How to Distinguish Food from Food-like Products

INTRODUCTION: National dietary guidelines in both Canada and the US focus on the variety of foods available in each of several defined ‘food groups’ and make recommendations about “healthy eating” based on how much of particular nutrients are in specific foods.  In Canada for example, foods that are rich in saturated fat, sodium or sugar are said to undermine health. This type of classification results in dishes rich in cheese and fried chicken both being deemed as unhealthy, as both are high in saturated fat and sodium. 

This article outlines an internationally established way of classifying foods that is based on the degree of food processing they have undergone — which I believe provides a better framework to help people to choose which foods they should aim to eat most often.


Many of us have heard the alarming health statistics in both the US and Canada, but they are worth repeating.

Obesity has risen in Canada from < 10% in 1970-1972 to almost 15% in 1989, to over 23% in 2004 [1,2]. That is, in the early 1970s, only one in 10 people in Canada was obese and now almost 1 in 4 people in Canada are obese [3]. The prevalence of obesity among American adults is almost 40% as of 2015-6 [4]. 

And it’s not only adults.

As of 2015, over 10% (1 in 10) children between the ages of 5 and 17 years of age in Canada were obese[3] and that figure rises to 20% (1 in 5 kids) in the United States [4]. 

It’s not only obesity.

As of 2015,  >25% of Canadians adults have been diagnosed with high blood pressure[3] and as of 2013, >30% of American adults have high blood pressure [5]. That’s 1 in 4 in Canada and 1 in 3 in the US [4] with hypertension; a major risk factor for heart attack and stroke.

Over 8% in Canada have been diagnosed with coronary heart disease (CHD) [3] and in the US, coronary heart disease accounts for ~13% of deaths as of 2016 [6] and over 8% of Canadians has diabetes [3] and in the US, almost 9.5% of Americans has diabetes [7].

What has changed over this time period to account for this? 

Too Many Carbs?

When I first started writing articles about obesity and the increased rates of metabolic diseases ~ 4 years ago, I thought it was largely related to the increased in carbohydrate content of the diet due to changes in the national dietary guidelines that occurred in Canada and the US in 1977. To some degree there is a relationship between these, but it is not as clear-cut as I once thought.

Industrial Seed Oils (Polyunsaturated Vegetable Oil)

With further reading in the scientific literature, I came to believe that it was the inclusion of novel “seed oils” (also called “polyunsaturated vegetable oil”) including canola, soybean, corn and cottonseed oil — along with too much carbohydrate in the diet that lay at the root of obesity and metabolic disease and while this is certainly part of the story, I was still missing a vital piece of the puzzle.

Manufactured Food-like Products

As national dietary guidelines in both Canada and the US in 1977 focused on reducing dietary intake of fat — especially saturated fat, food manufacturers sought to fill the gap left by the removal of butter, cream, lard and tallow (saturated fats) from the diet, and began to manufacture products that were made up of both refined carbohydrate and industrial seed oils (“polyunsaturated vegetable oils”). The food industry heavily marketed these manufactured products and promoted them as being “low in saturated fat”, which was perceived by the general public as being equivalent to “healthy”.

Since the mid-1980s, the food supplies of high-income countries such as Canada, the US, Australia and the UK have been dominated by pre-packaged, ready-to-eat “convenience foods” [13]. In fact, the percentage of energy (calories) in the diet of Canadians of these “ultra-processed foods” rose from <25% in 1938 (when manufactured products such as Crisco and soy oil were first created) to almost 54% in 2011 (9). Similar trends have been observed worldwide (10-12).

It is my now my conviction that it has been the over-consumption of these ultra-processed “convenience foods” that are high in both refined carbohydrate and seed oils which precipitated the huge deterioration of the Western diet, and which has fueled the concurrent epidemics of obesity, diabetes and other chronic diseases, such as hypertension and coronary heart disease [8].

Hundreds of thousands of people in Canada, and millions worldwide are metabolically unwell because the bulk of the diet has centered around eating these manufactured food-like products — from our morning sweetened cereal or spreads on toast to the burger with ‘plastic cheese’ and French fries we grab in place of real food.

So how do we distinguish real food from food-like products?

The NOVA Food Classification system – defining “processed food”

From the time food is harvested to when it is eaten, most food is processed in some way. Some of this processing may be as simple as peeling and chopping it, to cooking it, but food doesn’t become “unhealthy” just because it is processed. The issue is how much it is processed.

NOVA is a food classification system developed in Brazil and used in the US, Canada and other countries around the world to define the level of food processing.

The NOVA definition of types of food processing are as follows [13]:

Minimally processed foods are defined as ”unprocessed foods altered in ways that do not add or introduce any new substance (such as fats, sugars, or salt) but often involve removal of parts of the food.”  Examples of these include fresh, dry, or frozen vegetables, root vegetables, grains and legumes, fruits and nuts, and meats, fish, seafood, eggs, and milk [13]. For the most part, minimal processing is what’s involved in preparing it for eating and/or improving its palatability.

Processed foods are defined as ”foods made by adding fats, oils, sugars, salt, and other culinary ingredients to minimally processed foods to make them more durable and usually more palatable, and by various methods of preservation“.  They include simple breads and cheeses; salted, pickled or cured meats, fish and seafood; and vegetables, legumes, fruits and animal foods preserved in oil, brine or syrup.

Canned fish in oil would fall in this category, as would hummus (ground chickpeas with sesame seed butter, garlic and lemon juice), as well as bacon and sausages.

These foods can be part of a healthy diet, depending on how they are prepared and used in dishes and meals [13] and how much of these are eaten at a time.

Ultra processed foods are defined as ”not modified foods, but formulations of industrial ingredients and other substances derived from foods, plus additives. They mostly contain little if any intact food. The purpose of ultra-processing is to create products that are convenient (durable, ready-to-eat, -drink or -heat), attractive (hyper- palatable), and profitable (cheap ingredients). Their effect all over the world is to displace all other food groups. They are usually branded assertively, packaged attractively, and marketed intensively.

Foundations for Healthy Eating using Degree of Food Processing

I like to define foods as being either “everyday foods” or “sometimes foods”.  The issue is how much and how often we eat them.

“Everyday Foods”

Choosing foods to make up a meal should aim to include mostly unprocessed foods (whole foods in their original state) and minimally processed foods. This is how our grand-parents and great-grandparents ate (when obesity, hypertension and diabetes rates were a fraction of what they are now!).

Another way to determine what foods to include in a meal is to eat food that your great-grandparents would recognize as food.

“Sometimes Foods”

For people who are metabolically healthy, eating “processed foods” such as breads and cheese,  salted, pickled or cured foods (including meat, fish, seafood, vegetables, legumes) and whole foods preserved in oil or brine are perfectly fine to add to unprocessed foods (whole foods in their original state) and minimally processed foods to make up a meal.

For those who are already overweight or metabolically unhealthy, focusing on making up a meal of real, whole foods in their original state (i.e. unprocessed foods) and minimally processed foods is best, while limiting processed foods. How much bacon, olives, bread and cheese can be eaten really depends on a person’s metabolic health. This is where having a Meal Plan designed by a Dietitian is helpful because everybody’s needs are different.

Ultra-Processed Food

Ultra-processed food isn’t food. They are products made from a combination of refined carbohydrates (including sugar) and seed oils. These are convenient, hyper-palatable and cheap, and displace real food in the diet.

According to a 2015 study, some of the most addictive foods are in this category; including breakfast cereal, muffins, pizza, cheeseburgers, French fries and fried chicken — as are the desserts that often eaten with them including chocolate, ice cream, cookies and cake, and the soda we wash them down with. Even our favourite snacks like popcorn and chips are really nothing more than a combination of refined carbs and industrial seed oil eaten in place of real food.

Fifteen Most Addictive Fast Foods

These ultra-processed food-like products are intended to displace real food in the diet and as such are not something we should consider as components for making up a meal.

Does that mean we should never eat a slice of pizza or a cheeseburger? Of course not. But let’s be fully aware that this is not real food. It is something we eat in place of real food.

As well, there is a huge difference between a homemade burger with real melted cheddar cheese on top — sandwiched between fresh leaf lettuce and tomato, and what can be picked up at a 1000 drive-throughs in cities around the Western world.

National Food Guidelines as foundations for healthy eating

National food guidelines in both Canada and the US have traditionally categorized food based on the variety available in each food group; including grains and cereals, vegetables &/or fruit. milk and dairy, and meats and alternatives.

New Canada Food Guide (2019)

In the case of the new Canada Food Guide, it recently eliminated the Milk and Dairy food group and combined those foods with Protein foods. The other two food groups are now Grains and Vegetables and Fruit.

The new Guide centers it’s dietary advice around 3 “Guidelines”.

 

Guideline 1 of the new Canada Food Guide focuses on eating from the different food groups and stresses that Canadians should eat plant-based foods more often because they lower intake of saturated fat. 

Guideline 2 of the new Canada Food Guide encourages Canadians to limit processed or prepared foods and states the reason is because they contribute excess sodium, sugar and saturated fat.

Based on this definition, dishes made with lots of cheese and fried chicken are high in saturated fat and sodium, and thus are categorize as foods that undermine healthy eating.

Does eating cheese really undermine healthy eating?

Or a rib steak?

Or milk?

As covered in previous articles I’ve written on the new Canada Food Guide,  I am not convinced that there is a compelling reason to limit real, whole food simply because it is high in saturated fat.

Guideline 3 of the new Canada Food Guide encourages Canadians to learn how to prepare and cook their own food and promotes the use of nutritional food labels as a tool to help them make informed choices.

The fact is, there are no nutrition food labels on unprocessed food (real, whole foods).

Choosing Healthy Food

As I’ve said in prior articles, Canadians can use the new Canada Food Guide to make up healthy meals by focusing on the part of Guideline 1 which encourages them to eat “real, whole food” and on the part of Guideline 2 which encourages them to “limit processed or prepared foods” — and by defining “processed foods” using the NOVA category of “ultra-processed foods” given above. In this way they will be able to design meals with a wide range of healthy and interesting foods.

Defining what is healthy based on how much a food is processed makes good sense. In this way people are free to add bread and cheese,  and salted, pickled or cured foods (including meat, fish, seafood, vegetables, legumes) to their unprocessed foods (whole foods in their original state) and minimally processed foods to make up an interesting and healthful meal.

Furthermore, categorizing food using the NOVA categories based on the degree of food processing avoids lumping foods made with lots of real cheese with fried chicken as those that undermine healthy eating, based on their saturated fat and sodium content.

More Info?

If you would like to have a Meal Plan designed to meet your health and nutritional needs, I can help.

