January 2018 - The Low Carb Healthy Fat Dietitian

January 31, 2018November 1, 2020

PART 2: The Role of Protein in the Diet – Evolutionary Exposure to Macronutrients

This article is Part II in a series titled The Role of Protein in the Diet and looks at macronutrients in our diet from an evolutionary perspective.

Over the course of man’s existence, there have been a number of major shifts in the human diet and with that change, came the necessity of the body to adapt by producing enzymes capable of digesting and absorbing nutrients from these novel foods. This required the human genome (our genes) to adapt, evolve and change [1]. This takes time.

In the ~4.4 million span of mankind’s existence, solid evidence for use of human-controlled fires, which would have given us the ability to cook our meat is only about 800,000 years old [2] with less certain sites dating back 1,500,000 years [3,4].

The origin of domestication of animals is considered to be ~10,000 – 12,000 years and represent another relatively recent shift in the human diet [1], moving mankind from a hunting and gathering species, to an agricultural one. With this shift came the need to domesticate crops, which dramatically changed the human diet. The innovation of human agriculture greatly reduced diversity in the human diet. Instead of ‘food’ being what hunter-gatherers were able to find, ‘food’ was what each group grew and raised.

Of even more significance, it is estimated that 50%—70% of calories in the agricultural diet are from starch (carbohydrates) alone [5]. The advent of animal domestication and an agricultural diet may also resulted in an over-abundance of starch-based calories, which exceeded growth and energetic requirements [1].

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

Looking at it from the perspective of man’s evolutionary history, the appearance of cereal grains is very recent. Cereal grains as food were non-existent in the evolutionary diet. Same with legumes, such as chickpeas and lentils. These too were non-existent in the evolutionary diet. Refined sugar (made up of sucrose) was also non-existent in the evolutionary diet. Humans would eat wild fruit (fructose) and on the rare occasion when available they would eat honey (half glucose, half fructose), but this idea of a diet centering around sucrose and fructose was simply non-existent.

Consumption of dairy products and alcohol are also very recent in terms of human history. We didn’t milk wild animals, we ate them. Fermentation of fruit for wine is also very recent in terms of the evolutionary diet.

Our body did not evolve to see cereal grain, legumes, refined sugar, dairy foods and alcohol and all of these are very rich in carbohydrate.

We are exposed to carbohydrate in a way that were never evolved to see.

Our bodies developed metabolism patterns around our dietary intake of protein and fat.

We have very extensive and elaborate pattern for handling protein; for digesting and metabolizing it. We also have developed a very high ‘satiety’ (feeling full) to protein, such that we simply won’t over eat it. It is the only macronutrient that provides sufficiently strong feedback such that we can’t over eat it.

Fat, contrary to common belief is a very passive nutrient. It has very little direct effect on our body. We store it effectively and this ability to store excess intake as fat is what enabled us to survive as hunter-gatherers.

The macronutrient that is at odds in this picture is carbohydrate.

We have very little evolutionary exposure to carbs; in fact the body responds to it has if it were highly toxic. Carbs have to be rapidly cleared after we eat it because our body must maintain our blood sugar within a very narrow range between 3.3-5.5 mmol/L (60-100 mg/dl). When we eat carbohydrate, the body breaks it down to simple sugar (glucose) and insulin takes the extra sugar out of the blood and moves it into cells. Our only mechanism to protect us from carbohydrate is insulin. The problem is, when we eat carbohydrates every few hours, the ability for insulin to respond becomes overwhelmed.

We have a biological system for handling carbohydrate and the traditional teaching is that carbs are handled in the muscle, which is true if one exercises 2-3 hours per day. When were were hunter-gatherers and we came across a bee hive, for instance or a fruit tree in season, our muscle was able to process the short spike in glucose load because we were very active. The average North American or European is not typically exercising that much, with ~75% considered sedentary (inactive).

So where are those carbs going?

They’re going to body fat.

