2017 - Page 3 of 3 - The Low Carb Healthy Fat Dietitian

May 11, 2017July 8, 2019

1977 Dietary Recommendations — forty years on

Since 1977, the dietary recommendations in Canada and the US has been for people to consume a diet with limited fat and where ”complex carbohydrates” (starches) comprise the main source of calories.

From 1949 until 1977, the dietary recommendations of Canada’s Food Guide were for people to consume

~20-30% of their daily calories as carbohydrate

~40-50% of daily calories as fat

~20-30% of daily calories as protein

From 1977 onward, Canada’s Food Guide recommended that people consume:

55-60% of daily calories as carbohydrate

<30% of daily calories as fat, with no more than 1/3 from saturated fat

15-20% of daily calories as protein

The US recommendations since 1977 have been similar to those in Canada, with the Dietary Goals for the United States recommending that carbohydrates are 55-60% of daily calories and that calories from fat be no more than 30% of daily calories (of which no more than 1/3 comes from saturated fat).

Eating Well with Canada’s Food Guide which came out in 2015, recommends that people eat even more of their daily calories as carbohydrate;

45-65% of daily calories as carbohydrate

20-35% of daily calories as fat, with no more than 1/3 from saturated fat

10-35% of daily calories as protein

[Reference: http://www.hc-sc.gc.ca/fn-an/nutrition/reference/table/ref_macronutr_tbl-eng.php]

Health Canada recommends limiting fat to only 20-35% of calories while eating 45-65% of daily calories as carbohydrates and currently advise adults to eat only 30-45 mL (2 — 3 Tbsp) of unsaturated fat per day (including that used in cooking, salad dressing and spreads such as margarine and mayonnaise).

This is what people have come to call a ”balanced diet”.

But is it?

For the past 40 years, the public has come to believe that eating fat made you fat’ and that eating saturated fat caused heart disease. Evidence-based research does not seem to support that having a diet rich in healthy fats – especially monounsaturated fats like from olive and its oil, and avocados, nut and seeds and omega 3 fats from fish causes heart disease.

Our society has become ”fat phobic”. People guzzle skim or 1% milk with little regard to the fact that just 1 cup (250 ml) has almost the same amount of carbs as a slice of bread. And who drinks only one cup of milk at a time? Most people’s ”juice glasses” are 8 oz and the glasses they drink milk from are 16 oz, which is 2 cups. Who ever stops to think of their glass of milk as having the same amount of carbs as almost 2 slices of bread?

In addition, carbs are hidden in the 7-10 servings of Vegetables and Fruit they are recommended to eat — with no distinction made between starchy- and non-starchy vegetables. Many people eat most of their vegetable servings as carbohydrate-laden starchy vegetables such as peas, corn, potatoes and sweet potatoes and then have a token serving of non-starchy vegetables (like salad greens, asparagus or broccoli) on the ”side” at dinner. Who stops to think that just a 1/2 cup serving of peas or corn has as many carbs as a slice of bread — and often those vegetables are eaten with a cup of potatoes, adding the equivalent number of carbs as another 2 slices of bread?

People drink fruit juice and ”smoothies” with no regard for all of the extra carbs they are consuming (not to mention the effect that all of that fructose has). A ”small juice glass” is 8 oz, so just a glass of orange juice has the equivalent number of carbs as another 2 slices of bread! Many grab a smoothie at lunch or for coffee break without even thinking that the average smoothie has the same number of carbs as 5 slices of bread!

Then there is the toast, bagels and cereal or bars that people eat for breakfast, the sandwiches or wraps they eat for lunch and the pasta or rice they have for supper. These are carbs people know as carbs — which are added to all the carbs they consumed as vegetables, fruit and milk.

What has been the outcome of people following these dietary recommendations to eat a high carb diet since 1977 ?

Obesity Rates

In 1977, obesity rates* were 7.6% for men and 11.7% for women, with the combined rate of < 10 % for both genders.

* Obesity is defined as a Body Mass Index (BMI) â‰¥30 kg/(m)2

In 1970-72 the obesity rate in Canadian adults was 10% and by 2009-2011, it increased two and a half times, to 26%.

In 1970-72, only 7.6% of men were obese but by 2013, 20.1% of men were categorized as obese. In 1970-72, only 11.7% of women were obese but by 2013, 17.4% of women were obese.

In 1978 in Canada, only 15% of children and adolescents were overweight or obese, yet by 2007 that prevalence almost DOUBLED to 29% of children and adolescents being overweight or obese. By 2011obesity prevalence alone (excluding overweight prevalence) for boys aged 5- to 17 years was 15.1% and for girls was 8.0%.

The emphasis since 1977 on consuming diets high in carbohydrates and low in fat has taken its toll.

Effect on Health

Non-alcoholic liver disease is rampant and not surprisingly, considering 37% of adults and 13% of youth are abdominally (or truncally) obese — that is, they are carrying their excess body fat around and in the internal organs, including the liver.

Since the 1970’s, Diabetes rates have almost doubled.

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

If people eating a high carb, low fat diet has corresponded to an increase in obesity, overweight and Diabetes, then what’s the alternative?

That is where a low carb high healthy fat diet comes in , which supplies adequate, but not excess protein. It enables us to use our own fat stores for energy, and to make our own glucose (for our blood and brain) with ketones (that are naturally produced by our bodies when we sleep, for example) to fuel our cells and organs. Since humans are designed to run on carbs (in times of plenty) and in our fat stores (when food is less plentiful), being in mild ketosis is a normal physiological state. By eating a low carb high fat diet when we’re hungry and delaying eating for short periods, we can mimic the conditions that were common to our ancestors. By eating this way over an extended period of time, we can bring down insulin levels and as a result, decrease the insulin resistance of our cells. We can improve our blood sugar, lower our blood pressure and see our LDL cholesterol and triglycerides come down to normal, healthy levels.

Want to know more? Why not send me a note using the Contact Us form located above?

To your 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.

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.

May 10, 2017July 8, 2019

What is a Low Carb High Fat Ketogenic Diet?

A low carbohydrate high fat ketogenic diet supplies adequate, but not excess protein and low levels of carbohydrate that is naturally found in foods such as non-starchy vegetables, nuts and seeds, and certain fruit. A low carb high fat ketogenic diet enables our bodies to burn our own fat stores quite efficiently for energy, while making the glucose needed by our blood and brain, and using ketone (which our body naturally produces as we sleep) for energy for our cells and organs.

Note: Not all low carb diets are ketogenic diets. There are many types of low carb diets, ranging from moderately low carb diets (130 g carbs) to ketogenic diets (5-10% net carbs) and everything in between. As well, not all low carb diets are high fat diets. Some approaches are low carb higher protein diets and are also ketogenic, because carbs are limited. More on those in a later article. This article is only about a low carb high fat ketogenic diet.

Ketogenic Macronutrient Ratio

Generally speaking, in a low carb high fat ketogenic diet, the percentage of calories (kcals) from carbohydrate (carbs), protein and fat in a ketogenic diet (called the macronutrient ratio) is as follows;

65-75% of calories from fat

~20% of calories from protein

5-10% of calories from NET carbs (which is the carbohydrate in food, minus the insoluble fiber found in that food)

While each person’s energy needs and macronutrient needs are different (based on their age, gender and activity level, as well as any pre-existing medical conditions they may have), most people on ketogenic diets take in 10% or less of their calories from net carbohydrates*, with the amount of fat and protein intake varying from person-to-person within the above range.

* Net carbs are determined by subtracting insoluble fiber contained in food from the carbohydrate content of that food.

By eating low levels of carbohydrate, insulin level falls and glucagon and epinephrine levels in the blood rise.

This causes several things to occur;

Fat stores are burned for energy
The fat stored in fat cells (called adipocytes) are released into the blood as free fatty acids and glycerol. Since fatty acids contain a great deal of energy, they are broken down in cells that have mitochondria in a sequence of reactions known as β-oxidation, and acetyl-CoA is produced. This acetyl-CoA then enters the citric acid cycle where the acetyl group is burned for energy.
Glucose is made for energy
When insulin levels are low (or absent) and glucagon levels in the blood are high, glucose is produced via gluconeogenesis (literally, the “making of glucose”) and then released into the blood and used as an energy source. As elaborated on below, while the brain can use ketones for fuel, it has a need for some glucose.
Ketones are produced for energy
In significant carb restriction over several days, gluconeogenesis is stimulated by the low insulin and high glucagon levels results in acetyl-CoA being used for the formation of ketones (i.e. acetoacetate and beta-hydroxybutyrate and their breakdown product, acetone). These ketones are released by the liver into the blood where they are taken up by cells with mitochondria and reconverted back into acetyl-CoA, which can then be used as fuel for energy, in the citric acid cycle. Ketones can cross the blood-brain barrier, so they are used as fuel for the cells of the central nervous system – acting as a substitute for glucose (which is normally the end result of the body breaking down carbs and sugars found in various foods). After ~ 3 days on a very low carb diet, the brain will get ~ 25% of its energy from ketones and the other 75% from the glucose made via gluconeogenesis. After ~ 4 days the brain will get about 70% of its energy from ketones. While the brain can use ketones for some or even most of its fuel, it still has requirement for some glucose and that is supplied from gluconeogenesis. The heart ordinarily prefers to use fats as fuel but when carbs are restricted, it effectively uses ketones.

Ketosis versus Ketoacidosis

Ketones are naturally produced during periods of low carb intake or in periods of fasting and during periods of prolonged intense exercise. This state is called ketosis. Since the human body is designed to use glucose as a fuel source (in times of plenty) and to use fatty acids and ketones (in times of food shortage), ketosis is a normal, physiological state.

In untreated (or inadequately treated) Type 1 Diabetics (where the beta cells of the pancreas don’t produce insulin), the ketones that are produced are as the first stage of a serious medical state called ketoacidosis.

Ketosis, on the other hand is a normal, naturally occurring state that occurs naturally when we sleep for example or miss a meal, whereas ketoacidosis is a serious medical state associated most commonly associated with Type 1 Diabetes. While often confused, these two conditions are very different.

A Low Carb High Fat Ketogenic Diet

A low carb high fat ketogenic diet may appear at first glance to be like the Atkins diet or other low carb high fat diets but the main difference is that in a keto diet, protein is not unlimited. The reason for this is based on the premise that excess protein will be converted into glycogen and have a similar effect on ketosis as eating too many carbs, disrupting ketosis.

Since having too little protein may cause muscle loss, a keto diet is designed to have adequate, but not excess protein.

But why eat a low carb high fat keto diet?