You can learn more about my services under the Services tab or in the Shop. If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

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Copyright ©2019 The Low Carb Healthy 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

  1. Public Health Agency of Canada, Canadian Institute for Health Information. Obesity in Canada. A joint report from the Public Health Agency of Canada and the Canadian Institute for Health Information. Ottawa: Public Health Agency of Canada & Canadian Institute for Health Information; 2009. 62 pages.
  2. Katzmarzyk PT. The Canadian obesity epidemic: an historical perspective. Obes Res. 2002, Jul;10(7):666-74.
  3. Public Health Agency of Canada. Canadian Chronic Disease Indicators, Quick Stats, 2017 edition. Ottawa: Public Health Agency of Canada; 2017. 4 pages
  4. NCHS Data Brief, Prevalence of Obesity Among Adults and Youth: United States, 2015-2016, https://www.cdc.gov/nchs/data/databriefs/db288.pdf
  5. American Heart Association, Statistical Fact Sheet 2013 Update, High Blood Pressure, https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf
  6. American Heart Association, Heart Disease and Stroke Statistics-2019 At-a-Glance, https://healthmetrics.heart.org/wp-content/uploads/2019/02/At-A-Glance-Heart-Disease-and-Stroke-Statistics-%E2%80%93-2019.pdf
  7. Centers for Disease Control and Prevention, New CDC report: More than 100 million Americans have diabetes or prediabetes, https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
  8. Liu AG, Ford NA, Hu FB, Zelman KM, Mozaffarian D, Kris-Etherton PM. A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion. Nutr J. 2017 Aug 30;16(1):53. doi: 10.1186/s12937-017-0271-4.
  9. Moubarac JC, Batal M, Martins AP, Claro R, Levy RB, Cannon G, et al. Processed and ultraprocessed food products: Consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res. 2014 Spring;75(1):15-21.
  10. Monteiro CA, Moubarac J-C, Cannon G., Ng SW, Popkin B. Ultra-processed products are
    becoming dominant in the global food system. Obes Rev. 2013 Nov;14 Suppl 2:21-8. doi: 10.1111/obr.12107.
  11. Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultraprocessed food and drink industries. The Lancet. 2013 Feb 23;381(9867):670-9. doi: 10.1016/S0140-6736(12)62089-3.
  12. Baker P, Friel S. Food systems transformations, ultra-processed food markets and the nutrition transition in Asia. Global Health. 2016 Dec 3;12(1):80.
  13. Moubarac JC. Ultra-processed foods in Canada: consumption, impact on diet quality and policy implications. Montréal: TRANSNUT, University of Montreal; December 2017.
  14. Schulte EM, Avena NM, Gearhardt AN (2015) Which Foods May be Addictive? The Roles of Processing, Fat Content and Glycemic Load. PLoS ONE 10(2); e0117959. https://doi.org/10.1371/journal.pone.0117959

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The Three Concepts that Canada’s Food Guide Got (Mostly) Right

Note: this article is both an editorial (expressing my personal opinion on the subject) as well as a Science Made Simple article, rooted in the literature.

The new Canada’s Food Guide (CFG) hangs on three Guidelines and unfortunately many people discount the Guide entirely because of the caveats to which they are linked. In my opinion, this is a little bit like “throwing the baby out with the bath water”. The essence of the three Guidelines are sound and worth considering.

I have elaborated at length in previous fully referenced articles (such as here and here) as to why I believe that one of these caveats; the insistence that dietary saturated fat is associated with heart disease is less than clear. Even the Canadian Heart and Stroke Foundation position statement titled ”Saturated Fat, Heart Disease and Stroke” released in September 2015 concludes the same, but that does not mean that the Guidelines themselves should be entirely discounted or discarded.

I have also explained in a few previous articles (such as this one and this one) why I believe that a diet that is highly carbohydrate-centric may not be suitable for the vast numbers of people that are already metabolically unwell (88% based on a recent US study) and that a meal pattern that has a lower percentage of carbohydrate would be better suited to those who are insulin resistance, or who are already pre-diabetic or have Type 2 Diabetes already. That said, the three Guidelines on which the new Canada’s Food Guide is based are largely correct.

In this article, I will highlight what I feel the new Canada Food Guide got entirely right.

Guideline 1 – Real, whole food

Guideline 1 – vegetables, fruit, whole grains and protein foods should be consumed regularly

Guideline 1 of the new CFG is that nutritious foods are the foundation for healthy eating and the Guide defines nutritious foods as vegetables, fruit, whole grains and protein foods that include fish, shellfish, eggs, poultry, lean red meat including wild game, milk, yogurt, kefir and cheese, as well as legumes, nuts, seeds, tofu and fortified soy beverages.

The caveat to this advice that plant-based should be chosen more often and that animal-based foods be lower in fat and sodium and this is based on the enduring belief that foods containing saturated fat and/or sodium contribute to heart disease.

As mentioned above, I’ve already addressed the saturated fat issue in several previous articles and the concern about excess carbohydrate-based foods for those who are metabolically unwell, but it is true that nutritious foods as vegetables, fruit, whole grains and protein foods that include fish, shellfish, eggs, poultry, lean red meat including wild game, milk, yogurt, kefir and cheese, as well as legumes, nuts, seeds, tofu and fortified soy beverages are nutritious foods.

Yes!

Whole vegetables and whole fruit, and a variety of animal based and even plant-based protein foods and even unrefined grains are nutritious foods and suitable for healthy individuals.

How much and what types of fruit and how much and what type of carbohydrate-based foods a given person should consume will vary depending on a their specific metabolic health, however there is no reason to vilify any whole food as being unhealthy.

For more information about why I don’t believe that carbohydrates are inherently “evil” please read my previous article titled Carbohydrates Are Not Evil located here.

Vegetarians can choose their protein as tofu, nuts and seeds, yogurt, kefir, eggs and cheese, whereas pescatarians can include fish and seafood, and omnivores can include meat, including wild game — and all can include whole vegetables and fruit. Inclusion of “healthy whole grains”, as well as how much and how often really depends on which meal patterns someone has chosen, as well as their metabolic health. The matter as to whether one can exclude an entire food group is addressed in this previous article.

Regardless of a person’s chosen meal pattern — be it whole-food plant-based, whole-food pescetarian or omivore, Mediterranean or low carbohydrate, whole, real food is nutritious food.

I decided to pull some food out of my own fridge and take a picture of what whole, real, food looks like in my own meal pattern (low carbohydrate omnivore), but this by no means defines or limits what nutritious food can look like for you!

Example of whole, real food (low carb omnivore)

Perhaps the idea of buying a chicken the way I choose to doesn’t appeal to you and you’d prefer to buy yours boneless and skinless wrapped in plastic on a Styrofoam tray. Go for it! It’s still nutritious, real food.

Buying a whole rotisserie chicken at the store is totally good, too!

So is buying pre-made salad or veggies that are already cut up and frozen or packed ready-to-cook!

If it looks like something your grandparents or great grandparents would recognize as real food, it has a greater chance of falling in what is “nutritious food”.

Guideline 2 – Limit Processed or Prepared Food

Guideline 2 – Processed or prepared foods should not be consumed regularly

Guideline 2 of the new Canada Food Guide is that processed or prepared foods should not be consumed regularly, as these undermine healthy eating.

The caveat to this advice is that these contribute to excess sodium, free sugars or saturated fat which are believed to pose a risk to health and while I’ve previously addressed some of these in earlier articles, regardless of meal pattern processed foods make more energy available for absorption than the whole food from which they are made. In the case of those who have pre-diabetes or Type 2 Diabetes, they also make more carbohydrate available for ready digestion, contributing to a higher insulin response and higher blood sugar response. More information is available in this article as well as this one).

Regardless of the type of meal pattern a person follows, processed or prepared foods ought to be “sometimes foods” and not “everyday foods” — and it doesn’t matter if the processed food is a bake-and-eat frozen pizza, a low carb fat-head pizza or a pre-prepared fake meat burger. These aren’t real, whole foods. Sure, they are nice for an occasional treat but as elaborated on in several previous articles (links above), foods prepared from refined, processed foods have a very different impact on blood sugar response and insulin response than the whole foods from which they are made

Remember, real, whole foods are usually ones that your grandparents or great-grandparents would recognize as real food.

Guideline 3 – Know How to Prepare and Cook Food

Guideline 3 – food skills are needed to navigate the food environment and support healthy eating

Guideline 3 of the new Guide is that food skills such as buying, preparing and cooking are needed to navigate the complex food environment and support healthy eating.

I agree.

a cut up whole chicken; ready-to-cook parts and for stock parts

Unfortunately, it is my experience that many people lack the basic skills to buy foods as simple as raw vegetables such as whole broccoli, or a whole squash and know how to prepare them for eating.

In fact, so many young people lack basic food preparation skills such as how to prepare a simple meal that some school districts have toyed with the idea of bringing back “home economics” to the secondary school curriculum.

Of course, not everyone needs to know how to cut up a chicken (such as I did to the one above) but knowing how to cut up chicken legs into drumsticks and thighs, cut up broccoli or cauliflower or prepare a salad can save people money and increase their availability to eating nutritious (real, whole) food.

Some Final Thoughts…

I said in one of my earlier articles that I consider myself a “nutritional centrist” — that I don’t feel it is necessary to be “tribal” about food allegiances.

People choose different types of meal patterns for all kinds of reasons; from vegetarianism for religious or ethical reasons, to low carb for health reasons, and my role as a Dietitian is to help support them in eating healthy, nutritious food that fits the meal pattern they have chosen.

While I have two specific misgivings about the new Canada’s Food Guide (1) their continued insistence that saturated fat is associated with heart disease and (2) a carbohydrate-centric meal pattern approach when much of the public is already metabolically unwell, there are three things the new Guide got right;

  1. Real, whole foods are nutritious and should be foundational for healthy eating
  2. It is preferable to limit processed and prepared foods
  3. Food skills such as buying, preparing and cooking are needed to support healthy eating.

More Info?

If you would like to learn how the essence of these Guidelines can be adopted to you, I can help.

You can learn more about my services under the Services tab or in the Shop. If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

Copyright ©2019 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.

References

  1. Health Canada, What are Canada’s Dietary Guidelines? https://food-guide.canada.ca/en/guidelines/what-are-canadas-dietary-guidelines/
  2. Health Canada. Food, Nutrients and Health: Interim Evidence Update 2018. Ottawa: Health Canada; 2019.
  3. Health Canada. Evidence review for dietary guidance: technical report, 2015. Ottawa: Health Canada; 2016.

 

But Low Carb Diets Eliminate an Entire Food Group!

Note: This article is classified as an editorial as it reflects some of my own thoughts on these issues and is also classified as a Science Made Simple article, as it is rooted in the science.  By way of references,  I have linked to previous articles I have written (that are referenced) or to the original sources, rather than using footnotes and a reference list. 

One of the common concerns is that a low carbohydrate or ketogenic diet avoids “an entire food group” (i.e. grains) and implies that people will be setting themselves up for decreased nutrient status, or even deficiency if they eat this way, but is that true? Does eliminating this entire food group pose a nutritional risk? That is the subject of this article.

I will begin by discussing food groups, however I will make a small but necessary diversion into the evidence used for recent dietary guidelines that recommend a diet low in saturated fat, as there is a link between the two. As will become clear, it is advisable to include grains in a diet that is low in meat and other animal products.  

Food Groups Come and Go

With the recent re-design of Canada Food Guide, we’ve seen that food groups are not carved in stone.

The once-familiar Meat and Alternatives and Milk and Alternatives food groups were completely eliminated in the newest food guide and replaced by the somewhat all-inclusive “Protein” food group. I qualify this by saying ‘somewhat all-inclusive’ because while the illustrated sample plate of the new guide includes approximately equal amounts of animal-based and plant-based proteins, both milk and cheese are not illustrated on the front, although low fat yogurt is.

Milk and cheese both figured prominently in the past food guides, as did meat, fish and poultry of all kinds, but now inclusion of cheese and higher fat meats are relegated to the inner pages of the new guide where it is explained how to ”limit the amount of foods containing saturated fat” by limiting foods such as “higher fat meat”, “cheeses” and “foods containing lots of cheese” (see this article for details). 

Of course, milk, cheese and meat can all still be included in the diet, however the new food guide recommends that these be limited due to their high saturated fat content, which is said to be linked to an increased risk of cardiovascular disease. 

Health Canada writes about how the guidelines were prepared in their report What are Canada’s Dietary Guidelines?”. They state that they considered the “best available evidence” published between 2006 and 2018 to make their recommendations, but as I will outline below, the 2017 PURE study (Prospective Urban Rural Epidemiology) — which was the largest-ever epidemiological study to date and which recorded dietary intake in 135,000 people in 18 countries over ~ 7.5 years, including high-, medium- and low income nations did not seem to be included. This study found that increased saturated fat intake was NOT associated with increased rates of cardiovascular disease. 

Health Canada explains in its report that the Guidelines, including Guideline 1 to eat more plant-based food in order to lower the intake of saturated fat was based on “convincing findings” from scientific reports that included extensive systematic reviews of the literature on the relationship between food and health, and that these reports are listed in Table 1 of the report.

from Health Canada’s “What are Canada’s Dietary Guidelines?”