Carbohydrate regulation is very important to think about. Carbs are among some of the most regulated substances in the body. Blood sugar is controlled and kept within an extremely tight range between 3.3-5.5 mmol/L (60-100 mg/dl).

If we don’t burn off the 30 gm of carbs (equivalent to ~ 6 tsp of sugar) we ate for breakfast by the time we have a fruit mid-morning (another 15 gm of carbs / equivalent to 3 tsp of sugar), we have to store the carbs somewhere. Comes lunch, most people eat another 30 – 45 gm of carbs (~6 – 9 tsp of sugar) if they’re eating a lunch brought from home and even more than that if eating out at the food court. Maybe another fruit is eaten mid-afternoon, and without realizing it, people have consumed the equivalent of 24 tsp of more of sugar, eating what they’ve believed is a healthy diet. As explained in a previous post, the blood can only have at most the equivalent of ~ 1 tsp of sugar in it at any one time, so where does all the sugar go?

It goes to fat stores.

Fatty Acid Processing [slide from Dr. Donald Layman, PhD – Nutrition Forum, June 23, 2013, Vancouver, British Columbia, Canada.]

To synthesize the excess sugar into fat, the glucose (sugar) comes into the liver and is synthesized into free fatty acids.

Our body is constantly pulling out free fatty acids from our fat stores (adipose tissue) when we are sleeping or exercising, for example to use as a fuel source, so the free fatty acids that are coming in from adipose tissue (fat stores) and those that are being synthesized from glucose (the excess carbs we took in our diet) mix in the liver, and are then packaged into very-low-density lipoprotein (VLDL).

Think of these VLDL as ”taxis” that move cholesterol, triglycerides and other fats around the body. Once these VLDL “taxis” deliver their payload, the triglyceride is stripped out and absorbed into fat cells. The VLDLs shrink and becomes a new, smaller, lipoprotein, which is called Low Density Lipoprotein, or LDL — the so-called bad cholesterol’.

[Calling LDL ‘bad cholesterol’ is a misnomer, because not all LDL is harmful. LDL which is normally large and fluffy in texture is a good cholesterol (pattern A) that can become bad cholesterol (pattern B) when it becomes small and dense. In a healthy person, LDL is not a problem because they find their way back to the liver after having done their job of delivering the TG to cells needing energy. In a person with insulin resistance however ,the LDL linger a little longer than normal, and get smaller and denser, becoming what is known as ”small, dense LDL” and these are the ones that put us at a risk for cardiovascular disease.]

The origins of high triglycerides is the beginning of Metabolic Syndrome (also called Syndrome X). This is the point at which the body is getting too many carbs and the system is breaking down. The result is high than normal blood sugar after meals (called post prandial glucose), an increase in free fatty acids, and the increase in triglycerides and these together contribute to fatty liver. These are all symptoms Metabolic Syndrome.

If one is eating more than 30 gm of carbohydrates per day then they either need to have very high exercise to account for it, or they’re going to be making fat from it.

With an average carb intake of 300 gm per day and 75% of North Americans sedentary, it is easy to see where the problem of excess fat stores comes from.

Since our only mechanism for dealing with carbohydrate is insulin, by continually overwhelming the body with a steady supply of glucose – way above the small amount of carbohydrate that our genome has adapted to see, the system fails. This is where the origins of the overweight and obesity statistics elaborated on in the first part in this series (located here).

To address this carbohydrate excess, we can lower carbohydrate intake and either raise fat intake or raise protein intake. In Part III of this series, we will shift the focus to the benefits of increasing protein in the diet.