The last 40 years of burgeoning rates of overweight, obesity and Diabetes, provide the motivation. (Please read the next article titled 1977 Dietary Recommendations — forty years on for a summary of those issues).

A low carb high fat keto diet is one low carb approach that is used for clinical reasons, such as to seek to reverse the symptoms of Diabetes by enabling insulin levels to fall, glucagon and epinephrine levels to rise, resulting in the body:

(1) naturally accessing its own fat stores for fuel

(2) manufacturing its own glucose

and

(3) using ketone bodies for energy.

The human body is designed to use either glucose or fatty acids and ketones as a fuel source. Ketosis is a normal, physiological state where our bodies run almost entirely on fat.

Insulin levels become very low, which has benefit to those who are insulin resistant or Type 2 Diabetic.

As a result, burning of our own body fat stores for energy increases dramatically — which is great for those who want to lose weight, without hunger and a steady supply of energy.

Want to know more?

Feel free to send me a note using the Contact Me form, above.

To your 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 are different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

April 27, 2017July 8, 2019

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/

April 26, 2017July 8, 2019

A Dietitian’s Journey – practicing what I preach (9 week video update)

This coming Monday will be 9 weeks since I started this journey. The weight loss has been slow yet steady. I’ve lost 7 pounds and 2 1/2 inches off my waist. I can’t tell you how amazing it is to take jeans out of the dryer and put them on easily!

When I look in the mirror, I am starting to recognize the image that looks back. “She” had a neck and a chin – and “her” face is oval, not round. I know that person!

My blood pressure remains very stable (stage 1 hypertension) – down from the wildly erratic fluctuations between stage 2 hypertension, right up to a hypertensive emergency. It was that which started me on the journey, but what keeps me on it, is how I feel. I feel amazing.

My blood sugar is continuing to fall gradually, and for the last 2 weeks I’ve been in mild ketosis and am now “fat adapted”.

I no longer wake up with stiff, swollen fingers and for the first time in years, I fall asleep easily. Yes, I wake up several times to use the washroom, but I can certainly live with that.

This update, I am not going to post any statistics, no graphs, no fat percentages – in fact, I haven’t even taken it since last time. I’m not obsessing over every pound, every inch, or every percent. I’m just doing what I know to do and letting the results come as they come.

Two weeks after I started (March 16, 2017), I posted a video of me walking at the local track. It wasn’t “pretty” but it was real. The reason I posted it was because I believe it removes the barrier that somehow because I’m a Dietitian with a post-grad degree that I can’t really understand what it is like for my clients. I do.

I have to get healthy and make lifestyle changes, the same way as everybody else…one day at a time.

So instead of statistics, and charts and graphs, I am going to post the two videos. They’ve not been edited in any way – they are as-shot.

Want to know more?

Please send me a note using the “Contact Us” form above, and I’d be happy to get back to you.

To your health!

Joy

you can follow me at:

https://twitter.com/lchfRD

https://www.facebook.com/lchfRD/

Walking at Town Centre Track – March 19 2017

https://youtu.be/6VjayL5UOTc

Nordic Track workout – April 29 2017 (6 weeks later)

https://youtu.be/qrqxzuNj7YA

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.

April 20, 2017July 8, 2019

A Dietitian’s Journal – seven weeks eating a low carb high fat diet

It has been a little over seven weeks since I started eating a low carb high healthy fat diet, so here’s an update on my progress.

Weight

In 7 weeks (1 March – 16 April), I’ve lost ~6 lbs, which is quite a reasonable weight loss for someone who was not obese. Most of my weight loss was in the first few weeks, which according to Phinney and Volek (The Art and Science of Low Carbohydrate Living) is quite common for numerous reasons, not the least of which is that our bodies excrete sodium as our insulin levels fall and as a result we lose excess water.

But as mentioned in the previous article, a scale is not an effective measure of short-term changes as the average adult’s weight can fluctuate by as much as 4 1/2 pounds per day, due to water alone.

[see https://www.lchf-rd.com/2017/04/20/the-limitations-of-common-ways-of-determining-weight-loss/]

WAIST CIRCUMFERENCE

From 1 March – 16 April, I lost 2 inches off my waist. That is alot, but is it significant?

Since it is unknown how much of that decrease was due to water excretion and how much due to fat loss, the decrease in my waist circumference does not provide much information in the short-term.

BODY FAT PERCENT

Based on a Body Fat Analysis, my body fat percentage is down from 40.2% to 39.0% – a decrease of ~ 1.2% but as mentioned in the previous article, Body Fat Analyzers use electrical impedance to determine fat percentage, and this measurement is affected by a number of conditions, including environmental (room) temperature, a person’s hydration status, as well as emotional stress.

Since hydration status can fluctuate by ~4 pounds per day, a body fat analyzer is no more accurate a short-term measure than a standard bathroom scale.

As a result of the limitations of a scale, tape measure and body fat analyzer to capture short-term weight loss, I was left with two ways to assess my progress:

(1) people’s observations of me having lost “so much weight”

(2) how my clothes fit.

VISUAL ASSESSMENT

Over the last number of weeks, I have had quite a number of people remark about my ‘significant weight loss’, but given that I (seemingly) lost a nominal amount, this surprised me. Over the same period, I’ve been comfortably wearing clothes I could not even get into previously. Surprisingly, it was an inadvertent ‘before’ and ‘after’ photo that provided the most accurate measure of the effect low-carb eating has had on my body weight.

In filing a photo that was taken last week, I found another picture that was taken just before I started eating low carb – where I happened to be wearing the exact same outfit.

The difference was evident.

They say the “camera never lies”.

In retrospect, I would have deliberately taken ‘before’ pictures.

CLOTHES

Prior to coming face-to-face with my own denial, I was wriggling into most clothes – particularly pants. I had set aside some clothes because I simply could not get into them. Wash day always raised the uncertainty as to whether I would be able to get my clean clothes on after they came out of the dryer.

Now there are no clothes that I own that I can’t wear. That does not mean they all look great (by no means!), but I can easily close buttons, zippers and actually sit in them! Some clothes that I fit ‘before’ are now beginning to feel loose.

OTHER MEASURES OF LOW CARB SUCCESS

Fasting Blood Glucose

Five weeks ago my monthly average fasting blood glucose was 8.8 mmol/L. Two weeks ago, it was ~8.6 mmol/L. Now it is 8.0 mmol/L. The last time I had it taken by the lab (a year and a half ago), it was 9.7 mmol/L!

I am aiming for a fasting blood glucose of 5.0 mmol/L by November of this year.

Post Prandial blood glucose (2 hours after a meal)

My blood sugar 2 hours after lunch has dropped from 7.4 mmol/L to 7.0 mmol/L and after dinner, it has dropped from 7.7 mmol/L to 7.3 mmol/L. This is well below the target of < 10.0 mmol/L for a Type 2 Diabetic.

I am aiming for a 2 hour post-prandial blood glucose of between 5.0 – 6.00 mmol/L by November of this year.

BLOOD PRESSURE

For those that have been following my journey over the last 7 weeks, you may recall that it was a ridiculously high blood pressure that was the impetus to change the way I ate.

I’ve gone from ~30% Stage 2 Hypertension, 50% Stage 1 hypertension 15% pre-hypertension and the rest a hypertensive emergency (yikes!) to 80-85% Stage 1 Hypertension and 15-20% pre-hypertension.

This last week (week 7) my blood pressure has been 100% Stage 1 Hypertension, which one would think at first glance was a “setback”, but I don’t view it that way. Firstly, blood pressure that fluctuates a lot is much harder on the heart than blood pressure that is stable.

Secondly, the last two weeks I have been supplementing sodium to eliminate the headaches I had been getting and the periodic arrhythmia (irregular heart beats) that I started to get.

Phinney and Volek (The Art and Science of Low Carbohydrate Living) explain that if one is eating less than 60 gms of carbs per day, that 2-3 grams of sodium should be added to the diet (provided the person is not taking any diuretics or other blood pressure medication). A half a teaspoon of table or sea salt provides 1000 mg or 1 gram of sodium.

Failing to supplement sodium in a low-carb diet can result in really bad headaches and if sodium remains low, potassium will also be excreted to keep a necessary sodium-potassium balance. The drop in potassium can result in irregular heart beat, a condition known as arrhythmia.

Currently, I seem to do best on 1 to 1 1/2 tsp of sea salt, which provides 2 – 2.5 grams sodium. Of course, once the weather starts getting warmer or my exercise starts becoming more strenuous, I will need to increase that.

The ‘side effect’ of keeping my sodium levels constant is that my blood pressure has stabilized – and this is a good thing. Now I can watch it fall over time, without the wild fluctuations I had been experiencing when I was eating a high carb diet.

OTHER MEASURES – FASTING INSULIN, AM-CORTISOL AND C-PEPTIDE

Fasting Insulin

A year and a half ago, I asked my GP to assess my Fasting Insulin and Fasting Cortisol and he would not as he said he was unable to provide interpretive information. Instead, he referred me to an Endocrinologist.

The Endocrinologist assessed my Fasting Insulin (August 2015) and it was 49 pmol/L (20-180 pmol/L) – but she would not provide me with interpretative information, either. So I had this number, that meant nothing to me at the time.

I did some ‘digging’ in the literature and found a 2009 study from the European Journal of Endocrinology [European Journal of Endocrinology (2009) 161 223—230] which reported that Fasting Insulin was a strong and independent contributor to cardiovascular risk and atherosclerosis and that women with Fasting Insulin in the lower quartile (25 pmol/L) had significantly lower risk of systemic atherosclerosis, than those in the higher quartile (44 pmol/L). Now my Fasting Insulin result had some meaning – and it wasn’t good! My fasting insulin was above the higher quartile (49 pmol/L).

My goal is to lower my fasting insulin to at or below 25 pmol/L by November of this year- and the way to lower insulin is by (1) eating a low-carb diet and through (2) intermittent fasting which is what I have been doing.

Now I have even more motivation to stick with this long-term.

My journey is more about health and reduced cardiovascular risk than it is about looking good. Looking better is a great side benefit.

C-Peptide

Elevated C-peptide (not the same as C-Reactive Protein) is reported to be associated with the higher level of heart disease, including myocardial infarction and coronary artery disease – even in those whose fasting glucose is not impaired (Reference: Diab Vasc Dis Res. 2015 May;12(3):199-207).

Since my C-Peptide was 569 pmol/L (325-1090 pmol/L) a year and a half ago, my goal is to bring that number much closer to the lower end of the range (~350 pmol/L). I will be researching in the literature to determine what factors affect C-Peptide the most.