Best Available Evidence for Saturated Fat Recommendations

Table 1 of Health Canada’s report says that the “best available evidence” for the saturated fat recommendations in the new  food guide were based on the following three systematic reviews;

    1. Food and Agriculture Organization (FAO) of the United Nations 2010 – Fats and fatty acids in human nutrition — report of an expert consultation
    2. World Health Organization (WHO) 2016 – Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and
      regression analysis
    3. World Health Organization (WHO) 2017 – Health effects of saturated and trans-fatty acid intake in children and adolescents: Systematic review and meta-analysis

Based on Table 2 of the report titled “Convincing findings supporting Guideline 1” (the guideline which recommends more plant-based food in order to lower intake of saturated fat) lists the same three systematic reviews as above, plus adds;

  • Dietary Guidelines Advisory Committee 2010: Report of the DGAC on the Dietary Guidelines for Americans
  • Health Canada 2012: Summary of Health Canada’s assessment of a health claim about the replacement of saturated fat with mono- and polyunsaturated fat and blood cholesterol lowering
  • American College of Cardiology/American Heart Association 2013:  Guideline on lifestyle management to reduce cardiovascular risk: a report of the ACC/AHA task force on practice guidelines
  • Dietary Guidelines Advisory Committee 2015: Scientific report of the DGAC: advisory report to the Secretary of Health and Human Services and the Secretary of Agriculture

That is, the new saturated fat guidelines were based on systematic reviews from 2010, 2012, 2013, 2015 as well as the FAO/WHO recommendations from 2010, 2016 and 2017.

It appears that the largest-ever epidemiological study (PURE) that was published in 2017 and which found that saturated fat intake was not associated with cardiovascular disease, or increased rates of death was not included or was deemed for some reason to not be “best available evidence”. What is puzzling is that a key the 2018 Health Canada report titled Interim Evidence Update lists it as a reference, but doesn’t seem to refer to the study anywhere.  More on that in the next article.

Systematic Reviews of Epidemiological Studies

As pointed out at the end of the previous article, epidemiological studies are the study of diseases in populations. These are helpful for researchers to know which areas warrant clinical trials, because epidemiological studies can’t attribute “cause” of disease or death. 

When an epidemiological study finds an “association” between two factors  such as saturated fat and higher blood lipid levels — this does NOT mean that saturated fat ’causes’  heart disease. It only means that higher saturated fat intake is associated with higher blood lipid values. Other studies associate high blood lipid values such as total LDL cholesterol to cardiovascular disease, but this is only helpful when we know which LDL is raised; the atherosclerotic small, dense sub-fraction or the neutral (or possibly protective) large fluffy sub-fraction. To know whether higher saturated fat intake causes cardiovascular disease events requires clinical trials.

There had already been eight meta-analysis and systematic reviews of evidence from randomized control trials (RCT) that had been conducted between 2009-2017 that did not find an association between saturated fat intake and the risk of heart disease that I reviewed in this article — data that was available prior to the redesign of the new food guide. As of this week we also have a new meta-analysis of clinical data from 43 study cohort group studies that was just published on April 6, 2019 which found NO relationship between higher saturated fat intake and higher risk of cardiovascular disease (CVD) events. 

Not Carved in Stone

The recommendations made in the new food guide were based largely on epidemiological evidence and clinical data related to the association between saturated fat and blood lipid levels — sometimes lumping saturated fat and trans fats together. One one would hope that as clinical data from well-designed studies continues to emerge showing no association between saturated fat intake and cardiovascular disease (CVD) — the actual area of concern, that these recommendations will change. 

If food groups are not carved in stone, dietary recommendations ought not to be either. 

Eliminating an Entire Food Group

Now back to the topic of this article…

Is there a valid concern that those eating a low carbohydrate or ketogenic diet who are eliminating a entire food group (i.e. grains) are setting themselves up for decreased nutrient status or deficiency?

To answer that question we need to ask ourselves;

(1) which nutrients are found in grains in significant quantities

and

(2) can those nutrients be found in sufficient quantities in other foods in the diet?

If so, then eliminating grains does not predispose people to risk of decreased or deficient nutrient status.

Main Nutrients in “Healthy Whole Grains”

Yesterday evening, while writing this post,  I stumbled across a recent article title ‘Healthy whole grains’ – really?! that was written by Dr. Zoe Harcombe, a Ph.D. in public health nutrition.  In her article, Dr. Harcombe compiled data from the USDA’s National Nutrient Database for Standard Reference to evaluate the nutrient content in whole grain whole wheat flour, long grain brown rice, whole wheat spaghetti / pasta, oats and whole wheat bread. These foods are representative of what I think most Dietitians would categorize as ‘healthy whole grains’ which are known for being high in B vitamins such as B1 (thiamine), B2 (riboflavin), B3 (niacin) and folate (also called folic acid), as well as minerals such as iron, magnesium and selenium. 

Dr. Harcombe demonstrated that foods such as chicken liver, sardines, eggs and sunflower seeds are much better sources of the B-vitamins than these “healthy whole grains”. As well, I know from having researched the topic that meat and seafood are excellent sources of the most bioavailable form of iron (heme iron which is superior to the non-heme iron found in grains). As discussed in the previous article,  nuts and seeds, dark chocolate and avocados are all rich in magnesium and animal foods such as pork, beef, turkey, chicken, fish, shellfish and eggs are all rich in selenium.

Whole grains are also good sources of  fiber, but so are the wide range of non-starchy vegetables that are eaten on a well-designed ketogenic diet, as well as the starchy vegetables and berries that are eaten on a well designed low- carbohydrate diet. In fact I wrote an article about this a year and a half ago.

In short, there are no nutrients found in grains that are not found in adequate, or even higher quantities in foods eaten as part of a well-designed low carbohydrate or ketogenic diet.

Some Final Thoughts…

As far as I can see, it is only the conviction that there is an established relationship between saturated fat and cardiovascular disease (based on a proxy relationship between saturated fat and blood lipids) and the resulting dietary guidelines based on that relationship that makes the eating of whole grains ‘necessary’. 

The reason?

Current dietary guidelines recommend limiting animal foods so eating more plant-based foods and grains containing B-vitamins, iron, magnesium and selenium is necessary. If, however guidelines could change in the future based on emerging evidence (provided that they continue to be validated by future studies), then eating whole grains would be “optional”, since animal-based foods are equal or superior sources of those nutrients. 

If ‘eating foods with saturated fat causes heart disease’, then limiting them is necessary, and eating whole grains is the next best source of these nutrients.

Personality I am not convinced that the evidence is unequivocal and that it is warranted to limit foods rich in saturated fat. At the same time, I am not persuaded that there is evidence that eating lots of saturated fat to the exclusion of other healthy fats is necessary or preferred. 

Assuming the emerging evidence on the safety of saturated fat continues to hold, I believe including animal foods in the diet precludes the necessity to eat whole grains.

For those that choose to follow a vegetarian diet, the inclusion of some whole grains as good sources of B vitamins, iron, magnesium and selenium is advisable.

 If you would like nutritional support to ensure you are obtaining a wide range of nutrients while following a low carbohydrate diet, I would be glad to help.

You can learn more about my services and their costs above under the Services tab or in the Shop. If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

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Copyright ©2019 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.

Cannabis’ Effect on Appetite, Blood Sugar and Insulin Levels

As of October 17th 2018, marijuana (cannabis sativa, cannabis indica) will be legal to be sold to or possessed by adults 18 years or older in Canada and to be consumed for recreational use.  Medical marijuana has been available for sometime in Canada (and in some US states) to those with authorization from their healthcare provider, but will now be widely available to the general adult population. So why am I, as a Dietitian writing about marijuana? Because food cravings, commonly referred to as the “munchies” are one of the known side-effects of cannabis and result in people eating even when they’ve just eaten.  For those who have made a decision to lose weight and keep it off, knowing how marijuana affects appetite is something that needs to be considered. As well, for those that are at risk for Type 2 Diabetes, knowing how marijuana impacts blood glucose and serum insulin levels is also important. So as a public service, this article is about the effect of marijuana and the “munchies” on blood sugar, serum insulin and weight gain.

The “Munchies”

Tetrahydrocannabinol (THC) is one of the active components in marijuana that is responsible for people feeling “high” and is also responsible for “the munchies”.  It’s been know for sometime that the THC in cannabis activates a cannabinoid receptor in the brain (called CB1R) which triggers an increased desire to eat but a 2015 study indicates that a group of neurons (nerve cells) called pro-opiomelanocortin (POMC) which normally produce feelings of satiety (no longer feeling hungry after eating) become activated and promote hunger under the influence of THC. As it turns out, cannabis “hijacks” the POMC neurons, resulting in them releasing hunger-stimulating chemicals rather than appetite-suppressing chemicals. This is why despite having just eaten a full meal and being satiated, ordering a pizza suddenly becomes a priority. It is thought that THC from the weed binds to mitochondria inside of cells (the “powerhouse of the cell” that generates energy) and this binding acts to switch the feelings of satiety to feelings of hunger. But how does marijuana use affect weight gain, blood sugar and insulin levels?

Marijuana’s Effect on Fasting Blood Glucose and Fasting Insulin, Insulin Resistance and Weight Gain

Interestingly, epidemiological studies (studies of populations) have found lower rates of obesity and Type 2 Diabetes in those that use marijuana compared to those that never used it, suggesting that cannabinoids play a role in regulating metabolic processes. A 2013 study that analyzed data from almost 4657 adult men and women who participated in the National Health and Nutrition Examination Survey (NHANES) study from 2005 to 2010 were studied; 579 were current marijuana users and 1975 were past users. Results indicated that current marijuana use was associated with 16% lower fasting insulin levels and 17% lower insulin resistance as measured by HOMA-IR  which is calculated from fasting blood glucose and fasting insulin. As for weight gain as a side-effect from the “munchies”, this study  reported significant associations between marijuana use and smaller waist circumferences.

Marijuana and Metabolic Syndrome

A 2015 study which looked at 8478 adults 20-59 years of age who also  participated in the National Health and Nutrition Examination Survey (NHANES) study from 2005 to 2010 reported that current marijuana users had lower odds of presenting with metabolic syndrome than those that never used marijuana. Current marijuana users in the 20-30 year old range were 54% less likely than those who never used marijuana to present with metabolic syndrome.

Marijuana’s Possible Role in Type 2 Diabetes Treatment?

The epidemiological studies above indicate that fasting insulin levels were reduced in current cannabis users but not in former cannabis users or in those that never used it. This leads to the question as to whether THC may be of medical benefit to those already diagnosed with pre-diabetes or Type 2 Diabetes. Given that epidemiological evidence demonstrates there may be a correlation but not provide proof of causation, further study is warranted.

Some Final Thoughts…

Certainly as a reasonable precaution, those who are Diabetic and who will begin using marijuana now that it is legal (or already use marijuana) should monitor their body’s blood sugar response, especially if they are also taking medications to lower blood sugar. Assuming that cannabis can lower blood sugar on it’s own, taking it along with medications to lower blood sugar may result in blood sugar dipping too low (hypoglycemia).

Perhaps you’re curious how I can help you achieve your weight-loss and other health goals such as lowering risk factors for Type 2 Diabetes by making dietary and lifestyle changes. I provide both in person services in my Coquitlam, British Columbia office as well as via Distance Consultation (Skype, telephone). You can find out details under the Services tab above or in the Shop.

If you have questions regarding getting started or would like more information, please send me a note using the Contact Me form above and I will be happy to reply as soon as I’m able to.

To your good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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.