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

References

Luca F, Perry GH, Di Rienzo A. Evolutionary Adaptations to Dietary Changes. Annual review of nutrition. 2010;30:291-314. doi:10.1146/annurev-nutr-080508-141048.
Goren-Inbar N, Alperson N, Kislev ME, Simchoni O, Melamed Y, et al. Evidence of hominin control of fire at Gesher Benot Ya’aqov, Israel. Science. 2004;304:725—727
Brain CK, Sillent A. Evidence from the Swartkrans cave for the earliest use of fire. Nature. 1988;336:464—466.
Evidence for the use of fire at zhoukoudian, china
Weiner S, Xu Q, Goldberg P, Liu J, Bar-Yosef O

Science. 1998 Jul 10; 281(5374):251-3.
Copeland L, Blazek J, Salman H, Chiming Tang M. Form and functionality of starch. Food Hydrocolloids. 2009;23:1527—1534.

January 30, 2018July 8, 2019

Evidence that Low Carb Diets are Safe and Effective

Claims are sometimes made that “low carb diets are a fad” and “there needs to be scientific evidence to demonstrate they are both safe and effective“. What is the evidence?

In fact, a low carbohydrate diet is not new and was the standard recommendation for treating Diabetes prior to the discovery of insulin. More than 150 years ago, the first weight-loss diet book (ironically written by William Banting, a distant relative of Sir Frederick Banting, the co-discoverer of insulin) focused on the limiting the intake of carbohydrates, especially those of a starchy or sugary nature. The book was titled Letter on Corpulence — Addressed to the Public (1864) and summarized the advice of the author’s physician, Dr. William Harvey that had enabled Banting to shed his portly stature’.

Recent 10 week results of a nonrandomized, parallel arm, outpatient intervention using a very low carb diet which induced nutritional ketosis was so effective at improving blood sugar control in Type 2 Diabetes, that at the end of six months >75% of people had HbA1c that was no longer in the Diabetic range (6.5%). Details of the findings from this study titled A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes are available here.

I recently reviewed 2 two-year studies that demonstrated that low carb diets are both safe and effective for weight loss and improving metabolic markers;

This long-term study titled Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet clearly demonstrated that a low carb non—calorie-restricted diet was both safe and effective and produced the greatest weight loss, lower FBS and HbA1C, the most significantly lower TG and higher HDL and lower C-reactive protein (when compared with a low-fat calorie-restricted diet and a Mediterranean calorie-restricted diet).
This 2-year, randomized control study of more than 300 participants titled Low Fat Calorie Restricted Diet versus Low Carbohydrate Diet — a two year study found that both diet groups achieved clinically significant and nearly identical weight loss (11% at 6 months and 7% at 24 months) and that people who ate the low-carbohydrate diet had greater 24-month increases in HDL-cholesterol concentrations than those who ate a low-fat calorie restricted diet. As well, a significant finding of this study was a very favourable lowering of LDL for the first 6 months and lowering of both TG and VLDL for the first year.

These long-term data provide evidence that a low-carbohydrate diet is both a safe and effective option for weight loss and that this style of eating has a prolonged, positive effect on metabolic markers.

But is this all the evidence we have? By no means!

Below is a list of research studies and meta-analyses (complied by Dr. Sarah Hallberg) that used a low-carb intervention. These span 18 years, 76 publications, involve 6,786 subjects, and include 32 studies of 6 months or longer and 6 studies of 2 years or longer. At the bottom of this post is a downloadable pdf of this list. [Note: text in green represents meta-analyses.]

Hardly a passing fad!

Low carb diets have been well-studied and found to be both safe and effective.

Many thanks to Dr. Sarah Hallberg, a Physician and exercise physiologist from West Lafayette, Indiana (Twitter: @DrSarahHallberg) for compilation of this list.

A complete list of the Low Carb Diet studies to date (compiled by Dr. Sarah Hallberg) is available here.

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January 29, 2018July 8, 2019

Misconceptions About the Keto Diet

Alarming social media posts cry out dire warnings about the supposed “dangers” of the ‘keto diet’ but are they founded? What is “the keto diet”?

The Keto Diet

There is no one “keto diet”, but many variations of ketogenic diets that are used for different therapeutic purposes.