Cortisol

Cortisol, the so-called “stress hormone” is highest between 6 and 8 AM and it gradually falls during the day, reaching its lowest point around noon. A year and a half ago, my AM Cortisol was 451 nmol/L (140-690 nmol/L) and since cortisol is the hormone that is responsible for mobilizing glucose as part of the “fright and flight response”, it may contribute to my fasting blood glucose being so high.

My goal will be to look into ways to lower my AM Cortisol levels through diet, exercise and stress management.

Final Thoughts

This is a “journey”; one which is as much about the process of getting to my destination as the destination itself. It is about having a healthy relationship with food and about eating when I’m hungry; not because “it is time to eat”. It is about the process of enabling insulin levels to fall simply by delaying when I eat and what I eat. It is about addressing my body’s inability to process carbohydrates – no differently than I would address an inability to tolerate lactose or inability to tolerate gluten. Instead of lactose intolerance or Celiac disease, I have carbohydrate intolerance and as a Dietitian, the path forward is clear. I limit carbs to those contained in non-starchy vegetables, nuts and seeds and use healthy fats as my predominant fuel source. This allows my insulin levels to fall, lowering insulin resistance and enables me to access my own (abundant) fat stores for energy.

For the first time in years, I am sleeping well and the inflammation in my joints that plagued me for years, is largely gone. Just as a newly-diagnosed Celiac feels well for the first time once they eliminate gluten from their diet, so too do I feel so much better without eating carbs, as carbs.

Have questions about how I can help you? Feel free to send me a note using the form on the “Contact Us” tab, above.

To your good 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: 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.

April 20, 2017July 8, 2019

The Limitations of Common Ways of Determining Weight Loss

People who are eating differently in an effort to lose weight often hop on the scale daily to see how they’re doing. What they fail to consider is that an average adult’s body weight can fluctuate by as much as 4 1/2 pounds per day — solely as a result of changes in the amount of water they are retaining or excreting.

The Limitations of Using a Scale to Determine Fat Loss

An 80 kg person has, on average 48 liters of water in their body. The problem with using body weight as an assessor of fat loss is that the human body does not precisely regulate body water content.

Above 49 liters of water, the kidneys of an 80 kg person will clear the excess water by causing the person to urinate more and below 47 liters of water, the 80 kg person will feel thirsty and increase their fluid intake. People’s “weight” is affected by this change in body water content of ~2 liters per day — which weighs approximately 2 kg or 4.4 pounds! Put another way, each day our “weight” can fluctuate by this amount solely due to the difference in retained or excreted water.

Since there is no way to measure this daily change in water weight in non-clinical settings, the standard scale is a very imprecise way to measure fat loss over the short-term.

Waist Circumference

Many people know that carrying excess weight around the middle increases one’s risk of cardiovascular disease, including heart attack so they measure their waist circumference frequently. Even if waist circumference is measured halfway between the lower rib and the top of the hip bone, with a fully relaxed abdomen, their are limitations to using this as a short term measure of weight loss.

The Limitations of Using a Tape Measure to Determine Fat Loss

Since the average person’s body weight fluctuates by as much as ~4 1/2 pounds per day due only to changes in body water, a tape measure fails to capture decreases in waist circumference stemming from the kidneys excreting water.

That said, waist circumference is helpful as a long-term indicator of weight loss, just not a short-term one.

Body Fat Percent

Some people have bathroom scales that have body fat analyzers built in and think that what it is measuring is the amount of fat they are carrying, however a number of factors can influence this reading.

The Limitations of Using a Body Fat Analyzer to Determine Fat Loss

Body Fat Analyzers use electrical impedance to determine fat percentage, and this measurement is affected by a number of conditions, including environmental (room) temperature, a person’s hydration status, as well as emotional stress. Since hydration status can fluctuate by ~4 pounds per day, a body fat analyzer is no more accurate as a short-term measure than a standard bathroom scale, without it.

How to assess short-term weight loss

How one’s own clothes fit and comparative ‘before’ and ‘after’ photos are a much better short-term assessor of fat loss than a scale, a tape measure and a body fat analyzer. Since body water fluctuates considerably on a low carb high fat diet due to changes in sodium levels, I recommend that people eating a low carb high fat diet weigh themselves once every two weeks on the same day of the week, at the same time of day and measure their waist circumference at the same time. If they have a scale that assesses body fat percent once every two weeks is sufficient for taking these measurements.

None of these will provide much information on actual fat loss over the short term…so why rely on them for that, but they will be helpful measurement over the longer term.

Sodium and Body Water Content

As mentioned in a previous article, by eating only when hungry and only until no longer hungry, insulin levels have the opportunity to fall to baseline – something they do naturally after not eating for 12 hours.

On days where the time until eating is extended by a few hours (i.e. “intermittent fasting”), insulin levels stay low for an even longer period of time. In response, our kidneys excrete sodium in a process called naturesis.

Failing to supplement sodium while eating low-carb high fat can result in intense headaches – and if sodium remains low, potassium will also be excreted to keep the necessary sodium-potassium balance. This drop in potassium often results in irregular heart beats, known as arrhythmia.

Phinney and Volek (The Art and Science of Low Carbohydrate Living) recommend that if one is eating less than 60 gms of carbs per day, that 2-3 grams of sodium should be added to the diet (provided the person is not taking any diuretics or other blood pressure medication).

A half a teaspoon of table salt or sea salt provides 1000 mg or 1 gram of sodium.

Final Thoughts

Since hopping on the scale daily or even several times a week won’t provide any useful information, nor will measuring our waist circumference or using a body fat analyzer too often – why do it? Part of ‘getting healthy’ ought to include having a healthy body self image – something that won’t be nurtured by obsessing about such “numbers”.

Short-term measures of success

Short-term success is best measured visually – with comparative photos taken from the same distance away, from the same relative height and wearing the same clothing.

How one’s clothes are fitting is another way.

A person who is insulin resistant or Type 2 Diabetic should be seeing both their fasting blood glucose and post-prandial (2 hours after a meal) glucose levels gradually coming down. If they aren’t then they should schedule an appointment with their Dietitian to find out why that is.

Medium-term measures of success

Medium-term measures of success in eating low carb high fat can be measured both subjectively and objectively. Subjective measures include weighing oneself and taking one’s own waist circumference once every two weeks. Objective measures include having your Dietitian weigh you on a clinical scale, having her assess your waist circumference and body fat percentage using both a device that measures electrical impedance, as well as using good old-fashioned calipers, that measure subcutaneous (under the skin) fat, in 3 or four specific locations on the body.

A person with high blood pressure should be seeing both systolic (the first number) and diastolic (the second number) blood pressure coming down and Type 2 Diabetics or those with insulin resistance should be continuing to observe lower fasting blood glucose and post-prandial (2 hours after a meal) glucose levels.

Longer-term measures of success

After 6 or 8 months eating low carb high fat, both subjective and objective measures should be continuing to lower in a reasonably linear fashion. Of course there will be times where a ‘plateau’ is reached, but if that lasts more than two or three weeks, then its important to check in with your Dietitian to make sure the amount of carbs you think you are eating is what your Dietitian has been determined as being best for you.

A Type 2 Diabetic should be seeing both their fasting blood glucose and post-prandial (2 hours after a meal) glucose levels approaching more normal levels and both Type 2 Diabetics and those with insulin resistance (“pre-diabetes”) should have their HbA1C assessed at a lab every three months, as this provides insights into one’s 3-month average blood glucose level. Fasting blood glucose provides a ‘snap-shot’ of blood sugar in the morning after not eating, and should be done twice a year by a lab, especially if one is Diabetic. Comparing lab test results to previous lab test results is an objective indicator of the effect that eating low-carb high fat is having on specific markers and provides an opportunity to determine if the amount of carbs being eaten may still be too high.

The most accurate assessor is a 2 hour glucose tolerance test, however few doctors will requisition this after one is diagnosed as Type 2 Diabetic.

Finally, every year or so, it is helpful for those who have been diagnosed as Diabetic to have their fasting insulin, C-Protein and AM Cortisol levels assessed and compared to previous results. For these, your doctor may refer you to an Endocrinologist.

Remember, achieving health is a journey and takes time and like most journeys, it is best not done alone.

Have questions about how I can help or about the services I provide?

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

To your good health!

Joy

follow me at:
https://twitter.com/joykiddieRD

https://www.facebook.com/lchfRD/

April 5, 2017July 8, 2019

From Paleo to Present – a brief history of the human diet

Prior to the domestication of animals and the development of agriculture, the human diet centered around the ‘hunt’. They ate when they caught something, and didn’t eat until again until they either caught something else, or were successful in finding edible vegetation, berries or nuts. ”Feasting” and ”fasting” were normal events in the rhythm of life, and our bodies were designed to function using our fat stores for energy, as evidenced by our continued existence.

From hunter-gatherers to farmers

After the Ice Age, those that survived were left with an increasingly unpredictable climate, decreases in big-game species that were hunters’ first-choice prey, and increasing human population in the available habitats for hunting and gathering. To decrease the risk of unpredictable variation in food supply, people broadened their diets to second- and third-choice foods, which included more small game, plus plant foods which required much preparation, such as grinding, leaching and soaking. As I will demonstrate below, these plant foods, including grains were very different in carbohydrate and protein composition than they are today.

The domestication of animals and plant cultivation of ~ 13,000 years ago, forms a significant turning point in the human diet.

Humans began to transport some wild plants, including grains from their natural habitat to more productive selected habitats, and so began intentional cultivation, or farming. With the development of agriculture and the domestication of animals – the plants and animals themselves began to change.

This is important.

The fruit of today bear little resemblance to their ancient predecessors. The grains of today don’t either. For example, wild wheat and wild barley bear their seeds on top of a stalk, and sheds its seed spontaneously — enabling it to germinate where it falls.

Once people began bringing some wild wheat or barley seeds back with them in order to intentionally plant them, some seeds would accidentally spill along the way, germinating in new places. Over time, some seed would cross-pollinate with wild grain, while others would undergo spontaneous mutations, leading to wheat and barley varieties with non-self-shattering heads. Eventually, these non-shattering grains were selected for by humans for cultivating, leading to a very different type of grain than the wild species — and one with very different nutritional content than their wild predecessors.

Similarly, domesticated animals were selected based on traits that were considered desirable to people — chickens were selected to be larger, wild cattle to be smaller, and sheep to lose their bristly outer hairs and not to shed their soft inner wool. Eventually, the land where hunter-gatherers lived was overrun and replaced by people who had become agricultural – and who were ever-expanding the amount of land they required for raising animals, as well as for growing crops.