References

Government of Canada, Cannabis Legalization and Regulation, http://www.justice.gc.ca/eng/cj-jp/cannabis/

Koch M, Varela L, Kim JG et al, Hypothalamic POMC neurons promote cannabinoid-induced feeding, Nature, Volume 519 (2015), pages 45—50

Penner EA, Buettner H, Mittleman MA, The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults, Amer J of Med, 126 (7) July 2013, Pages 583-589

Vidot DC, Prado D, Hlaing WM et al, Metabolic Syndrome Among Marijuana Users in the United States: An Analysis of National Health and Nutrition Examination Survey Data, Amer J of Med, 129 (2) Feb 2016, Pages 173-179

 

Evidence that Refined Carbs with Vegetable Oils Cause Weight Gain

It has been my conviction for some time that the “perfect storm” which underlies the current obesity epidemic was the marketing of novel food products that were a combination of refined carbohydrates and manufactured vegetable oils and today I came across evidence that the food industry has known for some time that this specific combination results in significant weight gain. The proof wasn’t in a remote journal article, but in a product that was deliberately designed from refined carbohydrates and manufactured vegetable oils and marketed for the specific purpose of causing weight gain.  Yes, you read that correctly.

Just 5 years after the first manufactured vegetable oil product, Crisco® was created in 1911 — the brainchild of soap manufacturer Proctor and Gamble, a product called Wate On® was created by Dendron Distributors [1] of Chicago, Illinois in 1916 and promoted to doctors and the general public to promote weight gain through its “proven weight building elements”.

Wate On® boasted in magazine and newspaper ads that it was “loaded with concentrated calories so prepared to be far easier to be used by the system in building wonderful body weight“.

So what was its specially prepared formula?

It was the combination of vegetable oil and refined carbohydrates with added vitamins and minerals together in one easy-to-take product.

Early advertisement for Wait-On

Here are the words of the ad, above;

“if you are skinny, thin and underweight, mail this coupon for the latest discovery of modern medical science. It’s called WATE ON and anyone in normal health may quickly gain 2, 4 as much as 5 lbs. in a week…then 10 pounds, 20 pounds and more so fast, it’s amazing! Not a medicine, not intended to cure anything. Instead WATE ON is a new different formula that’s pleasant to take as directed and is loaded with concentrated calories so prepared to be far easier to be used by the system in building wonderful body weight. Cheeks fill out, neck and bust-line gain, arms, legs, thighs, ankles, skinny underweight figures fill out all over the body.”

Wate-On®’s formulation was no secrete and was published in their advertisements.

Actress June Wilkinson, in an ad from the early 1960s in referring to the two formulations, WATE-ON® and SUPER WATE-ON® writes”both forms of WATE-ON are super-concentrated with weight-building calories, vitamins, minerals, quick energy elements”. In other parts of the same ad, it lists that the product is “saturated with calories from maize oil” and that SUPER WATE-ON has “extra calories from energy-giving sucrose and easy-to-digest vegetable oils“.

Wate-On ad featuring June Wilkinson, early 1960s

The obesity crisis should have come as no surprise.

In the 1940s, 50s and 60s, manufactured vegetable oils combined with sucrose (the refined carbohydrate of table sugar) were sold and promoted for weight gain.

Then, in the early 1950’s, Ancel Keys proposed his diet-heart hypothesis  (the belief that eating foods high in saturated fat contributed to heart disease) which was followed by publication of his Six Country Study in 1953 where he claimed to have demonstrated that there was an association between dietary fat as a percentage of daily calories and death from degenerative heart disease. Despite the fact that 4 years later (1957)  Yerushalamy  et al published a paper with data from 22 countries which showed a much weaker relationship between dietary fat and death by coronary heart disease than was suggested by Keys’s Six Countries Study data, the link between saturated fat and heart disease endured (see this earlier article for more details and references.)

In August of 1967, Stare, Hegsted and McGandy — the 3 Harvard researchers paid by the sugar industry published their review in the New England Journal of Medicine — which vindicated sugar as a contributor of heart disease and laid the blame on dietary fat and in particular, saturated fat and dietary cholesterol.

This vilification of saturated fat laid the foundation for the food industry to promote their novel vegetable fats to the general consumer as a ‘healthy’ alternative to ostensibly ‘unhealthy’ saturated fats.

…and promote them they did!

In the late 1980s, the food industry marketed their manufactured vegetable fats to an unsuspecting public by providing “teaching resources” to future Dietitians to promote their products as “healthy oils”. I know.  I was one of them (more in this article). Then came the proliferation of manufactured “convenience foods” and “fast foods” — sold as products to make life easier, but which made us fatter instead. These products were (and are) the very combination of manufactured vegetable oil and refined carbohydrates of which weight-gain products of years-gone-by were made from!

Can the food industry claim — like the tobacco industry before them that they didn’t know fast food and convenience food would result in ill health, stemming from overweight and obesity? I don’t think so.

The food industry knew that the combination of manufactured vegetable oil and refined carbohydrates would lead to weight gain because before they were sold together as ‘convenience food’ and ‘fast food’, they were sold together in products deliberately designed to promote weight gain.

I remember when when the tobacco industry was challenged and how very long it took before a final verdict was reached and marketing and selling of disease-causing tobacco products to the public was legislated. How long will it take for foods containing a combination of manufactured vegetable oil and refined carbohydrates that we KNOW cause weight gain, to be likewise legislated?

How many more millions of people will die from food-related death or live poor quality-of-life due to obesity and obesity-related metabolic disease before the food industry is challenged?

Final Thoughts…

Having read this article, I would encourage you to begin reading labels of the foods you buy — and see how many of them have this combination of manufactured vegetable oil and refined carbohydrates. Start with ones in your pantry or fridge, then begin to read labels before you purchase them.

The manufactured vegetable oils to look for are mainly soybean oil, canola oil and corn oil [also called maize oil in imported products] and the refined carbohydrates can be anything from white flour to various types of sugar (sucrose, glucose, other words ending in —ose).

Then, look for healthful alternatives available in the marketplace. Monounsaturated fats such as olive oil and avocado oil are great alternatives and many of the products that have added sugars and vegetable oils really don’t need them, such as salad dressing or peanut butter!

Finding healthy products rarely requires shopping at a “health food store”, but simply shopping wiser at an ordinary supermarket — and realizing the the products you and others buy are the ones that stores will restock. If your store doesn’t have a healthy alternative to a product, then ask to speak to the department manager to request that they stock some.

When you have some time, ask for the ingredient list to the products you buy at your local fast food restaurant or coffee house — or go online and find them. By law (in both Canada and the US), food service companies are required to make these available. Ask. Read them. Look for they types of fats that are used and the types of refined carbohydrates.

Then, make food purchases for yourself and your family based on what you know and what you learned in this article about products that contain a combination of manufactured vegetable fats and refined carbohydrates.

If you need help to make healthier food choices, I can help.

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

To our good health,

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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.

References

  1. OTCToolbox, DDD seeks brands to distribute in the UK, Nov 11 2014, https://www.otctoolbox.com/news/archive-2014/ddd-seeks-brands-to-distribute-in-the-uk.aspx
  2. The History of Dendron http://www.dendron.co.uk/history

Evolving Theory of Obesity – a combination of refined carbs and industrial seed oils

Three years ago, my theory about the roots of the current obesity and Diabetes epidemic was simple. I believed that it was largely a matter of us eating too many carbs while having reduced the amount of healthy fat we ate. I now think it is a little more subtle than that, and that it is specifically the combination of a diet too high in refined carbs while high in industrial seed oils (such as soybean and canola oil) that underlies the issue.

When I first started reading and writing about the current obesity and Diabetes epidemic, my thoughts were summarized in two articles written in May and June of 2015. In the first article, I documented how in 1970-72 only 6% of men and 11.7% of women were considered obese (Body Mass Index > 30) in Canada, but by 2013 obesity in men had tripled to 20.1% in men and to  17.4% in women. In the second article, I explained how the changes in the obesity rates coincided with the changes in the Dietary Recommendations that began in 1977 and continued in 1982, 1992 and 2005 and which encouraged people to eat considerably more carbs and a lot less fat coincided with the increased obesity rates, and that the increasing rates of Type 2 Diabetes (9.4% in 2014 in Canada) was just a natural outworking of the higher obesity rates.

The problem was, I really didn’t know of any specific mechanisms that related one to the other.

Now I know of several.

This article summarizes my current theory of obesity, as it relates to previous articles and a brand new study published last week.

Correlation is not Causation

There’s an expression in science is that “correlation is not causation”.

That is, the fact that a dramatic increase in obesity rates correlates (or coincides) with the changes in the Dietary Recommendations doesn’t mean that the Dietary Recommendations ’caused’ the obesity epidemic or the Diabetes epidemic.

One can hypothesize that there is a relationship between these two things, but without some understanding of the mechanism and more data, we don’t know what this relationship might be.

From the reading I have been doing the last number of years, I have some ideas of some of what may be involved.

Evolution of the Theory

A presentation at a conference at the beginning of March (documented in  two previous articles) got me thinking that the picture was bigger than just “too many carbs” and a “decrease in the satiety effect of saturated fat” from full fat milk, cheese and butter. I was challenged by the fact that in the late 1960s and early 1970s, people in the US and Canada were generally slim, despite eating carbohydrates at just about every meal;

“They ate cereal or toast for breakfast and just about every household had a toaster. Lunch was often sandwiches, as there were no microwaves to heat food up in. Potatoes were a mainstay at dinner, sometimes pasta — yet the majority of young adults and adults were slim. Of course there were always some people that were overweight. Most elementary school classes had one chubby’ kid, but when one looks around the classes of today or on public transit or in stores and supermarkets, most people are considerably heavier than people in the 1950’s and 1960’s”

(from A New Hypothesis for Obesity Part 1)

The question was raised ‘what resulted in overweight and obesity all of a sudden exploding in the 1970’s and just keep rising?’

What changed?

We knew that (based on US data) people began eating ~240 calories a day more as carbohydrate but what was causing them to do this? Was it just because the Dietary Recommendations were encouraging us to eat more carbohydrate or was there something else going on?

Not More Fat but the Type of Fat

While people were eating more carbohydrate, neither people in Canada nor the US were eating more fat, but the type of fat we’ve been eating since the 1970s has changed substantially. This tweaked my interest.

We’d reduced our intake of saturated fat (because the “Diet-Heart Hypothesis” had told us they were the “cause of cardiovascular disease”) and we dutifully ate more and more of ‘polyunsaturated fats’ / vegetable oils  which as I wrote about previously are more appropriately called “industrial seed oils”.  These oils, including soybean, corn oil and canola oil contain high amounts of linoleic acid which is at the very top of the omega 6 (n-6) pathway and these fats which elongate to arachidonic acid are pro-inflammatory products in nature.

There is nothing inherently ‘bad’ about linoleic acid which is found naturally in nuts and seed oils, including walnut, macadamia and sesame oil, but it is the sheer amount of these industrial seed oils which suddenly became excessive in our diet, which I think may be a significant factor.  These fats are in our bread, pastries, salad dressing, margarine and even our peanut butter.  Canned fish is packed in it, our mayonnaise is made from it and everything we eat that is fried from a restaurant is bathed in these industrial seed oils. On top of that, many of us use it our own homes to cook with.

So many of the foods we now eat are prepared with soybean or canola oil and as a result, we consume a much greater amount of linoleic acid than our body ever evolved to handle.

As outline in previous articles, these oils are much more unstable than the saturated fats they were created to replace. What I mean by ‘unstable’ is that they are more easily oxidized – that is, when industrial seed oils are heated in the making of commercial foods using them or in cooking, they react with oxygen in the air to form toxic substances including  aldehydes  and lipid peroxides.  When these oils are heated, they produce oxidized metabolites which have been also been implicated in the development of a variety of conditions, including non-alcoholic fatty liver disease (NAFLD), cardiovascular disease and cancer and it has been proposed that inflammation is involved in the development of Type 2 Diabetes and metabolic syndrome, as well.

Also as written about previously, cardiolipin  is an important component of the inner membrane of the mitochondria (the so-called “powerhouse of the cell”) and the fats that make up cardiolepin change, depending on the types of fats in the diet. That is, the fatty acid composition of cardiolepin is altered by us eating a diet high in linoleic acid, such as soybean and canola oil. This past week a study about cardiolepin was published that added a very interesting piece to my evolving theory of the obesity and Type 2 Diabetes epidemic.