Some therapeutic ketogenic diets are used in the treatment of epilepsy and seizure disorder and are extremely high in fat. Other types of therapeutic ketogenic diets are used in the treatment of various forms of cancer (those that feed on glucose), such as brain cancer. There are ketogenic diets that are used in the treatment of Polycystic Ovarian Syndrome (PCOS), as well as for weight loss and for increasing insulin sensitivity in those with Type 2 Diabetes and insulin resistance. Even among those using a nutritional ketogenic diet for weight loss and to increase insulin sensitivity, there is no one “keto diet”. There are ketogenic diets with a higher percentage of fat than protein, with a higher percentage of protein than fat and mixed approaches which may have different ratios of protein to fat – depending on whether the individual is in a weight loss phase or a weight maintenance phase. There are as many permutations and combinations as there are people following a keto diet for these reasons.

What makes a diet ketogenic (or keto) is that the amount of carbohydrate relative to the amount of protein and fat results in the utilization of fat as a primary fuel source rather than carbohydrate.

Macronutrient Percentages of Keto Diets

Another assumption is that a keto diet used for weight loss (as if there were only one?) is 20% protein, 70% fat and 10% carbohydrate (and such posts are often accompanied by photos of large plates piled high with bacon and eggs), however therapeutic ketogenic diets used for weight loss ranges from those with a higher percentage of fat than protein (which may focus on mono-unsaturated fats and omega 3 fats), a higher percentage of protein than fat (thus no piles of bacon!), and a mixed approach with different ratios of protein to fat depending on whether the individual is in a weight loss phase or a weight maintenance phase.

This idea that a “keto diet” has a specific percentage of fat to protein to carbs in itself is very confusing, because the percentage of calories of any of these macronutrients will depend on how many calories a person is eating in a day. For example, two different people may be eating ~30% of their calories as protein but one person is eating just over 55 gm of protein on an 800 calorie a day diet, while another person is eating 160 gm of protein on a 2000 calories diet. When discussing macronutrients, we have to specify grams of protein, grams of fat and grams of carbohydrate, otherwise the figures are meaningless.

What makes a diet ketogenic is that the amount of carbohydrate in the diet results in people’s body utilizing fat as its primary fuel and depending on the individual, how insulin resistant (IR) they are, how long they have been IR or had Type 2 Diabetes and whether they are male or female will affect the degree of carbohydrate restriction. Some may do very well with 100 gms of carbohydrate, while others may need to consume less.

Not everyone with lactose intolerance for example, needs to restrict milk to the same degree; some can tolerate 1 or 2 cups whereas other can only tolerate a few ounces. It is the same case with those that have become intolerant to carbohydrate. Different individuals depending on their metabolic state and clinical conditions, have varying ability to process carbohydrate. That is why there is no “one size fits all” ketogenic diet.

The “Dangers” of Keto Diets

Some articles warn that “ketosis is actually a mild form of ketoacidosis” which is simply not true.

Ketones are naturally produced in our bodies during periods of low carb intake, in periods of fasting for religious or medical tests, and during periods of prolonged intense exercise. This state is called ketosis. It is normal and natural and something everyone’s body does when using glucose as its main fuel source.

Once our glycogen levels are used up, fat is broken down for energy and ketone bodies are a byproduct of that. These ketones enter into the mitochondria of the cell and are used to generate energy (as ATP) to fuel our cells.

Ketosis is a normal, physiological state and we may produce ketones after sleeping all night, if we haven’t gotten up and eating something in the middle of the night.

Ketoacidosis on the other hand is a serious medical state that can occur inuntreated or inadequately treated Type 1 Diabetics, where the beta cells of the pancreas don’t produce insulin. It may also occur in those with Type 2 Diabetes who decrease their insulin too quickly or who are taking other kinds of medication to control their blood sugars.

In inadequate management of Type 1 Diabetes or in insulin-dependent Type 2 Diabetes, ketones production will be the first stage in ketoacidosis. This is not the case when the above medical issues are not present.