At Tell Abu Hureyra, in the Euphrates valley of modern Syria are the remains of a civilization that lived between 13,000 and 9,000 years ago, spanning the Epipaleolithic and Neolithic periods. This site is significant because the inhabitants of Abu Hureyra started out as hunter-gatherers, but gradually moved to agriculture, making them the earliest known farmers in the world. Meals consisting of the meat of gazelle, wild goat and game birds were supplemented with wild-growing Einkorn wheat-porridge, as well as berries, nuts or fruit, if in season. Tools such as sickles and mortars for harvesting and grinding grain, as well as pits for storing it have been found at Tell Abu Hureya and remains of harvested Einkorn wheat (which was ground by hand and eaten as porridge) have been found at Tell Aswad, Jericho, Nahal Hemar, Navali Cori and other archeological sites.

The diet of man forever changed at that point.

As previously mentioned, plants underwent change as a result of both natural cross-pollination as both underwent change as a result of intentional manipulation by man. This occurred everywhere that man settled — from the lush valleys of the Middle East*, to Africa and Asia.

[*yes, the Fertile Crescent of the Middle East was lush and green, then.]

The grain we know today as ”wheat” and ”rice” is nothing like their wild ancient predecessors. Likewise with fruit. The fruit of today has been bred to be sweet — not so with the wild cultivar. A brief history of wheat will help illustrate this type of change.

Evolution of Wheat – but one example

The first wild grass that was cultivated was Einkorn wheat. As cultivation techniques improved, Einkorn eventually became an essential component of the diet — reducing the need for hunting and gathering. Einkorn wheat contained only 14 chromosomes.

Shortly after the cultivation of the first Einkorn, the Emmer variety of wheat (Triticum turgidum) appeared in the Middle East; a natural offspring of Einkorn and an unrelated wild grass, called goatgrass’ (Aegilops speltoids.

Emmer wheat is what is referred to in the Hebrew Bible (Exodus 9, Exodus 32, Isaiah 28, Isaiah 25) as Kes-emmet (×›Ö¼Ö»×¡Ö¼Ö¶×žÖ¶×ª) and both Eikorn wheat (×—Ö´×˜Ö¼Ö¸×”) and ”Emmet” (Ö¼Ö»×¡Ö¼Ö¶×žÖ¶×ª), translated in English as ‘spelt’, are referred to together as distinct species (e.g. Exodus 9:32). It was the ancient Egyptians that are credited with the addition of wild strains of yeast in order to make bread rise — which gives an added dimension to the story of Passover, where the Jews left slavery in Egypt in ”great haste”, “not having time to let their bread rise”.

Since plants do not combine genes but add (or sum) them which provides evidence of what cross-bred with what. Goatgrass added its genetic code to that of Einkorn , so Emmer wheat had 28 chromosomes.

Emmer wheat then naturally cross-bred with another wild grass called Triticum taushii, giving rise to the original cultivar of Triticum aestivum, the predecessor of modern wheat, which has 42 chromosomes. This was a higher yielding wheat variety which had many desirable baking properties that Eikorn and Emmer lacked. This new strain remained largely unchanged until the mid-eighteenth century when Carolus Linneaus, who invented the Linnean system of categorizing species, counted only 5 species.

Today, Eikorn, Emmer and the original cultivated strains of Triticum aestivum have been replaced by almost 25,000 strains of modern human-bred wheat strains that are hundreds, if not thousands of genes apart from the original Eikorn and Emmer wheat species.

Our food is not the food of our ancestors.

Modern Triticum aestivum is on average 70% carbohydrate by weight and only 10% protein. Emmer wheat, on the other hand was 57% carbohydrate and 28% protein — and was suitable to supplement the protein of a meal.

Paleo Diet compared with the Low Carb High Healthy Fat diet

The premise of Paleo eating to eat like our Paleolithic ancestors did is understandable, however the foods that exist now are nothing like the foods our ancient ancestors ate. Fruit, for example is considered “paleo” -but the carb content of paleo fruit was substantially less than that of today.

In a low carb high healthy fat way of eating, carbs are not avoided. It is the foods that are high in carbs that are easily broken down to glucose and have little nutrient-density that are limited.

[It is hard to justify eating grain products made from varieties of wheat that were bred for no other reason than they could be grown in nutrient- poor soils in novel parts of the world.]

No justification is needed to eat carbs that come as part of fibre- and nutrient-rich non-starchy vegetables and to eat carbs found in nuts that are a good source of protein and monounsaturated fat.

A diet where 45 – 65% of calories are as carbohydrate is has us eating ”carbs for carb’s sake”, but a low carb high healthy fat diet should not be about “fat for fat’s sake”.

Some people think they should eat large amounts of saturated fat ”just because they can”, and I suppose that’s true. One can certainly eat a pound of bacon, but when compared with a fat marbled grain-fed steak or a Brome Lake- or wild duck, one is more nutrient-dense than the other. The yolks of free-range egg comes as part of a nutrient-dense package, which includes good quality protein, as well as other nutrients. A pound of bacon, does not. That doesn’t mean that eating bacon is ”bad”, but in comparison to grilled salmon with a large serving of non-starchy vegetables bathed in cold-pressed olive- or avocado oil, it doesn’t quite measure up. It is not just about not being hungry, but about being healthy.

A Low-Carb-High-Healthy-Fat Diet is about ”nutrient density” — not just ”fat density”.

Final Thoughts

In a Low-Carb-High-Healthy-Fat Diet, carbs are not ”bad” and fat is not ”good”. Carbs and fat that come in nutrient-dense food and in particular ratios are what we are striving for.

As well, protein quantity is based on physiological need and not unlimited (as excess in a low carb diet will be converted and stored as fat). The source of that protein ought to be considered, as well. For example, it is well documented that fatty fish such as salmon, mackerel and tuna are high in omega-3 fatty acids and are good for our brains and our hearts so for those that enjoy fish, eating it often is ideal.

The good thing about the Low-Carb-High-Healthy-Fat Diet is that it can be adapted to culture- or religious restrictions. Don’t eat pork? No problem. Don’t eat beef? Not an issue. Take fast days? That is easily worked-in.

Want to know more?

Feel free to send me a note using the form on the “Contact Us” tab, above. Remember, Nutrition is BetterByDesign.

To your health!

Joy

follow me at:

https://twitter.com/joykiddieRD

https://www.facebook.com/lchfRD/

References

Binford LF. New Perspectives in Archaeology, 1968; 313—341

David, W. Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health Rodale Books, 2011; 15-32

Diamond J. Evolution, Consequences and Future of Plant and Animal Domestication. Nature, 2002; 418:700-7

Flannery KV. The Domestication of Plants and Animals, 1969;73—100

Hillman GC, Davies, MS. Measured Domestication Rates in Wild Wheats and Barley under Primitive Cultivation, and their Archaeological Implications. J. World Prehistory; 1990; 4:157—222

Raeker RO, Gaines CS, Finney PL, Donelson T. Granule size distribution and chemical composition of starches from 12 soft wheat cultivars. Cereal Chem 1998;75(5):721-8

Shewry PR. Wheat. J Exp Botany 2009;60(6):1537-53

Stiner MC, Munro ND, Surovell TA. The Tortoise and the Hare: small-game use, the broad-spectrum revolution, and Paleolithic demography. Curr. Anthropol. 41, 39—73 (2000).

Zohary D, Hopf M. Domestication of Plants in the Old World 3rd edn (Oxford Univ. Press, Oxford, 2000).

April 3, 2017July 8, 2019

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”!

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.

March 27, 2017July 8, 2019

A Dietitian’s Journey – out of denial and approaching health

Today it’s 4 weeks since I began “practicing what I preach” when it comes to a low carb high fat diet and to be frank, the results have astounded me. Over the last two years, I’ve been reading through the literature on this topic and while I knew that eating this way could produce significant results – I had no idea that it would be possible to see blood sugar and blood pressure come down this much in this short a time, especially given how well, and much I eat. Then there is the weight and inches lost. This is a summary of my progress to date.

Out of Denial

Part of this ‘journey’ of getting healthy myself, has been to come out of denial.

When we ‘deny’ something, we say it is untrue – but it was not as though I was deliberately deceiving myself or anyone else about my health, I was simply omitting to find out the magnitude of reality.

In psychological terms, I was in denial.

Out of Diabetes Denial

In the first entry in this journal, I mentioned how I didn’t know how high my blood sugar was because I hadn’t measured it in ages. I hadn’t had my HbA1C measured in a year and a half. I didn’t want to know how bad it was. Despite being a Dietitian with a post graduate degree in Human Nutrition, I didn’t want to know how unhealthy I was.

In 6 months from the time that I began this journey, I want to know what my labs show. HbA1C measures the amount of glucose bound to hemoglobin (glycated hemoglobin) and since it takes 3 months for the red blood cells in our bodies to turn over, it takes that long for HbA1C to begin to reflect the dietary changes made. Having my HbA1C measured in 6 months will show my average plasma glucose level since I started eating a low carb, high healthy fat diet.

Using good scientific methodology, I should have measured my fasting blood glucose and HbA1C at baseline – before I started to change what I am doing and then measure them again in 6 months. That way, I could calculate the magnitude of change, but I didn’t so I can only go on what I have.

I know that my blood sugar has been ~12 mmol/L because that’s what it would be this past month when I would eat more ~ 50 gm of carbs. Before I started this journey, I was eating significantly more carbs than that. Furthermore, the previous three years, my fasting blood glucose was 7.9 mmol/L (Feb 2013), 9.1 mmol/L (Sept 2014) and 9.7 (Aug 2015). Extrapolating that data to the present date brings it pretty close to 12 mmol/L.

Out of Hypertension Denial

Without question, prior to a month ago, I would have been diagnosed with hypertension (high blood pressure) as the first week of this journey, my blood pressure was 1/3 of the time in Stage 2 Hypertension with one hypertensive emergency (i.e. higher than Stage 3 hypertension) and 50% of the time I was in Stage 1 hypertension, with the remaining ~ 15% in pre-hypertension. The last time my GP measured my blood pressure was a year and a half ago (Aug 2015), I was straddling Stage 1 and Stage 2 hypertension.

It was a ridiculously high blood pressure of a month ago that was the impetus for me to change. That day, I became my ‘first client’. That day, I began practicing what I preach and as someone with insulin resistance, I began eating low carb, high healthy fat.