In this new study, researchers at the University of Copenhagen found that when large amounts of cardiolipin are produced in ‘brown fat’ cell mitochondria, there is much stronger calorie-burning. Conversely, when there are low amounts of cardiolepin in brown fat, there is much less calorie-burning. Low amounts of cardiolepin and less calorie-burning in brown fat was reported to be associated with obesity and Type 2 Diabetes [1].

Note: “Brown fat” is a specialized type of fat that burns fat, rather than stores it and cardiolepin acts like a kind of on-off switch for the activity in our brown fat.

This study got me thinking that since it is known that the fatty acid composition of cardiolepin changes according to the fatty acid composition of the diet (covered in previous blogs), what effect has the massive increase in linoleic acid intake in the diet in both Canada and the US had on the function of the cardiolipin?

Could it be that a shift in the types of fats that make up cardiolepin in brown fat stemming from a very high linoleic acid intake from industrial seed oils has had a similar effect as an absolute decrease in cardiolepin – and that this is somehow related to the increase in obesity and Type 2 Diabetes?

Type of Fats and Refined Carbohydrates

My theory of obesity has evolved and will likely continue to evolve. I don’t think that increased carbohydrate consumption based on changes in the Dietary Recommendations in the late 1970s / early 1980s in and by itself resulted in the obesity epidemic and huge increase in Type 2 Diabetes we see now.

I currently believe that the introduction of these manufactured industrial seed oils (soybean, canola, corn) that were created in the 1970s and meant to replace saturated fat in the diet (presumably to protect people from heart disease!) may be part of the initiation of the disease process.

As documented in earlier articles, we know that these fats are easily oxidized, have a direct impact on increasing inflammation and triggering the disease generation process in several health conditions and on acting on the endo-cannibinoid receptors in the body, in much the same way as cannabis (marijuana).  Could it be that these created oils that are very high in the average Western diet actually lead people to consuming more and more carbohydrate-based foods; foods that often comes liberally bathed in more industrial seed oils?

The mechanism of how the above might work was presented in an earlier article and had to do with how energy is generated in the electron transport chain of the mitochondria being different for saturated fats and unsaturated fats.

There are several possible mechanisms that may link consumption of these novel fats to obesity and development of Type 2 Diabetes (oxidation, inflammation, food cravings) and now based on this new study, the possibility of an increase in linoleic acid content in cardiolepin and it’s effect on fat burning.

It will take years more research before we have a fuller picture, so what do we do in the meantime?

Sensible Recommendations based on the Current Knowledge

For someone who is metabolically healthy (i.e. does not have Type 2 Diabetes or Insulin Resistance, hypertension or high cholesterol), it would seem that a whole-foods approach combined with avoiding omega – 6 industrial seed oils such as soybean, canola and corn oil combined with being mindful of the amount and type of carbohydrate in the diet may be sufficient to avoid developing these chronic diseases. Such a scenario would not be unlike the diet of the average American or Canadian in the 1950s and 60s. Not that that diet was that healthy, when compared with a classic Mediterranean diet, Japanese or Okinawan-style diet, or a whole food low-carbohydrate diet. These, it would seem offer a much healthier alternative.

For those who are already are insulin resistant or been diagnosed with Type 2 Diabetes, avoiding industrial seed oils would prudent and eating naturally-obtained vegetable fats such as olive oil or avocado oil instead. Since it does not seem that studies clearly support that saturated fat causes heart disease and not simply increase in surrogate markers of heart disease such as higher LDL (which LDL subfraction?), it would seem that using modest quantities of real butter is preferable to eating margarine made from industrial seed oils. It would also seem that at least initially, eating a diet where the amount and type of carbohydrate is kept to a quantity that does not trigger large amounts of insulin release or spike blood glucose makes good sense. As I wrote about recently, with the availability of Continuous Glucose Monitoring (CGM), this approach can be tailored to each individual person’s response to specific foods. We are no longer reliant on Glycemic Index or Glycemic Load, which are derived from healthy people’s response to foods, not those with Type 2 Diabetes. A suitable diet could be expressed as a variety of different lifestyles (just as for the healthy individual) including a Mediterranean diet, Okinawan-style diet, or whole food low-carbohydrate diet – with carbohydrate levels tailored on an individual basis, based on glycemic response and insulin levels.

Whether a person is healthy or metabolically unwell, based on the studies I have read and some of the mechanisms that have come to light, I can see no benefit in people eating either industrial seed oils or refined, processed carbohydrates. There is every reason to believe that both of these may have been part of the underlying cause of the current obesity and Type 2 Diabetes epidemic.

Unrefined Carbohydrates and Healthy Fats

If someone is metabolically healthy, I recommend eating minimally processed carbohydrates as they reduce the ‘incretin effect’ of hormones such as GIP, GLP-1 and GLP-2 that are released in the intestine and trigger the release of insulin from the pancreas beta-cells. Eating minimally processed carbs would result in less triggering of the release of insulin, thus reducing the likelihood of developing either insulin resistance or Type 2 Diabetes.

If someone is already insulin resistant or has Type 2 Diabetes, it seems from recent studies that minimizing carbohydrate initially, along with weight loss and some forms of activity may be at least as good if not more beneficial than a low-fat calorie-restricted diet. Certainly, many people find they are a lot less hungry eating a low carbohydrate whole foods diet and are easily able to stick with it long term (a year or two in studies), allowing for a period of improving insulin sensitivity and lower overall blood sugar levels. It certainly has been demonstrated to be safe and effective in periods up to two years.

For both those that are metabolically healthy or insulin resistant or have Type 2 Diabetes, avoiding industrial seed oils makes good sense, for all the reasons outlined above.

What about your specific situation?

Do you have questions about the type and amount of carbohydrates that are most suitable for you based on your health and family history? What about which fats are are the best choices given your lifestyle?

I can help.

Please feel free to send me a note using the “Contact Me” form located on the tab above to find out how I can support your needs and I will reply as soon as possible. Remember, I provide both in-person services and am experienced providing services via Distance Consultation (telephone or Skype).

To your good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Reference

Sustarsic EG, Ma T, Lynes MD et al, Cardiolipin Synthesis in Brown and Beige Fat Mitochondria Is Essential for Systemic Energy Homeostasis,
Cell Metabolism (2018), https://doi.org/10.1016/j.cmet.2018.05.003

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.

 

 

 

 

 

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!

you can follow me at:

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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.

 

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.

Brussels 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

 

you can follow me at:

 https://twitter.com/lchfRD

  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.


 

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.

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 about how I can help you? Please send me a note using the “Contact Us” form on the tab above.

you can follow me at:

 https://twitter.com/lchfRD

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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.


 

Keto Water – replacing electrolytes

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

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

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

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

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

”KETO-WATER”

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

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

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

Keto-water salts

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

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

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

You can follow me at:

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Copyright ©2017 The Low Carb High Fat Dietitian (a divisions 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 regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read or heard in our content. 

 

New Obesity Study Sheds Light on Dietary Recommendations

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

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

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

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

The Food Guide Pagoda

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

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

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

Specific Dietary Recommendations (2007-2015)

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

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

The Results (2005-2015)

1. Leading cause of death

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

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


2. Leading cause of premature death

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

 


3. What caused the most death and disability combined?

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

 


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

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

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

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

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

China’s “solution”?

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

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

New Dietary Recommendations (2016)

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

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

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

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

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

Final Thoughts…

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

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

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

1 1/2 cups of milk

and

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

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

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

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

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

Should we expect different results in China?

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

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

Want to know more? Send me a note using the “Contact Us” form, on the tab above.

To our health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


You can follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/


References

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

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

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

 

Oh Nuts!

One of the challenges with trying to lose weight is reaching a plateau – where one’s weight stays the same for an extended period of time. When eating a low-carb or ketogenic diet, some foods such as nuts are a common pitfall. Despite being a rich source of heart healthy monounsaturated fats, some nuts contain high amounts of carbohydrate.


Carbs Per Serving of Nuts

Serving Size

A serving size* of nuts is generally considered one ounce (1 oz.) which is about a handful of an ‘average-sized hand’. The problem with using this kind of measurement is that not all nuts have the same mass per volume, nor does everybody have the same size hand!

Here are the number of nuts per ounce for common varieties:

  1. Cashew 16-18 nuts per ounce
  2. Pistachio 45-47 nuts per ounce
  3. Almond 22-24 nuts per ounce
  4. Pine Nuts ~3 Tbsp. (160 kernels) per ounce
  5. Hazelnut 10-12 nuts per ounce
  6. Walnut 8-10 halves per ounce
  7. Peanut 27-29 nuts per ounce
  8. Macadamia 10-12 nuts per ounce
  9. Pecan 16-18 halves per ounce
  10. Brazil Nuts 6-8 nuts per ounce

* When eating shelled nuts, many people eat a few palm fulls, so I’m going to indicate the carbs for a 1 oz and 3 oz serving.

Carbs are listed as “net-carbs” (i.e. once fiber (which is not digestible) has been subtracted from the total amount of carbohydrate).

Carbohydrates per Ounce

1. Cashews

Cashews contain the most carbs per serving; a whopping 9 g per 1 oz serving, which is about 16-18 nuts.

2. Pistachio
Pistachios contain 6 gms of carbs per 1 oz serving ~ 46 nuts – that’s 18 gm of carbs in an average 3 handful serving (3 oz) – a little more than a slice of bread.

3. Almonds

Almonds contain 6 gms of carbs per 1 oz serving ~ 22-24 nuts.

4. Pine Nuts

Pine nuts (also called pignolias) contain 3 gms of carbs per oz. (which is about 3 Tbsp.)

5. Hazelnut

Hazelnuts (~11 nuts per ounce) contain ~2 1/2 gms of carbs for a 1 oz serving (~11 nuts) / 7 gms of carbs for 3 oz / 3 average handfuls.

6. Walnut

An ounce of walnuts (9 halves per ounce) contain the same amount of carbs as an ounce of hazelnuts (~2  1/2 gms of carbs for a 1 oz serving / 7 gms of carbs for 3 average handfuls or ~ 27 halves.

7. Peanut

An ounce of peanuts (~28 shelled peanuts per ounce) also contain the same amount of carbs as an ounce of hazelnuts or walnuts (~2  1/2 gms of carbs for a 1 oz serving.

Top three low carb high fat / keto-friendly nuts:

Macadamias, Pecans and Brazil nuts are the 3 most low-carb and keto-friendly nuts – having between 4 and 5 gms of carbs for a 3 oz serving! That’s far better than the 27 gm of carbs for 3 oz of cashews and 18 gm of carbs for 3 oz of pistachios!

8. Macadamia

Macadamias have slightly more than 1  1/2 gms of carbs for a 1 oz serving (~11 nuts) / 5 gms of carbs for a 3 oz serving.

9. Pecans

Pecans have 1.3 gms of carbs for an ounce of nuts (~17 halves) / 4 gms of carbs for a 3 oz serving.

10. Brazil nuts

Brazil Nuts also have only 4 gms of carbs for a 1 oz. serving (~ 7 nuts)

A Tough Nut to Crack

Back in the day, eating nuts meant cracking nuts.

It was common to see living room tables with bowls of nuts in their shell, with nutcrackers and nut-picks readily available for use.

Each house had its preference for the style of nutcrackers they insisted were the best.  Growing up, we had ones like those above.

Nuts and “Carb Creep”

“Carb creep” is when we think we are eating low carb, but hidden sources of carbs are sneaking into our diet without us being aware of it.

When I was pondering why I had reached my own weight plateau, I knew carb creep had to be the reason – but from where?

After analyzing my diet, it seemed that nuts might be the source and it was.

My biggest single downfall was that I like to crack and eat pistachios on the weekend, while working on my foreign language studies – and it is WAY too easy to crack them and eat copious amounts!  In fact, I am somewhat of an expert at shelling them, as my brother and I were placated by our parents with bags of pistachios, on long car trips. To get my “fair share”, I learned to be quite efficient at shelling them and so it seems, I haven’t lost that ‘skill’.