Final Thoughts…

There is no one “keto diet” but rather many variations of ketogenic diets that are used for different therapeutic purposes. Depending on the condition for which a person is using a therapeutic ketogenic diet, the number of grams of fat, protein and carbohydrate will vary. Even in those utilizing a ketogenic diet for weight loss or lowing insulin resistance, the number of grams of carbohydrate will vary considerably person to person.

People following a ketogenic diet need to work closely with their doctor. For those on blood sugar- or blood pressure lowering medication this is very important, because clinical studies have demonstrated that the dosage of medication needs to be adjusted downwards as glycemic control is restored.

As with anything we read in magazines or on the internet, a healthy dose of discernment is needed. The person writing the article may not be current with the research in this field and be sincerely operating on an older paradigm. I encourage you to ask questions, read reviews of current studies using ketogenic diet for the condition of relevance (whether on this site or others) and to speak with your doctor. Let your decision will be an informed one, not fueled by dramatic headline with dire warnings and misinformation.

Have questions?

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

To our good health,

Joy

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January 28, 2018July 8, 2019

A Dietitian’s Journey – a picture tells a thousand words

Sometimes a photo can say more than all the words in the world.

The two photos below are a comparison of me 11 months ago and today. I certainly haven’t “arrived”, but like any journey there are markers along the way – markers that you are headed in the right direction, markers as to how far you’ve come and markers as to how far you’ve left to go. This photo is such a marker.

Me – 11 months ago (left) and today (right)

Everybody’s road to better health is different and “A Dietitian’s Journey” tells mine. You can read my story from the beginning with all the ‘gory details’ – from my “fat pictures”, to my lab work, and everything in between. It tells the story of my struggle with denial and how the pain of remaining the same was greater than the pain of changing, and so I changed.

I keep making small, corrective changes in my path to ensure that it time I arrive at my ‘destination’ – which for me is to have a waist circumference (in inches) that is half my height (in inches). This is not an arbitrary goal based on vanity, but is based on me having the lowest risk of cardiovascular events (heart attack and stroke), given my lab work continues to improve, as time goes on.

A summary of where I am on this journey now is here.

If you have questions as to how I could help you achieve your own health and nutrition goals, please send me a note using the “Contact Me” form on the tab above.

To our good health!

Joy

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January 26, 2018July 8, 2019

Bone Broth – a rich source of protein and essential amino acids

This recipe is posted as a courtesy to those following a variety of low-carb and ketogenic diets (not necessarily Meal Plans designed by me). This recipe may or may not be appropriate for you.

To those who are new to a Low Carb High Fat or Ketogenic lifestyle, “bone broth” may be something new. At first glance it may seem like a stock, but it is very different. A stock is made with meat and is cooked for ~ 2 hours, whereas bone broth is made with animal bones (beef or chicken, usually) and only whatever meat clings to it and is simmered for 18 hours or more.

Bone broth is the beverage of choice for many when they are intermittent fasting (also called ‘time restricted eating’) – more on that here. Intermittent fasting is really a misnomer as a “fast” involves a period of time without nutrition, a temporary form of starvation. During therapeutic intermittent fasting, bone broth is often taken as it provides a good rich of protein and electrolytes, so the body is not put in starvation mode (which slows metabolism). Drinking bone broth while intermittent fasting would be similar to following a ‘protein-sparing modified fast’.

Below is the nutrient comparison done by a professional food lab, showing the difference between an ’18 hour bone broth’ and a ‘2 hour meat stock’.

Here is a 2 hour meat stock;

2 hr meat stock nutrition — Nutrient Analysis – 2 hr Meat Stock – Anresco Laboratories, San Francisco CA, Jan 22 2015

Here is an 18 hour bone broth;

18 hr bone broth nutrition — Nutrient Analysis – 18 Hour Bone Broth – Anresco Laboratories, San Francisco CA, Jan 22 2015

As you can see, the 18-hour bone broth has more than 3 times the amount of protein – almost 10 g of protein per 1 cup (244 g) serving. The 2 hour meat stock pales in comparison.