Out of Dyslipemia (Cholesterol) Denial

I have no idea what my lipids were when I started changing how I eat, but I know what they were for the last 3 consecutive years. My LDL cholesterol (so-called “bad cholesterol”) was hovering around 3.00 mmol/L, with the normal range for low risk individuals being 1.50-3.39 mmol/L. However due to having Type 2 Diabetes, as well as a family history of high cholesterol, I am high risk and my LDL levels need to be â‰¤ 2.00 mmol/L.

My HDL cholesterol (so-called “good cholesterol”) was high; ranging between 1.76 mmol/L three years ago, to 1.91 mmol/L two years ago, to 2.25 mmol/L – significantly above the 1.10 mmol/L cutoff, however my GP did not consider that protective. His determination for putting someone on lipid lowering medication (statins) is based only on LDL levels. In discussion with him, I decided that I would take a dietary approach first and that this would be following a low carb high healthy fat diet. The agreement was that I would get my labs taken again in 3 months.

Out of Obesity and Overweight Denial

I knew how much I weighed a month ago, but it had been a year and a half – since August 2015 since I calculated my BMI – and more significantly, since I measured my waist circumference. Today, after a month of significant diet changes, I came out of denial with respect to my weight, and calculate my “numbers” – just as I do for my clients. After all, I am now my ‘first client’.

It turns out, I am overweight now – which means I was just in the obese category at a BMI of 30.5 (obese is a BMI > 30) when I began this journey.

No matter how I calculate it, I still need to lose at least another 30-40 pounds.

By the Scale

Based on the scale, I need to lose 29 pounds for my BMI to reach the high end of the “normal weight” category (< 25). To put myself in the mid-range of the normal weight category, I should lose another 35 pounds.

By Fat Percentage

Based on my fat percentage, I need to lose 17% of my body weight (29. 1/2 pounds) to be at a healthy 23% (non-athlete, female). That’s another 30 pounds.

By Waist to Height Ratio

For my waist circumference (in inches) to be half my height (in inches), I need to lose 30 pounds.

How do I know?

Because all these years, I kept my leather pant belt from when I was that size and I remember well how much I weighed, then.

MY RESULTS – ONE MONTH UPDATE

So how am I doing after one month eating low carb high healthy fat?

My Weight

It is now the end of the 4th week and I have lost 5 pounds.

That’s right, I didn’t lose a thing this week. Am I upset? Not at all, because I lost another half off my waist.

My Waist Circumference

In the first two weeks, I lost an inch off my waist, the third week, another 1/2 inch came off and today I measured my waist again – without sucking in my belly (what would that prove?!) and it is down another half inch. In total, in one month, I lost 2 inches off my waist.

Based on my Waist to Height Ratio (WHTR), I still have another 8 inches to lose off my waist – which would have seemed so discouraging a few weeks ago, except that 2 inches came off effortlessly, with me following the Meal Plan that I designed for myself.

It’s great having the skills to take my health into my own hands, knowing I am getting all the micronutrients that I need – but for those that need help getting started, there are Dietitians such as myself who can help!

During the entire 4 weeks I was never hungry (if I was, I could eat!) and I’ve been meeting my daily requirement for protein as well as Calcium, Magnesium, Potassium, Vitamin K, Vitamin A, Vitamin C and Vitamin E.

Yes, my fat intake is high (~75% of calories) but most of the fat I choose to eat is monounsaturated fat, such as cold pressed olive- and avocado oil, fats in nuts and seeds, as well as omega-3 fats from fatty fish such as salmon, mackerel and other fish (such as cod). Based on the reading I have been doing in the literature, I do not believe that eating this way poses any adverse health risk to me. If it did, I wouldn’t eat this way and would certainly not encourage others to do so.

Based on the literature, there is nothing inherently “bad” about eating saturated fat. Our bodies actually make it in the form of palmitic acid. I eat eggs occasionall or cheese and put a splash of cream in my coffee but when it comes to my main sources of fat, I look to cold pressed olive oil which is 65-80% monounsaturated (oleic), 7-16% saturates (palmitic) or cold pressed avocado oil which are 76% monounsaturated (oleic and palmitoleic acids), 12% polyunsaturates (linoleic and linolenic acids) and 12% saturates (palmitic and stearic acids), as well as fat from nuts (almonds, pine nuts, macadamia nuts) and seeds (pumpkin, mostly).

The only thing that is “low” in my diet is carbs, but since I am being sure to meet my micro-nutrient and protein requirements, I can see no physiological purpose for having more carbs.

My Fat Percentage

I’ve gone from ~ 41.5 % body fat to 40 % body fat in a month. Okay, I’ve a long way to go, but I am doing what I need to do, the results will come.

My Blood Sugar

I should mention that to track my blood glucose accurately, I am using two glucometers; (1) one that is a year old made by GE and using it with brand new blood glucose test strips and (2) a brand new glucometer, made by Abbott which also takes Ketone Strips, so I can track my ketone levels.

I am purposely keeping my ketones from going too high and being sure that the “numbers” (weight, waist circumference,fat %, blood glucose and blood pressure) decrease slowly and steadily. As far as those who recommend a high fat diet, I take what most would consider a conservative approach.

Ketone meter – measuring B-hydroxybutyrate

Ketone sticks – for measuring ketones in urine

As long as I kept my net carbs (carbohydrate minus fiber) reasonably low, I did very well, but above that my body could not handle the carbohydrate load. Without a doubt, I was very insulin resistant -which is no surprise, considering I was diagnosed with Type 2 Diabetes ~ 10 years ago.

This past week, I tracked my carbs carefully (easy to do and requiring no apps) and my blood glucose continued to decrease this past week, in a linear fashion at all times of the day .

My body is doing exactly what it was designed to do; happily breaking down the fat I have stored up over the years and converting it into glucose for my blood.

This was my blood sugar last night, 2 hours after supper.

I haven’t seen post-prandial (after-a-meal) blood glucose levels like this since I’ve been Diabetic, which is 10 years!

This was supper;

zucchini spaghetti – with meat sauce and Asiago cheese

mixed green salad with extra virgin olive oil, goat feta and pumpkin seeds

As you can see, I am hardly starving!

I used to love fruit on my salad, but have found that snap peas cut up have just the right amount of sweetness, lots of fiber and a whole lot less carbs!

Blood Pressure

I should mention that to track my blood pressure accurately, I purchased a brand new, top-of-the-line sphygmomanometer which measures my blood pressure automatically 3 times, one minute apart and takes the average.

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

This week my blood pressure was;

~81% Stage 1 Hypertension

~19% pre-hypertension

Its getting progressively lower each week.

The last few nights, I saw “normal” blood pressure readings;

No, my blood pressure readings are not (yet) always normal, it has only been FOUR WEEKS! On average, my blood pressure has come down 1 mmHg / day for 4 weeks in a row.

Final Thoughts

Data is data and while not scientifically ‘objective’ data, and with a sample set of only 1, the “numbers” are convincing.

I feel well, I am eating better than I have in years. My sleep has improved significantly. My clothes fit looser and when I look in the mirror, the face that looks back is more familiar. An added benefit is that my fingers, which have been stiff for years, are much less so.

I can’t think of any drawback to eating this way, except for the space required to have lots and lots of fresh vegetables in the house and that I am going through them at an alarming rate! Thankfully, I have an extra fridge in the garage, so I don’t need to shop more than once a week.

Even food cost, which was a bit of a shock the first week (as I had to purchase ingredients I didn’t use before, and certainly not in that quantity) has leveled off. I spend a lot less money on milk and large amounts of cheese and a lot more on the best quality olive oil and avocado oil. Protein quantities are about the same as before, except there is more animal protein now as I used to be mostly vegetarian. Protein sources are mainly fresh fish, chicken, and marinated flank steak. None of these are high in saturated fat, so even those of my peers that might worry about people who may be physiologically sensitive to higher saturated fat levels would not be concerned about the way I am eating.

Yes, I am eating “high fat” but 80% of it is what even the most conservative health care practitioner would admit are “healthy” fats; olive oil, avocado oil, fat in nuts and seeds and the fat naturally found in fatty fish. Studies seem to show that even those who eat a much higher saturated fat diet, suffer no adverse health issues. At the end of the day, I am meeting all my dietary needs and the only thing that is missing is the “carbs”. So?

Unless someone can present me with a compelling reason why I need those carbs, I see no reason not to keep eating the way I am eating and teaching others who wish to do so, the same.

To our health!

Joy

you can follow me at:

https://twitter.com/lchfRD

https://www.facebook.com/lchfRD/

March 26, 2017July 8, 2019

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.

you can follow me at:

https://twitter.com/lchfRD

https://www.facebook.com/lchfRD/

follow me at:

https://twitter.com/joykiddieRD

https://www.facebook.com/lchfRD/

March 22, 2017July 8, 2019

Significance of Insulin Resistance

Insulin resistance is a condition where your body keeps producing more and more insulin in order to transport glucose out of the blood and store the excess by converting it to fat. When cells have become resistant to insulin, glucose builds up in the blood and results in ”high blood sugar”. The problem is that high blood sugar is a symptom of the problem, it is not the problem itself. Insulin resistance is the underlying cause and is highly significant to those with completely normal blood sugar levels.

Those with high fasting blood glucose may notice symptoms that are associated with Type 2 Diabetes; including excess urination and excess thirst. This is the body’s way of trying to dilute the high levels of glucose in the blood. A very sobering fact is that 75% of people with insulin resistance have normal fasting blood glucose levels and don’t know that they are insulin resistant.

They have NO symptoms whatsoever.

They don’t know that they are at increased risk for heart attack and stroke.

The Silent Risk of Insulin Resistance

Insulin resistance is a risk factor for atherosclerosis* – also called “hardening of the arteries”. Atherosclerosis is where plaque builds up inside the body’s arteries and if the plaque build-up occurs in the heart, brain or kidney, it can result in in coronary heart disease, angina (chest pain) or chronic kidney disease. These diseases are normally associated with Diabetes, but it is the underlying insulin resistance of Diabetes that creates the increased risk – not the high blood sugar itself. Worthy of note, it is being insulin resistance that increases one’s risk – whether or not one also has high blood blood sugar.

The plaque that builds up in atherosclerosis may partially block or totally block blood flow to the heart or brain and if a piece of the plaque breaks off or if a blood clot (thrombus) appears on the plaque’s surface – this can block the artery resulting in a heart attack or a stroke (in the brain).

Three quarters of people with normal fasting blood glucose are at increased risk of atherosclerosis and as a result, to heart attack and stroke due to insulin resistance and they don’t even know it, because their blood sugar is normal!