Over the course of several hours I can shell and eat 1/2 to 1 lb of pistachios without really noticing eat, and in the worst case scenario that’s almost 100 gms of hidden carbs!

Add to that a handful or two of almonds a day (another hidden 10 gm of carbs per day) and the source of my “carb creep” became clear.

Portioning

Of course to try to prevent eating too many, nuts can be portioned out in 1 oz or 3 oz ‘servings” and the rest put away for another time, but it is still way too easy for someone who is hungry or tired to mindlessly reach for a handful or two of nuts. It seemed to me that having large containers of shelled nuts that are too easy to reach for, may not be the best solution.

Unshelled Nuts

Replacing shelled nuts with nuts in the shell, like we ate in the “old days”, turns out to be a far more effective solution.

It’s very hard to over eat nuts you have to shell first.

Bingo!

Since pecans are a much lower carb nut than pistachios, they have become my go-to nut from the nut-bowl…and let me assure you, it takes quite a while to shell 17 halves for a mere 1.3 carbs! In fact, I’m pretty sure I expend more energy cracking them, than I take in, eating them.

The Right Tools for the Right Job

Despite having a variety of nutcrackers, I found pecans a “very tough nut to crack” – with them frequently flying out of the standard pinch-style cracker.

I found out that there is a special “pecan cracker” that one can order that apparently does the job very well and looks like this:

…but the little contraption below that I invented in my garage (with a d-clamp and a stick-on felt pad, works great, and I use it for pecans, walnuts and even hazelnuts. Even eating walnuts, which are a higher carb nut – it takes quite a while to shell 9 halves (2  1/2 gms of carbs).

How I can help

For the last 2 years, I have helped my clients lose weight and keep it off using a low-carb approach. More recently, I am ‘practicing what I preach‘ (as you can read about in the blogs titled “A Dietitian’s Journal”). The things I am learning “doing it” adds to what I know academically – which makes me able to coach people much more effectively.

Have questions?

Why not send me a note using the “Contact Us” form on the tab above.

To our good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 

 

Humans – the perfect hybrid machine

Long before the ‘hybrid car” there was the human body – a hybrid ‘machine’ perfectly designed to use either carbohydrates or fat for energy. Like a hybrid car, we can run on one fuel source or the other at any one time.

If we are eating a largely carbohydrate based diet, we will be in ‘carbohydrate mode’ by default. Carb-based foods will be broken down by our bodies to simple sugars and the glucose used to maintain our blood sugar levels. Our liver and muscle glycogen will be topped up, then the rest will be shuttled off to the liver where it will be converted into LDL cholesterol and triglycerides and stored in fat cells.

Historically, in times of plenty, we’d store up glycogen and fat and in lean times, we’d use up our glycogen and then switch fuel sources to be in “fat-burning mode” — accessing our own fat stores, for energy.

The problem is now that we rarely, if ever access our stored fat because we keep eating a carb-based diet.  So we keep getting fatter and fatter.

GLUCOSE OR FAT AS FUEL

When we are in “carb burning mode”, the carbs we eat are broken down by different enzymes in our digestive system to their simplest sugar form (monosaccharides) such as glucose, fructose and galactose.

Glucose is the sugar in our blood, so starchy foods such as bread and pasta and potatoes are broken down quickly so they are available to maintain our blood sugar levels.

Monosaccharides are the building blocks of more complex sugars such as disaccharides, including sucrose (table sugar) and lactose (the sugar found in milk), as well as polysaccharides (such as cellulose and starch). When we drink milk for example, the galactose found in it is broken down into lactose and glucose.  When we eat something sweetened with ‘sugar’ (sucrose), it is quickly broken down to glucose and fructose.

Any glucose that is needed to maintain our blood sugar level is used immediately for that purpose and the remainder is used to “top up” our glycogen stores in our muscle and liver. There are only ~ 2000 calories of glycogen – enough energy to last most people one day, so when our glycogen stores are full, excess energy from what we eat is converted to fat in the liver and stored in adipocytes (fat cells).

One problem is that most of our diets are high in fructose – naturally found in fruit but also as high fructose corn syrup in many processed foods. Fructose can’t be used “as is”, so it is brought to the liver.  If our blood sugar is low, it will be used to make glucose for the blood (via gluconeogenesis) otherwise it will be converted into LDL cholesterol (so-called “bad cholesterol”) and triglycerides and stored as fat.

Feasting and Fasting

When we don’t eat for a while, such as would have occurred when our ancestors were hunter-gatherers, we’d use up our glycogen stores hunting for an animal to eat, or gathering other edible foods and if we weren’t successful at finding food to eat, then our bodies would access our fat stores, for energy.  This is known as lipolysis. This process is regulated mainly by a hormone called glucagon, but other hormone such as epinephrine (the “fright and flight” hormone), cortisol (the “stress hormone”) as well as a few others (ACTH, growth hormone, and thyroxine) also play a role.

In times of plenty, we’d store up glycogen and fat and in lean times, we’d use up our glycogen, switch into “fat-burning mode” and then rely on our stored fat for energy.

The problem for most of us in North America and Europe is that we have access to food in our homes, in stores and at fast food restaurants 24/7. We can’t go for a walk without passing places selling or serving food and if the weather is bad or we are too tired, food is just a phone call or web-click away. So we just keep storing up our fat for ‘lean times’ that never come.

In addition, irrespective of our cultural background, our eating style is carb based; pasta, pizza, sushi, curry and rice or naan, potato, pita – you name it.  Every meal has bread or cereal grains, pasta, rice or potatoes – and even what we consider “healthy foods” such as fruit and milk have the same number of carbs per serving as bread, cereal, pasta, rice and potatoes. That wasn’t always so. Our indigenous cultural foods were very different.

Compounding that, many “low-fat” products have added sugar (sucrose) in order to compensate for changes in taste from reducing naturally occurring fat, which then adds to excess carb intake.  Sucrose (ordinary table sugar) is made up of half fructose, so a diet high in sugar adds even more fructose transport to the liver, for conversion to cholesterol and fat.

The vilification of fat

In 1977, both the Canadian and US food guides changed in response to the promoted belief that eating diets high in saturated fat led to heart disease. Multiple studies and reanalysis of the data of older studies indicates that saturated fat is not the problem, but that diets high in carbohydrate combined with chronic inflammation and stress, is.

In 2016, it came to light that the sugar industry funded the research in the 1960’s that downplayed the risks of sugar in the diet as being related to heart disease and highlighted the hazards of fat instead – with the results having been published in the New England Journal of Medicine in 1967 with no disclosure of the sugar industry funding*. The publication suggested that cutting fat out of the American diet was the best way to address coronary heart disease, and which resulted in the average American and Canadian as inadvertent subjects in an public health experiment gone terribly wrong. Overweight and obesity has risen exponentially and with that Diabetes, hypertension (high blood pressure) and high cholesterol.

*(Kearns CE, Schmidt LA, Glantz SA. Sugar Industry and Coronary Heart Disease Research A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016;176(11):1680-1685. doi:10.1001/jamainternmed. 2016. 5394). 

Over the last 40 years the promotion of “low fat eating” by governments and the food industry has resulted in carbohydrate-intake skyrocketing. Every high-carb meal is followed by another high-carb meal, and if we can’t wait, a snack, too. We eat every 2-3 hours, and eating carb-based foods every 2 or 3 hours all day, every day is quite literally killing us.

How do we get fat out of “storage”?

The “key” to unlocking our fat stores, is decreasing overall intake of carbohydrates by decreasing the amount of carbohydrates we eat, both by eating much less of it and on occasion, by delaying the amount of time between meals.

Decreasing carb intake lowers insulin, the fat-storage hormone. At first our bodies access liver and muscle glycogen for energy, but since that is only about a one day’s supply, our bodies then turn to our own fat stores as a supply of energy.

By eating a diet rich in fat and keeping protein at the level needed by the body but not in excess, dietary protein is not used to synthesize glucose, but fat is.

An added bonus is that since insulin also plays a role in appetite, as insulin falls, appetite decreases.

This is the role of a low carb high healthy fat diet, a topic covered in this article.

Have questions?

Why not send me a note, using the “Contact Me” form above?  I’d be happy to answer your questions.

To your health!

Joy

If you would like to read well-researched, credible ”Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

you can follow me at:

 https://twitter.com/lchfRD

  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.

A Dietitian’s Dichotomy

Two years ago, the paradigm from which I’ve understood nutrition shifted dramatically. That was when a friend, a retired physician, asked my professional opinion on the approach that Dr. Jason Fung was expressing in his blog, Intensive Dietary Management. I began to read it from the beginning and after almost 3 weeks of reading, I concluded that the physiology was what we learned in our undergraduate degrees – and promptly set aside when we specialized in our respective professions. As healthcare professionals, we talk about “evidenced based decisions” and at that point, I had to decide whether the evidence was sufficiently strong to change the way I thought and practiced.  This was this Dietitian’s dichotomy.

Fast forward 2 years, and the learning-curve continues as I read through further studies and watch conference talks from some of the leading researchers and practitioners in the low carb high fat world.

Five weeks ago, I started practicing what I preached, and began eating what I call a “low carb high healthy fat” diet, myself.

So how’s that been going?

Well, I am definitely out of denial. I am overweight, insulin resistant, my LDL was too high and so was my blood pressure – and no matter how I looked at it last week, I had 30-40 more pounds to lose.

But here it is a week later, and I still have 30-40 pounds to lose. Am I discouraged or concerned? No. Here’s why;

Weight and Waist Circumference

I had to ask myself – or shall I say, ‘re-ask’ myself “how do I measure success”? If it is by the scale or a tape measure alone, then clearly I am ‘failing’. But am I?

My fat percentage is down from 40.2% to 39.8% – which means, despite NO CHANGE in my weight or my waist circumference, I’ve lost body fat.

How was that accomplished if I didn’t lose weight or “inches“?

Ketone sticks – for measuring ketones in urine – high

This past week, I’ve been maintaining a higher level of ketones then I did last week, so my body has been breaking down triglycerides (fat!) in my liver and fat cells, to make ketones for my brain and to synthesize glucose for my blood. I check my blood sugar every few hours to ensure it doesn’t drop too low.

Electrolytes and Water Balance

Something that has been slow for me to grasp hold of, is the need to add salt to my food.  I have been used to eating fresh foods with no added salt and preparing foods with the minimum of salt, but with insulin levels falling, so does the kidney’s retention of sodium.

By eating only when hungry and only until no longer hungry, my insulin levels have the opportunity to fall to baseline – something they do naturally after not eating for 12 hours. On days where I extend the time until I eat by a few hours (i.e. “intermittent fasting”), my insulin levels stay low for an even longer period of time.  In response, my kidneys excrete sodium, in a process called naturesis.

The one thing that has to be monitored closely – even for people like myself who are not on any kind of medication for Diabetes or high blood pressure, is that my sodium levels don’t fall too low, as well as potassium, calcium and magnesium. Sodium and potassium and calcium and magnesium are used in pairs in a number of systems in the body and I’ve learned quickly how important these are. All the more important for anyone taking medication to lower blood sugar or blood pressure! After having one or two excruciating headaches from letting my sodium fall too low, I learned quickly that if I feels certain symptoms, I need to take some salt. As well, I’ve learned that people that let their potassium get to low sometimes experience heart palpitations – not a pleasant feeling. I already was supplementing Calcium and Magnesium (along with Vitamin D) prior to adopting a low carb high fat diet, but how to get adequate sodium and potassium?

“KETO-WATER”

It’s fairly difficult to meet the potassium Dietary Reference Intake on a regular diet, but even with a very high non-starchy vegetable intake, it is still hard.  Many of the good sources of potassium, such as potato and yams are not part of the low carb high fat diet. I do eat a lot of mushrooms (high in potassium) but am severely allergic to avocado, one of the best sources, so I make what I call “keto-water”.  Keto-water is club soda (I make mine at home with my Sodastream!) to which 1/8 tsp of half-sodium / half potassium salt has been added. I put a tiny twist of lime or lemon to round out the taste and also to add a source of Vitamin C to my diet and voila, “keto-water”!

