal. The most natural “intermittent fast is the one between after supper and breakfast the next morning.  Yes, that is why it is called “breakfast“.

Why Fast?

When we eat, insulin is released in response to the presence of carbs in the food we eat and functions to (a) move glucose out of the blood and to (b) store the glucose that is not immediately needed for energy, as fat.

When we are accustomed (as most of us have been) to eating three meals a day plus having a couple of snacks, insulin is released every few hours. If we have been “grazing”, we have been constantly releasing insulin. As a result of this, our cells have become insensitive to insulin – something known as “insulin resistance“, or insulin tolerant.  To conceptualize this, think of going into a room with loud music.  At first your ears buzz and your auditory system is overwhelmed, but after a bit of time, your body adapts. It’s similar with smell.  When you’re exposed to a pungent odor, at first that’s all your can concentrate on, but after time passes, your brain starts to “tune out” the signals from your nose and you become less aware of the smell.  It’s not that the odor decreases, but our response to the odor, decreases as we become “tolerant” to that molecule bound to our olfactory receptors.

The difference with “insulin resistance” is that it is more than our body becoming “tolerant” of the circulating insulin, it actually responds less to it.

Think of someone that drinks considerable amounts of alcohol.  They can have 3 or 4 drinks and not feel intoxicated, because they have a “high tolerance” to the ethanol in the drink.  It takes more and more alcohol for them to respond. When someone is “insulin tolerant” (also called “insulin resistant“), the same amount of insulin has less and less effect, so to adapt, to be able to move the glucose out of the blood and store the excess energy as fat, the body needs to release more and more insulin. From years and years of eating 3 carb-based meals plus a couple of carb-laden snacks each day, our insulin levels simply don’t fall to baseline.

When someone is not insulin resistant, delaying the time before the next meal enables their insulin levels to fall to baseline (10-30 pMol) in approximately  12 hours, so if they don’t eat anything after dinner and their first meal of the day is breakfast the next morning, that time period is usually close to 12 hours. However, for people who are insulin resistant,  a longer time period is often needed for their insulin levels to fall to baseline. Just as insulin resistance developed over time, gradually, a new lower baseline can be set over time by increasing the length of time that one intermittently fasts.

Twelve-Hour Fast

A twelve-hour fast is the easiest one for most people to do, because during most of it, they’re asleep!

This is the one I suggest to my clients once they’re fat-adapted (usually after ~4 weeks of eating low carb high fat) as all it entails is not eating anything after supper until breakfast the next morning.

That’s it.

So, say they finish dinner at 6:30 PM, then the next time they eat is breakfast the next morning at 6:30 AM. This simple, short 12-hour “fast” is just enough to enable their insulin to fall to baseline. Doing this often, if not daily is the goal. This is entirely do-able and an important first step in restoring insulin sensitivity and it is certainly not something “radical”. Years ago, people didn’t eat after supper!

People who have Type 2 Diabetes should check with their doctor before beginning doing any form of Intermittent Fasting – and definitely should do so if they are on any kind of medication to manage their blood sugar, blood pressure or cholesterol, without having their doctors oversee it.  Medication will often need to be adjusted downward (and sometimes eventually discontinued entirely) as insulin sensitivity returns, so don’t do this without involving your doctor, first!

Eighteen Hour Fast

Once people have become used to not eating from supper until breakfast, they may want to wait to eat their first meal until noon the next day, especially if they don’t feel particularly hungry in the morning. Some people are not “breakfast” people and if they eat well the night before, they may not want to eat in the morning. An eighteen hour “fast” is from after someone has finished dinner (say, at 6:00 PM) until noon the next day.

Many do want their cup of coffee, which is totally fine provided it is unsweetened. I don’t recommend that people use sugar substitutes, especially the sugar alcohols such as sorbitol, mannitol or xylitol which have the same number of carbs per teaspoon as ordinary table sugar.

Cappuccino foamed with 1/2 oz of cream diluted with 1 oz of cold, filtered water

Cream can certainly be added to drip coffee and there’s no need to give up your morning latte or cappuccino – just a little creativity to replace the milk (which has almost as many carbs per cup as a slice of bread!).

My trick is to foam 1/2 an ounce of cream with an ounce or ounce and a half of cold, filtered water.

This makes fasting until lunch entirely possible!!

Twenty-four Hour Fast

Note: I don't do these and I don't recommend that my clients do these unless they are being very closely monitored by their doctor, however I want to describe them, so people know what they are.

A twenty-four hour “fast” is from the end of supper one day, until the start of supper the following day (technically it is a 23-hour fast unless you add the extra hour  😯). As with the eighteen-hour fast, one can have unsweetened coffee or tea with a drop of cream, club soda (seltzer) with a twist of lime or lemon, or “bone broth“. “Bone broth” can be made from any kind of meat, fish or poultry bones, but for me, when I think of “bone broth“, I think of a wonderful, rich broth made from beef marrow bones, that is gently simmered overnight on the stove, ready to be sipped as desired, on a fast day.

To avoid getting constipated, many people will take psillium fiber with water each morning and which can be added to cups of “bone broth” or dissolved in a little bit of diluted coconut milk.

Ingredients for “bone broth” – beef marrow bones, ox feet, onion, garlic and fresh peppercorns

 

 

 

 

 

cup of beef “bone broth” – made from ingredients above

What’s not to love about sipping this when “fasting”?

 

 

 

 

 

The main purpose of delaying the time between meals (“intermittent fasting”) is to restore insulin sensitivity. When we aren’t eating, we aren’t releasing insulin – and as we continue eating low carb high fat and delaying the time between meals, our insulin receptors become sensitive to insulin once again.

Normalized blood sugar levels (both fasting blood glucose and HbA1C) is a natural byproduct, not the goal.  The goal is releasing less and less insulin in response to the food we eat and our body’s sensitivity to the insulin that we do release, being restored.

Weight loss is another added benefit!

Have questions?

Want to know how I can help you?

Please send me a note using the “Contact Us” form on the tab above.

 


 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/

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.