* a few recent references (there are many more): Pansuria M, Xi H, Li L, Yang X-F, Wang H. Insulin resistance, metabolic stress, and atherosclerosis. Frontiers in Bioscience (Scholar Edition). 2012;4:916-931. Santos, Itamar S. et al., Insulin resistance is associated with carotid intima-media thickness in non-diabetic subjects. A cross-sectional analysis of the ELSA-Brasil cohort baseline, Atherosclerosis 2017 Mar 10;260:34-40

Insulin Resistance with Normal Blood Glucose

Dr. Joseph R. Kraft, MD was Chairman of the Department of Clinical Pathology and Nuclear Medicine at St. Joseph Hospital in Chicago, Illinois for 35 years. He spent a quarter century devoted to the study of glucose metabolism and blood insulin levels.

Between 1972 and 1998, Dr. Kraft measured the Insulin Response to a carbohydrate / glucose load in almost 15,000 people aged 3 to 90 years old using a 5-hour oral glucose tolerance test with insulin assays. Data from 10,829 of these subjects indicated that 75% of subjects were insulin resistant — even though their fasting blood sugar level was normal.

That is, having a normal fasting blood glucose level, and normal HbA1C level does not preclude someone from being insulin resistant and at increased risk for heart attack and stroke.

The American Heart Association states on its web page that;

“exactly how atherosclerosis begins or what causes it isn’t known, but some theories have been proposed. Many scientists believe plaque begins to form because the inner lining of the artery, called the endothelium, becomes damaged. Three possible causes of damage to the arterial wall are (1) elevated levels of cholesterol and triglycerides in the blood (2) high blood pressure and (3) cigarette smoking”.

It is known that high triglycerides in the blood are largely a result of diets high in carbohydrates where excess carbohydrate that isn’t converted to glycogen and stored in muscle and liver is stored as triglyceride (three fatty acids attached to a glycerol molecule).

Insulin resistance in our cells, results in our bodies releasing more and more insulin in order to try to clear the same amount of glucose from our blood to store it in our liver as triglyceride (fat!). As covered in the blog post on the hormonal effect of insulin, it is the insulin which drives increased hunger and specifically increased craving for carbohydrates. A viscous circle is created. Diets that are 45-65% carbohydrate result in more and more insulin to handle the same carb load (that is the very nature of insulin resistance) and this increased insulin leads to even more insulin resistance, increased hunger and craving for….you guessed it: more carbs.

Since insulin’s main role is to store the excess glucose not needed immediately to fat – our bodies produce more and more triglyceride (fat!) the more carbs we eat and the more insulin resistant we are. That is, a high carb diet results in high triglycerides – which the American Heart Association recognizes as playing a role in the development of atherosclerosis. That is because triglycerides are converted to VLDLs to transport fat around the body and when their triglycerides ‘passengers’ are depleted, what is left is LDL, the “bad cholesterol” we have all heard about. The ONLY source of LDL is VLDL, and high triglyceride is largely the result of a diet that is too high in carbohydrate.

Insulin also plays a significant role in the regulation of blood pressure through its effect on sodium transport. As insulin rises, excess sodium is retained by the kidneys, increasing blood pressure. Insulin resistance compounds this problem, causing blood pressure to rise even more. It has long been known that people with Diabetes develop high blood pressure – but it is the underlying insulin resistance that is driving that, not the symptom of high blood sugar.

What is alarming is that based on Kraft’s research with ~11,000 people over 20 years, potentially 75% of people are insulin resistant — even though their fasting blood sugar level is normal. This insulin resistance drives the increased triglycerides and high blood pressure that characterize what the American Heart Associations states is believed what underlies the development for atherosclerosis – and the corresponding risk of heart attack and stroke.

Could insulin resistance be a silent killer?

Kraft’s Patterns of Insulin Response

Kraft plotted the data from ~11,000 subjects and five distinct Insulin Response Patterns emerged.

Insulin Response Curves – image adapted from Dr. Ted Naiman

‘Pattern I: is a normal, healthy insulin response to a standard glucose load. Dr. Kraft called this ‘Euinsulin’.

image by Joy Y. Kiddie MSc RD — Pattern I: Normal Insulin Response Curve

Pattern II — is a hyperinsulinemic insulin response to a standard glucose. Note that Pattern II is considerably greater than the normal insulin response curve (Pattern I) and this greater insulin response is sustained for 5 hours after the ingestion of the glucose.

Superimposing the hyperinsulinemic insulin response of Pattern II over the normal Pattern I insulin response curve, it is easy to see how much higher the Pattern II (yellow curve) is over the normal Pattern I (green) curve. This is the early stages of insulin resistance.

Pattern III — is a hyperinsulinemic insulin response to a standard glucose load. Compared to the normal insulin response curve (Pattern I), it much greater during for 5 hours after taking in the glucose.

image from Joy Y. Kiddie MSc RD — Pattern III hyperinsulinemia compared to normal glucose response (Pattern I)

Superimposing Pattern III (hyperinsulinemia) insulin response curve over the normal (Pattern I) insulin response curve, its easy to see how the insulin response is delayed (skewed to the right). This results in blood glucose remaining high, as insulin is not responding as it should. Keep in mind, this is occurring in people with normal fasting blood glucose levels.

The Pattern III curve also goes so much higher than the normal Pattern I insulin response curve — which means that more insulin is released and this higher insulin release is sustained for the 5 hours after taking in the glucose.

This is ”silent” pre-diabetes – delayed insulin response and much higher levels of insulin for a much longer time — but with normal fasting blood glucose!

Pattern IV — Pattern IV is what Dr. Kraft calls “Diabetes in Situ” – literally “Diabetes in Place”. Looking at the Pattern IV insulin response curve compared to Pattern I (the normal insulin response), it is apparent that it is much greater for the entire 5 hours after taking in a standard amount of glucose.

image created by Joy Y. Kiddie — DIABETES IN-SITU: Pattern IV insulin response points compared to the normal Pattern I insulin response curve (in green)

image created by Joy Y. Kiddie MSc RD — DIABETES IN-SITU: Pattern IV insulin response curve compared to the normal Pattern I insulin response curve (in green)

Surprisingly, 40% of people with a Pattern IV Insulin Resistance still had normal fasting blood glucose.

75% of people displaying Pattern II, II or IV insulin responses do not know that they are at greater risk for atherosclerosis and as a result to heart attack and stroke because they have no symptoms. Their blood sugar levels are normal.

Finally, insulin resistance is the most common cause of Type 2 Diabetes.

Normal fasting blood glucose and normal HbA1C results do not reveal whether or not a person is insulin resistant – only a 2 hr glucose tolerance test can do that. Unfortunately, a 2 hour glucose tolerance test is usually only requisitioned when fasting blood glucose and HbA1C results come back abnormal.

Potentially, up to 75% of people are insulin resistance and have NO IDEA!

They are at increased risk for heart attack and stroke and have NO SYMPTOMS.

They don’t have increased thirst or increased urination like Type 2 Diabetics, but are at the same risk.

The Good News

The good news is, we can lower insulin resistance – and as a byproduct of that, shed excess weight in the process. This is accomplished through (1) a low carbohydrate diet with or without the use of (2) stretching the amount of time between meals (sometimes called “intermittent fasting”).

When designed properly, a low carbohydrate diet can provide all of the recommended intake of vitamin and minerals – while lowering insulin resistance.

That is where I come in.

I can assess your physiological needs for energy and nutrients and design an Individual Meal Plan that will enable you to lose weight, without being hungry all the time – and that will help lower your insulin resistance and the associated risk of cardiovascular disease related to insulin resistance.

Want to know more? Click on the “Contact Me” tab above and send me a note.

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.

follow me at:

https://twitter.com/joykiddieRD

https://www.facebook.com/lchfRD/

March 22, 2017July 8, 2019

A LCHF Diet

A low carb high fat (LCHF) diet is a way of eating that maximizes the body’s natural ability to access one’s own fat-stores for energy. Fat takes the place of carbohydrate as the preferred source of energy, so most of the body’s energy needs comes from a wide variety of healthy fats. All low carb high fat diets minimize carbohydrate-based food, have a moderate amount of protein and high amount of healthy fats, some versions (e.g. Phinney and Volek) have higher protein and lower fat during the weight loss phase.

When we eat this way, our body uses dietary fat that we eat and our own stored fat for energy and by keeping carb intake low, insulin levels are allowed to fall, which in time makes our cells more sensitive to it. As insulin levels fall, so does hunger – so we eat meals when hungry, until we are no longer hungry – but are no longer hungry every few hours.

The low carb high healthy fat diet

These are the categories and types of food that are available to enjoy on a low carb high healthy fat diet;

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

Macronutrients

The exact ratio of macronutrients in your diet (i.e. grams of carbs, fat and protein) will differ depending on your age, gender, activity level, current body composition as well as any health conditions or medication you may be taking – and of course, which style of low carb high fat diet you follow.

Here are some general guidelines to give you an idea;

Protein

A low carb high healthy fat diet does not have unlimited amounts of animal protein, although some variations of this style of eating do. As mentioned above, some versions of this eating style have higher amounts of protein than fat only during the weight loss phase.

Fat

One thing all low carb high fat diets have in common, is that they are lower in carbs than the conventional low fat calorie-restricted diet and high in fat.

During weight loss, some approaches have ~60% fat and higher amounts of protein, whereas others have 75-80% fat (e.g. Fung’s approach) and moderate amounts of protein. But isn’t all this fat “bad” for us – especially saturated fat?

It’s important to keep in mind that only ~ 20% of the saturated fat in our body comes from diet, with the remainder being made by our body. If it were that ‘bad’ for us, why would our bodies naturally manufacture it?

How much saturated fat should we eat?

According to Phinney and Volek (The Art and Science of Low Carbohydrate Living), when someone is adapted to eating a low carb high healthy fat (i.e. are in “fat-burning mode”), saturated fats do not raise LDL cholesterol. That said, why eat only saturated fat? Eating a wide range of healthy fats from a variety of natural sources provides our bodies with all the essential fatty acids we can’t make, as well as provides us with foods that can reduce inflammation.

Beyond saturated fat that is found in the diet’s protein sources (meat, fish, egg, cheese and poultry), I recommend that people look mainly to mono-unsaturated plant-based fats such as those found in avocado, olive, and avocado oil along with saturated fat and medium chain triglycerides from coconut oil (processed through the lymphatic system rather than the liver), modest amounts of omega 6 fats from nuts and seeds, as well as plenty of omega 3 fats found in fatty fish.