Keto-water salts

Provided I drink two liters of “keto-water” per day, I feel great!

No doubt, drinking keto-water has resulted in my body retaining more water, along with the sodium (which is what it is supposed to do!) which would account for my loss of fat, with no change in my weight or waist circumference.

Note: do NOT use “keto-water” if you are taking medications such as Altace (Ramipril) or other medications that cause potassium retention.

MY BLOOD SUGAR

Here is a snapshot of what has occurred with my blood glucose over the last 5 weeks.

My fasting blood glucose started off averaging 8.6 and then went up, as I began to mobilize fat reserves to supply my blood glucose. Now, my average fasting blood glucose is 7.4 – with dips as low as 6.2 (this morning!) and higher levels in the low 8’s.

My postprandial (2 hours after a meal) blood glucose is great after lunch, a bit higher later in the day (I’m guessing due to the circadian rhythms of cortisol) but then drops nicely before bed. Keep in mind, these results have been realized in only 5 weeks of eating a low carb high healthy fat diet!

BLOOD PRESSURE

Now this is a beautiful thing! For those that have been following this journey over the last 5 weeks, you may recall that it was a crazy-high blood pressure that was my impetus to change the way I ate.

Week One

The first week my blood pressure was divided up between

50% Stage 1 hypertension

~30% Sage 2 Hypertension

1 hypertensive emergency (not good!)

<15% pre-hypertension


Week Two

The second week my blood pressure dropped to;

>80% Stage 1 Hypertension

<20% pre-hypertension 

This can largely be explained by naturesis (kidneys getting rid of the excess salt through the urine) in response to the insulin drop.


Week Three

The third week my blood pressure was;

~85% Stage 1 Hypertension

~15% pre-hypertension 

Yes, it was a tiny bit higher, but very stable, with my diastolic pressure (the second number in blood pressure) hitting normal levels several times.

Week Four

The 4th week my blood pressure was;

~81% Stage 1 Hypertension

~19% pre-hypertension 

It has been pretty steady the last 2-3 weeks but certainly down from what it was.

Week Five – this week

Look at this!

From 3 weeks in a row stalled at ~80% Stage 1 Hypertension and ~20% pre-hypertension, it is almost 60% / 40% now…and that is WITH taking sodium and potassium “keto-water”!

This is how I measure success.

Final Thoughts

Success is about achieving goals and my goals have been about lowering my insulin resistance and blood pressure and losing weight and inches in the process.  Success is attained when you measure the appropriate outcomes.

Have questions? 

Wonder how I might be able to help you accomplish your goals?

Whether you live in the Lower Mainland or hundreds of kilometers away, I have service options to meet a wide variety of needs. Please send me a note using the form on the “Contact Us” tab, above.

To your health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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

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

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

 

 

Two People, Two Options: living healthy or dying prematurely

This weekend has been a challenging one, as I received two pieces of news. The first was of one client’s incredible success following the low carb high healthy fat diet and the shocked reaction of his doctor, and the other was of the death of a friend who had Diabetes, high blood pressure and high cholesterol. In this blog, I will share how these two events embody the two options each of us have; (1) living a healthy life to the fullest or (2) living with diet-related disease and dying prematurely of ‘natural causes’.

“JP” – a Picture of Success

Last fall, I had a reasonably fit 35-year-old client contact me wanting to lose 15 pounds. He went to the gym twice a week for an hour, and ran 10 km per week, but had put on some pounds and wanted to lose them.

As I always do, I asked for a copy of recent blood test, assessing his fasting blood glucose, HbA1C (3 month average of blood glucose), cholesterol (lipid panel) and requesting his doctor-assessed blood pressure. (Sometimes people insist that I counsel them without seeing blood work, but I explain that they ran out of crystal balls when I was graduating, so I have no choice but to get labs.)  I gave my new client a Lab Test Request form to bring his doctor.  The GP scoffed at the Lab Test Request Form asking him to requisition a lipid panel for a young, fit 35 year old whose parents are both living. That changed when the tests came back, and this man’s triglyceride level was higher than I had ever seen anyone’s, ever. His non-HDL cholesterol was very high and his HDL was very low. LDL wasn’t even available because his triglycerides levels were through the roof. His ferritin was astronomically high – not a sign of excess iron, but likely inflammation.

His doctor called him into the office immediately and wanted to put him on statin medication right away and referred him to the Lipid Clinic at a major local hospital.

My client told his doctor he wanted to wait 3 months and first follow my dietary recommendations and see what would happen to his lipids, and was advised against it by his doctor. My client was insistent, so the doctor told him that his recommendations were for him to eat “decrease saturated fat and carbohydrates, increase fruit and vegetables, increase insoluble fiber and fish, make his plate 1/2 vegetables, 1/4 protein, 1/4 starch“.

After seeing me, he agreed to limit fruit to max 1 / day, preferably a few berries on top of 2 or 3 huge salads with plenty of good quality olive oil and to have most of his carbs as vegetables. He learned that “not all vegetables are created equal” and I taught him to differentiate between those he could eat as much as he wanted at each meal and those he should limit or avoid. We talked about milk consumption, and the health benefits of eating plenty of fatty fish, such as salmon, mackerel and fresh sardine. And we talked about carbs. We talked a lot about carbs. Carbs in fruit, carbs in milk, carbs in bread, pasta and rice, and carbs in vegetables.

I designed an Individual Meal Plan for him, making sure he obtained sufficient macronutrients (protein, fat and carbs) as well as micronutrients (especially potassium, magnesium, sodium, vitamin C and calcium, vitamin D and vitamin K) – and factoring in his desired weight loss. I explained that if he followed his Meal Plan, it is perfectly reasonable for his triglyceride levels to be <2.00 mmol/L in 2 more months.

Three weeks later, his doctor ran his labs again.  His triglyceride level was almost a third what it was! His non-HDL was down substantially and his HDL was rising nicely. When he was seen at the Lipid Clinic, they were willing to give him 2 more months to get his lipids in the normal range before starting him on medication.

Friday, he wrote me telling me that his triglycerides we down well below 2.00 mmol/L and added;

“this amazed the doctor!”

My client left his doctor’s office without a medication prescription and with only the recommendation to keep eating the way I taught him. My client added that he was already within 2 – 3kg of his goal weight.

It’s not magic.

The doctor should not have been amazed that diet alone can be this effective – even for someone for whom high cholesterol has a genetic component. The literature documents the role of a low carb high fat diet.

But it is easier to write a prescription than educate a patient.

My High School Friend – preventable premature death

Last night I learned that my friend since high school, died from natural causes. She had Type 2 Diabetes, high blood pressure and high cholesterol. She and I were the same age.

Three years ago, when my friend was first diagnosed as having Diabetes, she asked my opinion about having received Diabetes counselling in her province to eat 45 gm of carbohydrates at each meal and at least 15 gm of carbohydrates at each of 3 snacks – that’s 180 gm of carbohydrates per day.  A mutual friend of ours from the same province, who had also been recently diagnosed with Diabetes confirmed that she too was advised to eat 45 gm of carbohydrates at each meal and at least 15 gm of carbohydrates at snacks. At that time, I had explained to my friend what I had been learning about the role of excess carbs in Diabetes, hypertension (high blood pressure) and high cholesterol. While I provide distance consultations in my practice (using a combination of phone, email and fax), as Dietitians we are advised specifically not to provide dietary counselling to family members or friends. With my ability to help directly being very limited, I recommended that she find a Dietitian near her who could teach her about managing this triad (called “metabolic syndrome”) using a low carb high fat diet. She followed the  standard dietary recommendations to the letter and took her multiple medications as prescribed. Her blood sugar levels came down using medication (but that was effectively treating the symptom of high blood sugar, not the cause which is the underlying insulin resistance). Her blood pressure kept going higher and higher despite medication, so more medication was added.  She then developed high cholesterol.

Today, my friend is dead, in what may have been an entirely preventable, premature death.

So I am left asking myself ‘could following the standard recommendations of eating 180 gm of carbohydrate per day (or more) with Type 2 Diabetes, high blood pressure and high cholesterol — without treating the underlying cause (insulin resistance) have contributed to her death’?

The literature is certainly full of studies documenting the beneficial effects of a low carb high fat diet on metabolic syndrome – but she was never given that as an option.  She was prescribed medication for lowering blood sugar and blood pressure, but nothing was done to lower her insulin resistance.

A lifetime of work by the late Dr. Joseph Kraft with almost 300,000 people documents that it is the insulin resistance that underlies cardiovascular disease – not the high blood sugar. Furthermore, 65-75% of people with normal blood sugar levels still have insulin resistance – and the same elevated risk of having a heart attack.

We keep treating the symptoms and people keep dying anyways – and those without any symptoms are walking around with elevated risk of dying from cardiovascular disease, and don’t even know it.

We are told;

“Diabetes is a chronic, progressive disease”

which means that once diagnosed with Diabetes, you’ll have it forever – and that eventually it will get worse, requiring medication, then more medication and finally insulin.

When people have bariatric surgery (“stomach stapling”), their blood sugars come back to normal within weeks and at the end of a year, they no longer have any of the clinical symptoms of Diabetes.  Their fasting blood glucose levels are normal and their HbA1C levels are normal. They are essentially as if they don’t have Diabetes. Their Diabetes is in remission.

So is Diabetes REALLY a “chronic, progressive disease”? No, it can be stopped.

If the reason people became Diabetic was because of how they were eating, why is it SO hard to grasp the concept that they could get well, but changing how they are eating?

At the end of the day, we have a choice.

We can do as my client above did and put everything we have into changing how we eat based on good, sound scientific studies and with medical supervision, or we can keep doing what we’ve been doing, expecting different results.

I made my choice a month ago tomorrow, and will write an update in the blog titled “A Dietitian’s Journey” tomorrow, for week four  (see Food for Thought tab, above).  Here’s a teaser; two days ago my blood sugar levels were several times at normal levels – and were overall much lower than a month ago. Last night (twice) and once this morning, my blood pressure was in the normal range.  One month!

I ask myself, what will my labs look like in 3 months or 6 months of addressing the underlying insulin resistance (instead of the symptom of high blood sugar?) What will be life be like, when I have normal blood sugar levels and normal blood pressure and normal cholesterol levels?

It will look better than the alternative.

Rest in peace, dear friend.

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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.


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Carbs or Fat – which one should we eat less of?

Intro: Since 1977, Health Canada and Canada’s Food Guide have been promoting a diet which is high in carbs (45-65%) and low in fat (20-35% ) and which recommends that no more than 7% of fat comes from saturated fat — with the goal of lowering heart disease.

As elaborated on in an earlier blog, prior to 1977, the obesity rate [measured as Body Mass Index (BMI) ≥ 30 kg / m2] of Canadian adults was <10% and in 1978, only 15% of children and adolescents were overweight or obese.

As a result of lowering dietary intake from fat and increasing it substantially from carbohydrates, what happened to obesity statistics? Diabetes statistics?

Obesity became an epidemic.

In adults the prevalence of obesity [body mass index (BMI) ≥30 kg/m2] went from 10% in 1970-72 to 26% in 2009-11! In children, that rate doubled to 29% of children and adolescents being overweight or obese by 2007 and by 2011, obesity prevalence for boys was 15.1% and for girls was  8.0% in 5 to 17 year olds.

Based on waist circumference, 37% of adults and 13% of youth are currently considered abdominally obese.

Diabetes rates almost doubled.

In the 1970s, the rate of Type 2 Diabetes in women was 2.6% and 3.4 % in men, in the 1980s that number rose to 3.8% for women and 4.5% for men.  In the 1990s the rate was almost double what it was in 1970; 4.7% for women and 7.5% for men.

Now get this: Type 2 Diabetes contributes to increased risk of heart disease.

So in an effort to reduce rates of heart disease by lowering fat intake and increasing carbohydrate intake, rates of Type 2 Diabetes doubled — which in turn, raised the risk of heart disease! Ironic.

If eating a high carbohydrate, low fat diet is associated with higher rates of obesity which in turn results in a higher incidence of Type 2 Diabetes, what is the option? Isn’t it also a problem to eat a low carbohydrate / high fat diet… isn’t a high fat diet bad for you?”.

This is the question that we will begin to answer in this article and conclude in the next one.


Are all fats the same? Is extra virgin olive oil in the same category as bacon? Or fish oil as lard?

The Health Canada guidelines recommend eating low fat dairy products, lean meat and using a “small amount — 2 to 3 tablespoons (30 to 45 mL ) of unsaturated fat each day. This includes oil used for cooking, salad dressings, margarine and mayonnaise“.

1. We are told to use a small amount of unsaturated fat per day; what is an unsaturated fat and are they all the same?

2. Is the fat in dairy products and meat “bad” for you?

I am going to answer the first question in this article and the second question in the next one.


1. What are the different type of fats.

There are two main classes of fats — saturated fats and unsaturated fats.

Unsaturated fat can be further classified as polyunsaturated fats and mono-unsaturated fats. Polyunsaturated fats include everything from omega-3 fats from fish oil to the fat found in omega-6 fats found in canola oil and corn oil. More about what makes it an ‘omega-3’ or ‘omega-g’ below. Omega-3 fats, especially the long chain ones from fish oil (e.g. DHA, EPA) are heart-healthy and are anti-inflammatory and have been found to be protective against heart disease. Refined seed oils that are high in omega-6 fats are pro-inflammatory.

Monounsaturated fats such as those found in avocado and nuts or cold-expressed from olive oil or avocado or nuts and seeds are considered by Health Canada and the writers of Canada’s Food Guide as the healthiest (and thus, preferred) kind of fat.

We’ve been told to eat a “low fat diet” but are all fats the same? Are omega-3 fats from fish to be lumped together with fat from bacon? And if we eat a diet low in saturated fat, will our “bad” cholesterol (LDL) go down?

Most people have heard that of the fats taken in from the diet, saturated fat is “bad” for you and mono-unsaturated fat and polyunsaturated fat is “good” for you.  Before we deal with whether this is true, let’s define what these are.

There are some basics that we need to cover, to ‘follow’ the discussion as to whether saturated fat in the diet results in high LDL cholesterol and high Triglycerides (TG). I’ll try to make this much less painful than it may have been when you first learned this.

  • fatty acids are molecules made up of a carbon backbone.  Think of it like a train with cars connected together.  Actually think of it more like “fuselage” of a plane (which will become clear as to why, below). The body is made up of carbons all in a row.
  • if there are no double bonds in the carbon chain, it is a saturated fatty acids because something can bond at every carbon along the carbon chain.  Think of those molecules that bond to a carbon as “wings” sticking off the fuselage.
  • if there is one double bond in the carbon chain, it is an unsaturated fatty acid. It is “unsaturated” because no other compound can bond where the double bond is. So it can have “wings” every where else along the carbon chain (which makes it unsaturated) but not at the place where the one double bond is.
  • if the carbon chain has more than one double bond, it is called a polyunsaturated  fatty acids (PUFAs).
  • there can be a double bonds off one of the carbons in the carbon backbone chain.
  • where the double bond off the carbon backbone is located determines whether it is an omega-3 polyunsaturated fatty acid or an omega-6 polyunsaturated fatty acid.
  • all omega-3 fats have their first double bond in the same place on the carbon chain (away from what is called the ‘carboxyl’ end).  All omega-3 fats have their first double bond starting at the 3rd carbon (away from what is called the ‘carboxyl end’).
  • all omega 6 fats have their first double bond starting at the 6th carbon (away from the carboxyl end)

That’s pretty well all the chemistry you need to know.

So we’ve heard that we should decrease our intake of all fat, especially saturated fat as it leads to high LDL cholesterol, high triglycerides (TG) but is that true?   2. Is the fat in dairy products and meat “bad” for you?

3. Is saturated fat in the diet the only source?

Spoiler alert!

Our bodies not only make fat, they synthesize saturated fat!

We will cover the making of endogenous (“in the body”) saturated fat in Part 2, coming soon!

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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 ©2015 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.


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Why do we Gain Weight — the Myth of ”Calories in, Calories out”

People often assume that the answer to the question why do we gain weight is obvious and it is because people eat more calories than they burn; the old ”calorie in, calorie out” paradigm.  That is, calories not used in some form of exercise are converted to fat and stored.  If we assume that the cause of weight gain is that simple, then the solution must be equally simple; eat less and exercise more, right? But is it?

Many Physicians and Dietitians continue to hold to this ”calorie in, calorie out” model and to counsel their patients that in order to lose the stored fat, they need to eat less and exercise more.  If it is really that simple, then why are 4.7 million adults in Canada classified as obese and more than 40% of men and 27% of women classified as overweight? If it is that simple, why do obesity statistics continuing to rise? Because it isn’t that simple.

There is an underlying assumption that ”calories in” and ”calories out” are two independent events.  That is, if you reduce ”calories in”, ”calories out” is unaffected. The difficulty lies in that the body decides where it is going to ”spend” the calories taken in. Let’s say we take in 2000 calories; some will be used for the energy we need during a 24-hour period by our body during resting conditions (Basal Energy Expenditure) and some will be used to synthesize muscle, bone or other proteins.  ”Calories out” is not just exercise.

Another underlying assumption is that all calories are created equal. But are they? First what is a calorie?

A calorie is the amount of heat that is released when certain foods are burned in a laboratory.  It doesn’t matter if the food is protein, fat or carbohydrate, if they have 100 calories then 100 calories of heat is released when they are burned. So in the ”calorie in, calorie out” model it really doesn’t matter what we eat whether it is broccoli or butter, in the end it only matters how many calories they add up to.  Period.

If we start with the assumption that ”calories in” are independent of ”calories out” then the only thing that really matters is how many calories we take in, not from what sources. In this model, since all food is burned and a certain amount of calories are released, then we arrive at the conclusion that weight gain is simply a matter of comparing what goes in (energy) to what goes out (energy expenditure).  In this simplistic view, weight gain is caused by having too many calories (energy) compared to too little exercise (energy expenditure).  But it is not that simple.

Some of the energy expenditure will be for building tissue, staying warm, cognitive function and our bodies determine whether ”calories in” go to those involuntary functions over voluntary exercise Looking at weight loss in terms of the ”calorie in, calorie out” model fails to take into account that the body will slow its metabolism in response to reduced calories, because it needs to use those calories for vital functions so restricting calories doesn’t necessarily translate to weight loss.

Furthermore, assuming that all foods can be boiled down to how many calories they contain fails to take into consideration that the composition of different types of foods actually increases or decreases hunger and thus eating when and what and how much we eat. The assumption by many health care professionals has been that obese people are overweight because their metabolism has slowed and that keeps them from burning off the calories they take in.

To explain this in terms of the ”calories in calories out” model, say a slim person takes in 2000 calories and has a Total Energy Expenditure (TEE) [the amount of calories they burn per day] of 2000 calories, which means they don’t gain or lose weight. An obese person will take in the same 2000 calories, but assuming their TEE is lower, say 1500 calories, 500 calories are store as fat and they gain a pound. But is that in fact so?

A recent study however has disproved this.

When measured in the laboratory, obese people had a Total Energy Expenditure (TEE) of 3244 calories compared to lean people who had a TEE of 2404 calories. That is, when excess calories are eaten in someone who is already obese, the body will actually increase its Basal Energy Expenditure (BEE) to try and get rid of those calories.

So why are obese people obese?

Shouldn’t this increase in Total Energy Expenditure over time caused them to burn off those calories and become lean again? Actually, body weight, like other functions in our body is a closely regulated system and we have so something called a ”Set Point” which acts to regulate it. When too many calories are taken in, the body tries to get rid of them and when too few calories are taken in, the body tries to conserve them. The body does this to maintain its set point’. So if we are overweight, the body will adjust its processes to maintain that set point. More on that below. It is not about how many calories we take in but what changes the Set Point.

People also make the assumption that how much we eat (”calories in”) is voluntary; that is we can choose to eat or not eat, but there are a number of hormones such as leptin, ghrelin, cholecystokinin, and peptin YY that tell our body when we are hungry and we are not. Hunger and satiety (feeling full) are under hormonal control and as such, when we eat (”calories in”) is not voluntary.

People also assume that Calories Out’ is voluntary; that we control how much exercise we do and assuming that our basal energy expenditure is stable and unchanging over time, we ignore it.  But it is not. This mistaken belief that the only variable that changes is the energy expended in voluntary exercise and that this consumes a major proportion of our calories leads to the conclusion that ”diet” and ”exercise” are equal partners in weight management and they aren’t.

The fact is, most of our Total Energy Expenditure is used for generation of body heat and other metabolic processes (called Basal Energy Expenditure). Furthermore, Basal Energy Expenditure is not stable and can increase or decrease by as much as 50%. This up-regulation and down-regulation of our body processes contributes way more to weight loss or gain than exercise does. But that is not what we’ve been told.  We have believed that if we just exercise more and eat less we will lose weight. Let’s look at this a little more closely.

What happens to our body if we suddenly restrict caloric intake? According to ”calories in calories out” model, a reduction in calories will result in Total Energy Expenditure (TEE) using fat for energy and the person would lose weight.  Sounds great except that is not what happens.

In fact, Total Energy Expenditure drops substantially — by as much as 30-50%.  People complain of being unable to stay warm even with plenty of clothing and that is because calories are spared in heating the body. Heart rate and blood pressure drop to conserve energy (calories).  People even find it difficult to concentrate because the brain is very metabolically active and restricting calories suddenly turns that down. Calories are needed to move, so in sudden calorie restriction people feel weak during physical activity. In other words, metabolism slows.

Why does the body do this? It’s survival.

Consider a person normally eating 3000 calories a day suddenly starts eating 2000 calories a day.  If they were to continue to burn 3000 calories daily, they would soon deplete all their fat stores, then their protein stores and then they would die. The body tightly regulates body weight and compensates for this sudden decrease in calories by saving calories from its Total Energy Expenditure.  Instead of burning fat in storage, the body reduces its caloric expenditure on body functions to 2000 calories a day and restores balance.

The ”calorie in calorie out” model does not factor in that basal energy expenditure is not stable.  It ignores that restricting calories results in down-regulation in Total Energy Expenditure. That is, ”calories in” and ”calories out” are not independent.

The ”calorie in calorie out” model of weight gain also ignores that hunger, eating and fat storage are regulated by numerous hormones. Leptin (a hormone correlated to the amount of body fat) is one such mechanism, adiponectin (a hormone suppressed in obese people) may be another mechanism and there are others being researched.  It is also believed that cortisol, the stress hormone may play a role.  But there is one well-known hormone that plays a very significant role in hunger, eating behavior and fat management and that is insulin. Insulin’s effect will be covered in detail in future blogs. A little teaser’; we as health care practitioners have been focusing on blood glucose while overlooking insulin, which regulates it.

So in summary,

  1. ”calories in” and ”calories out” are not independent, but one affects the other.
  2. ”Calories in” is not only under voluntary control (what and how much we choose to eat) but several hormone play a significant role in terms of hunger and fat storage.
  3. ”Calories out” is not only controlled voluntarily through exercise but also involuntarily by up-regulating and down-regulating basal metabolic expenditure (tissue synthesis, heat generation, etc).
  4. Fat storage is not simply a result of having more ”calories in” than ”calories out” burned as exercise.

So what causes us to gain weight? This will be the topic of future blogs.

REFERENCES

DeLany J P, Kelley D E, Hames K C et al, High energy expenditure masks low physical activity in obesity, International Journal of Obesity 37, 1006-1011 (July 2013)

Fung, Jason, Intensive Dietary Management, The Aeteology of Obesity, August 2013

Health Canada, Overweight and Obese Adults (2102), http://www.statcan.gc.ca/pub/82-625-x/2013001/article/11840-eng.htm

 

Copyright ©2015 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this website, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content.