It’s important to note that nuts and seeds such as almonds, walnuts, pumpkin and sunflower seeds, pistachios are a source of carbs (ranging from ~1.5—4 grams net carbs per ounce (30g)), so it’s important to use these in moderation, such as a few as a topping for a salad. In addition, nuts are high in omega-6 fats which are pro-inflammatory as they compete for binding-sites with omega-3 fats such as those found in fish.

Chia and flax seed are approximately 1—2 grams net carbs per 2 Tbsp (50 ml) and are excellent sources of both soluble and insoluble fiber.

All fats on the meal plan are healthy – which is why I call this approach “low carb high healthy fat”, but for a small percentage of people for whom high LDL cholesterol continues to be a concern, eating less saturated fat may be beneficial. Each person’s needs and familial risks are different, so no one low carb high healthy fat Meal Plan is the same.

Carbohydrate

Carbs are a healthy part of the low carb high fat diet, but the quantity of carb is minimized.

There are naturally-occurring carbs in non-starchy vegetables and low-sugar fruit (such as lemon, lime, eggplant, cucumber and tomatoes) as well as berries, as well as those found in nuts and seeds, as mentioned above.

Some versions of a low carb diet do not include nuts, seeds or berries during weight loss.

When starting a Low Carb High Healthy Fat Diet

Although not everyone does, some people experience some of the following symptoms, which usually subside within a couple of weeks. For each, I have offered some suggestions to minimize them:

headaches: often a result of eating too little salt. As insulin levels fall, so sodium is excreted by the kidney in urine. The drop in sodium results in the headache. Taking 1-3 gms of salt per day (I prefer sea salt) will alleviate this. If you are taking medication for high blood pressure, be sure to check with your doctor before making any changes to your diet. “Bone broth” is another way to restore electrolytes that are lost as insulin levels fall. Be sure you’re drinking plenty of water and also consuming enough salt/sodium.
sleep disruption: often a result of needing to urinate more, but sometimes experienced when people of switching from being in “carb-burning mode” to being in “fat burning mode”. Some people find taking some magnesium (with calcium) before bed helpful.
digestive changes: some people find they get slightly looser stools or get slightly more constipated when starting. I can help troubleshoot this with you to get things back on track.
aches and pains: some people feel a little achy and almost flu-like for a few days when they are switching fuel sources. Some people call this the “keto-flu”. Making sure to have a balanced amount of sodium/potassium and calcium/magnesium as well as taking extra omega 3 fatty acids is helpful.

My role as a Dietitian

As a Dietitian, I make sure that you understand the effect that following a low carb high healthy fat diet can have on your body. If you are taking medication for high blood pressure (hypertension) or to lower blood sugar, I’ll ask you check with your doctor before starting, as blood sugar and blood pressure medications may need to be adjusted lower, as insulin levels fall.

If you aren’t taking any medication, I’ll help you transition into understanding that fat in and by itself is not ‘bad’ and that eating good quality healthy fats, nutrient-dense carbohydrate-containing foods and high quality animal protein is part of a healthy diet that will enable you to feel better, lose weight and lower insulin resistance.

I’ll design your Meal Plan so that it is adequate in macronutrients (protein, carbohydrate and fat) as well as micronutrients (vitamins and minerals – especially Calcium, Magnesium, Potassium, B-Vitamins, Vitamin A, Vitamin D, Vitamin K and Vitamin C) and sufficient in soluble and insoluble fiber – suitable for your age, gender and activity level, and that factor in any diagnosed medical conditions you may have.

I’ll make sure that you are eating sufficient food in each of the food categories to meet your dietary needs, while adjusting for weight loss, if that is also a goal – so that you can just focus on eating healthy, ‘real food’.

Have questions? Feel free to send me a note using the form on the Contact Me tab, above.

To your health!

Joy

you can follow me at:

https://twitter.com/lchfRD

https://www.facebook.com/lchfRD/

March 21, 2017July 8, 2019

A Dietitian’s Journey – three weeks in

INTRO: Three weeks ago, the pain of changing was less than the pain of remaining the same and so I changed. At that time, my blood pressure had hit dangerously high levels and I didn’t even know what my blood sugar levels were, as I hadn’t checked them in ages. I didn’t want to know. Despite being a Dietitian, I was in classic denial. March 1st, I began eating low carb high fat (LCHF) and delaying the time until the next meal (called “intermittent fasting”). Keep in mind, three weeks is an incredibly short period of time, but I did not expect to see these kinds of results. There was not only significant weight loss (water?) but loss of inches around the waist (also water?), but lower blood sugar and blood pressure, as well.

Today is three weeks since my journey began and here is an update on my progress – three weeks in.

Blood Sugar

In the first two weeks, my blood sugar decreased substantially even on the days I was not intermittent fasting – provided I ate very few carbs. When I was eating what most would consider “low carb”, my blood sugar would spike.

arrows indicated 2 periods of eating 10-15% carbs

It became clear that as long as I kept my net carbs (carbohydrate minus fiber) fairly low, I did very well but above a certain level my body could not handle the sugar load. You can see this from the graph above.

On Saturdays I was eating more than that level of carbs, which can be seen indicated by the grey arrows, below the graph. My blood glucose would spike if I had any more than the carbs found naturally in low carb meals.

I could see clearly that I was very insulin resistant -which is no surprise, considering I was diagnosed with Diabetes ~ 10 years ago. Despite my pancreas producing more and more insulin in response to eating carbs, the insulin was unable to take the glucose (sugar) from my blood in a reasonable amount of time, to store it in my liver.

[Note: According to the research of Dr. Joseph R. Kraft between 65-75% of people with normal blood sugar are actually insulin resistant – that is, they have the same risk of hardening of the arteries and heart attack as those with Diabetes, they just don’t know it because they don’t have high blood sugar to indicate that. That’s is very sobering.

Since realizing how sensitive I was to more than the carbs naturally found in non-starchy vegetables and nuts and seeds, I cut out all other sources – including my beloved Hawaiian purple yam and homemade (baked) yam fries…for now, until my blood sugar levels are consistently in the non-diabetic range and my insulin levels, normalized. Even then, I know I will only be able to eat such things once in a while and in small servings, but that’s okay. As one of my sons would say “dying is bad“.

A week ago, I began tracking my carbs (easy to do and requiring no apps – not even a pencil). I aimed to keep them at the same lower levels and as you can see from the graph below, there has been linear decrease in my blood glucose levels at all times of the day – including first thing in the morning, after lunch, after dinner and before bed. It’s only been three weeks!

Interestingly, the little ‘spike’ yesterday was in the early morning after – I hadn’t eaten for 12 hours! The effects of cortisol, perhaps?

My body was breaking down the fat I have stored and was converting it into glucose for my blood – a process known as lipolysis. This is a ‘good’ thing. My body was doing exactly what it was designed to do;

(1) store excess glucose as fat, in times of plenty,

(2) break down stored fat for glucose, in lean times.

The issue is, there have been no “lean times”.

Blood Pressure

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

It was all over the place (very hard on the heart) and the systolic pressure (the first number in a blood pressure) was very high.

After the issue with my eyes (which was non-diet or lifestyle-related) having hypertension (high blood pressure) put me at risk for blindness. I took this very seriously!

Week Two

The second week my blood pressure dropped to;

>80% Stage 1 Hypertension

<20% pre-hypertension

This can largely be explained by the fact that the first thing that happens when we reduce insulin levels (a response to eating low carb) is something called naturesis. That is simply a medical term meaning our kidneys get rid of the excess salt by making us pee a lot. This period usually lasts ~4-10 days following going low carb.

Week Three

This week my blood pressure was;

~85% Stage 1 Hypertension

~15% pre-hypertension

Yes, it was a tiny bit higher, but very stable.

The first two weeks I ate very low sodium as I usually did, but this week I actually had to start adding salt into my diet as my kidneys had expelled all the excess sodium it was retaining and my sodium levels were too low. I felt a bit lethargic and light-headed. The reading I’ve been doing in the literature and the Conference Proceedings I’ve been watching from some of the world’s leading physicians that treat diseases (such as Diabetes, hypertension / high blood pressure, dyslipidemia / high cholesterol as well as Alzheimer’s and some cancers) using a low carb high fat diet, mentioned this need for increasing sodium after the first 10 days.

A pleasant surprise was seeing my diastolic pressure (the second number in blood pressure) hit normal levels several times.

One of the roles of insulin (besides taking the glucose in our blood and storing it in our livers as glycogen or fat) is to signal the kidney to retain salt. That makes us bloated and causes our blood pressure to go up.

Being Diabetic or insulin resistant (65-75% of people aged 3- 90 years, according to Dr. Joseph Kraft’s robust studies) causes people to retain sodium and raises their blood pressure. Hypertension (high blood pressure) is called “the silent killer” – but much of this is entirely diet related. For the most part, is not too much salt, but too many carbs and too little green leafy veggies (rich in potassium) that underlies high blood pressure.

Anthropometrics

Weight

The first week and a half, my weight dropped ~4 pounds – much of it was water, from my kidneys expelling the excess sodium. My weight didn’t budge for most of the last week and a half, but I didn’t let that discourage me. My body was now burning fat and not carbs and the weight loss necessarily had to follow.

It is now the end of the 3rd week, and I have lost 5 pounds all together.

Waist Circumference

In the first two weeks, I lost 1 inch off my waist and this week, another 1/2 inch came off. That is a very good thing – but for a different reason than I thought.

As Dietitians, we were taught that BMI (weight-to-height ratio) and waist-to-hip ratio allows us to factor in the greatest risk of cardiovascular events (heart attacks, strokes) but current research is showing that there is a much better predictor years of life lost (YLL) due to overweight, and that is the waist-to-height ratio.

Years of Life Lost (YLL) compared to Waist to Height Ration (WHtR)

Most of us have heard that where we carry our fat is even more important than how much of it we actually have. This is true.

Carrying it around the abdomen (belly fat, what Dietitians and Doctors call “central adiposity”) is a greater predictor of cardiovascular risk than BMI (weight to height ratio). Simply put, being an “apple” as opposed to a “pear” is not good.

But what should our waist circumference be?

A meta-analysis from 2012 pooled data from multiple studies which in total looked at more than 300, 000 adults in several ethnic groups, found that Waist to Height Ratio (WHTR) was a far better predictor than BMI or Waist Circumference of cardiovasular of metabolic risk factors in both sexes.

Ashwell M, Gunn P, Gibson S (2012) Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 13: 275—286

The least amount of years of life lost is associated with a Waist to Height Ratio of 0.5 (mine was not anywhere near that!).

That is, take your height and divide it by 2.

NOTE: Measure your waist at the location that is the mid-point between your last rib and the top of your hip bone, with the front and back of a flexible seamstress-type tape measure at the same height, and your belly fully relaxed. This is not the time to suck it in! If you measure your height in inches, measure your waist in inches and if you measure your height in cm then measure your waist in cm.

If the result of your Waist to Height ratio is greater than 0.5, then welcome to the club. The question is, what to do about it?

That’s where I can help.

Practicing what I preach,

Joy

you can follow me at:

https://twitter.com/lchfRD

https://www.facebook.com/lchfRD/

March 16, 2017July 8, 2019

A Dietitian’s Journey – the road to better health

In the previous article titled “A Dietitian’s Journey – the beginning”, I shared about why I am (1) following a low carb high healthy fat diet and (2) extending the time between meals in my pursuit of improved health. In this post, I talk about the smaller third of the picture, (3) exercise. Why I am doing this is because quite literally, my life and quality of my life depends on it.

This “journey” is my road to better health – to optimal health.

As a Registered Dietitian in private practice, I’ve spent the last decade helping people in the Lower Mainland of Vancouver learn how to eat healthier, lose weight, lower their blood sugar and blood pressure and have cholesterol that is in the healthy range. While I had lost 50 pounds myself a few years ago, little by little over the last 2 years, I’d put 1/2 of it back and along with the higher weight, came higher blood sugar levels, followed by high blood pressure.

My “fat picture” – prior to losing 50 lbs.

I had two choices; (1) go on medication or (2) change my lifestyle. I chose the latter. March 5 2017 was the beginning of the journey, on the road to better health.

But what was the “road”?

Over the last 2 years, I’ve done a lot of reading with regards to the physiology of why and how diets high in carbs underlie the “obesity epidemic”. I understood how excess carbs that were not needed for energy were converted to fat and stored in the liver. I also understood how this excess fat in the liver negatively impacted cholesterol levels – that it wasn’t eating fat that gave people high cholesterol (except for a very small minority with genetic conditions) but eating too many carbs.

Day in, day out in my private practice I’d explain to people how eating “plenty of fruit and vegetables” was making things worse for them because of the carb content in these foods – foods that were eaten with- and between meals. I knew that following the standard recommendations of the last 40 years – to eat low fat and high carbohydrate and restricting portions was not going to accomplish my goal.

I decided to “practice what I preach” by eating a low carb, high fat diet (LCHF), and by extending the time between meals. In time, I also hope to incorporate short periods of high intensity interval training (HIIT), but for now I just need to get moving!

Since I am not yet “fat adapted” – that is, my body hasn’t yet switched over to using my own fat stores as a fuel source, I knew that I needed to start with walking. Baby steps!

Yesterday, I set an appointment with myself to do just that, and while I was 3 hours later than I planned to be today, my ipod wasn’t charged and it was 5° C and pouring rain, I went to the track and did what I said I would do.

you can follow me at:

https://twitter.com/lchfRD

https://www.facebook.com/lchfRD/

Here’s a clip from my first workout:

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.

March 14, 2017April 1, 2021

A Dietitian’s Journey – the beginning

A Dietitian’s Journey – the road to better health

I remember back at McGill, when I was doing my undergrad training as a Dietitian, one of my professors saying that most people chose Dietetics because they came from a background of disordered eating or diet-related health issues. True to form, most of my extended family were obese and most had Diabetes, high blood pressure and high cholesterol and were on a whole host of medications for each.

Fast-forward 20 years (and several children later) and despite losing 35 of the 60 pounds I had to lose, I became Diabetic. More recently, I’ve had high blood pressure.

Unable to answer my questions regarding addressing both of these through a low-carb-high-healthy-fat eating plan, my GP referred me to an Endocrinologist. After a thorough physical examination and a whole host of blood work, she asked me about how I planned to address this, given that I am a Dietitian. Hesitantly, I told her that I planned to eat a high healthy-fat diet and low carb diet with a medium amount of protein and use intermittent fasting to lower insulin resistance. She asked me what percent of “net-carbs” (total carbs minus fiber) I was aiming for and what percentage of protein and what my fat sources would be, and I told her. I was waiting for an extremely negative reaction, but instead was completely taken aback by her reply. She said that from she’s been reading in the literature, my plan was not only evidenced-based, but that if I didn’t don’t lose the rest of the weight and eat this way, that I will end up on both medication for my blood sugar, and cholesterol and likely for my blood pressure, too.

I began to implement the dietary and lifestyle changes and was seeing my “numbers” coming down, but like many people, life happened and I didn’t follow through. The weight crept up and presumably so did my blood sugar and pressure, but I had stopped monitoring those ages ago. But it was a problem with my eyes — one whose cause was unrelated to being Diabetic or having high blood pressure that was a game-changer for me. Having these conditions put me at higher risk of losing my vision and this was simply not something I was willing to risk.

Two weeks ago, I arrived at a fork-in-the-road. One direction was the same as most of my family took; with medication for blood sugar, blood pressure and cholesterol. The other was the road that I am taking; the one less traveled, but very well-researched, and with the encouragement of my Endocrinologist – a low-carb-high-healthy-fat way of eating, with extended periods of time between meals, and periods of days of eating and then not eating. Not “starving”, but “intermittent fasting”.

The difference?

Starving results in the body lowering its metabolism to spare calories and intermittent fasting and alternate-day fasting results in the body raising its metabolism and burning stored fat.

The expected outcome?

The first goal begins with lowering insulin resistance; which is the underlying cause of Type 2 Diabetes, and with lower insulin resistance follows lower blood sugar levels – both fasting blood sugar and A1C (3 month average).

A change in diet and strategic use of fasting, lowers insulin and cortisol levels which in turn, lower triglycerides (TG). TG are largely a byproduct of a high-carb diet (especially affected by fructose), so lowering these results in lower TG and in turn, lower levels of LDL (bad cholesterol) and higher levels of HDL (good cholesterol). Lower insulin and cortisol as well as less abdominal fat, results in lower, more normalized blood pressure.

Will it work? The research seems to indicate it will and over the weeks to come, I will posting the results of some of that research so that the context of what I’m doing can be understood. After all, I am a Dietitian and a scientist — it has to be evidenced-based.

The First Two Weeks – off to a good start

Blood Sugar

Of course this is an incredibly small period of time to look at, but in the first two weeks since I started my low-carb-high-healthy-fat eating with intermittent- and alternate-day fasting , my blood sugar has decreased substantially even on the days I was eating, provided I was eating very few carbs.

Blood Pressure

My blood pressure went from 50% Stage 1 hypertension with 1 hypertensive emergency (scary!) and ~30% Stage 2 Hypertension the first week:

…to approximately 80% Stage 1 Hypertension and almost 20% pre-hypertension the second week.

That is a significant change!

My weight is only down ~ 4 pounds, but I’ve lost 1 inch off my waist.

I am not hungry on my intermittent-fast days …and keep in mind, I talk about food all day long with my clients. If I am not talking about food, I am working on meal plans and writing about food! If I was hungry, this would be torture, but it’s not. In fact, the last time I ate was last night at supper and I feel fine. I should have had a coffee though (as I get caffeine headaches if I don’t). I’ll make one soon.

I’ve only taken one alternative-day fast so far and it went fine. I drank “bone-broth” (I’ll explain in coming blogs!) and had my morning coffee with a little cream, no milk because of the carbs. I don’t really like cream, but it was okay. Bone broth is interesting — a bit like chicken broth, but different.

One side-bonus that I never expected, is that I am sleeping better than I have in years. Crazy good sleep and waking up rested. What a great added bonus.

I have a long way to go to get to my goals (plural) because I’ve set the bar very high…and why not? If the literature indicates that this works, then I want;

(1) blood sugar in the non-diabetic range

(2) normal blood pressure

(3) normal / ideal cholesterol levels

(4) a waist circumference in the “at or below” recommended values of the Heart and Stroke Foundation

Will I meet all these goals? Who knows?! But I won’t know if I don’t try and the alternative of a life of medication for blood sugar, blood pressure and eventually cholesterol too does not appeal to me!

So join me in my journey – a journey of change, of good health and on a road less traveled.

To our health!

Joy

you can follow me at:

https://twitter.com/lchfRD

https://www.facebook.com/lchfRD/

Obesity Rates

Effect on Health

Ketogenic Macronutrient Ratio

Ketosis versus Ketoacidosis

A Low Carb High Fat Ketogenic Diet

GLUCOSE OR FAT AS FUEL

Feasting and Fasting

The vilification of fat

How do we get fat out of “storage”?

Weight

WAIST CIRCUMFERENCE

BODY FAT PERCENT

VISUAL ASSESSMENT

CLOTHES

OTHER MEASURES OF LOW CARB SUCCESS

Fasting Blood Glucose

Post Prandial blood glucose (2 hours after a meal)

BLOOD PRESSURE

OTHER MEASURES – FASTING INSULIN, AM-CORTISOL AND C-PEPTIDE

Final Thoughts

The Limitations of Using a Scale to Determine Fat Loss

Waist Circumference

The Limitations of Using a Tape Measure to Determine Fat Loss

Body Fat Percent

The Limitations of Using a Body Fat Analyzer to Determine Fat Loss

How to assess short-term weight loss

Sodium and Body Water Content

Final Thoughts

From hunter-gatherers to farmers

Evolution of Wheat – but one example

Paleo Diet compared with the Low Carb High Healthy Fat diet

Final Thoughts

References

Weight and Waist Circumference

“KETO-WATER”

MY BLOOD SUGAR

BLOOD PRESSURE

Week One

Week Two

Week Three

Week Four

Week Five – this week

Final Thoughts

Out of Denial

Out of Diabetes Denial

Out of Hypertension Denial

Out of Dyslipemia (Cholesterol) Denial

Out of Obesity and Overweight Denial

By the Scale

By Fat Percentage

By Waist to Height Ratio

MY RESULTS – ONE MONTH UPDATE

My Weight

My Waist Circumference

My Fat Percentage

My Blood Sugar

Blood Pressure

Final Thoughts

“JP” – a Picture of Success

My High School Friend – preventable premature death

The Silent Risk of Insulin Resistance

Insulin Resistance with Normal Blood Glucose

Kraft’s Patterns of Insulin Response

The Good News

The low carb high healthy fat diet

Macronutrients

Protein

Fat

Carbohydrate

When starting a Low Carb High Healthy Fat Diet

My role as a Dietitian

Blood Sugar

Blood Pressure

Anthropometrics

A Dietitian’s Journey – the road to better health

A Dietitian’s Journey – the road to better health

The First Two Weeks – off to a good start