Here are the nutrition labels written the way they would be if you purchased these in a store;

18 hr bone broth nutrients — Nutrient Analysis – 18 hour Bone Broth – Anresco Laboratories, San Francisco CA, Jan 22 2015

2 hr soup stock nutrition — Nutrient Analysis – 2 hr Meat Stock – Anresco Laboratories, San Francisco CA, Jan 22 2015

Stock versus Bone Broth

In addition to the significant difference in nutrients, there is a fundamental difference in a meat stock compared to bone broth and that is gelatin. I’m not talking about the flavoured, coloured stuff that our mothers or grandmothers fed us for dessert, but the protein that is extracted by simmering animal bones, cartilage and other connective tissue to extract the collagen, the protein that connects muscle and cartilage to bone in animals. When bone broth is simmered for 18 hours or more, collagen breaks down and is transformed to the flavourless, colorless substance called gelatin. That is why after bone broth cools, it has a jelly-like texture.

gelatin2 — natural gelatin from the chicken bones and feet results in this texture, when chilled

Gelatin also contains the amino acids glycine, proline, lysine, alanine, arginine and valine which is an essential amino acid that cannot be produced by the human body, which means it must come from the diet.

In addition to giving bone broth it’s characteristic body, there are some clinical studies that seem to indicate that gelatin may reduce pain and improve joint mobility in those with osteoarthritis.

Beef Bone Broth Recipe

Making bone broth is less about a recipe and more about a method. It takes the right ingredients and lots and lots of time.

1 – When I make beef bone broth, I used both beef marrow and beef foot bones. The marrow bones are round with the marrow in the centre and the beef foot bones have lots of cartilage, which helps form the gelatin.

bones and herbs — beef marrow and foot bones with onion, peppercorns and sea salt

2 – I brown the marrow and foot bones on both sides in a little coconut oil and add a small onion for flavour, some fresh or dry peppercorns and sea salt, then cover with cold, filtered water. The reason I use cold water, is to enable me to skim off the “foam” which is produced as the bone broth begins to simmer.

[Note: Be careful not to put in too much water, otherwise the bone broth won’t ‘gel’.]

add time - beef — the most important ingredient is time

3 – The most important “ingredient” in making bone broth is time; at least 18 hours at a low, slow heat. It shouldn’t boil, but be held just below the boiling point the entire time. A slow-cooker works well for those who work or study outside of home.

beef bone broth cup — A cup of 18-hour beef bone broth

4. Enjoy!

Chicken Bone Broth Recipe

Like a beef bone broth, a chicken bone broth is about a few essential ingredients and lots and lots of time. A stewing hen is essential for making chicken bone broth because it is mostly bone and connective tissue with almost no “meat” on it. On a whole hen, there is maybe 1 cup of meat. These fowl are usually birds that have outlived their usefulness for laying eggs and it’s the age of the chicken and all it’s connective tissue that makes it perfect for making bone broth (or soup).

The other essential ingredient is the addition of chicken feet. Yes, chicken feet. Like the beef feet in beef bone broth, the chicken feet have lots of connective tissue which results in the production of gelatin. I chop the nails off of them before making bone broth but many butchers that sell them will do this for you, if you ask.

1 — Put two or three stewing hens at the bottom of a large stock pot.

ingredients for magic soup — Stewing chickens, chicken feet and herbs

2- Place the chicken feet on top, and any herbs or small amount of vegetables used only for flavour. Cover with cold, filtered water and add sea salt. [Note: Be careful not to put in too much water, otherwise the bone broth won’t ‘gel’.]

3 — Skim off the foam with a small mesh designed for this purpose until it stops producing foam.

4 -Lower the heat to medium low and simmer soup for at least 8-10 hours, overnight if possible. Be careful not to boil.

5 – Enjoy!

Want to know more about how I could help you reach your health and nutrition goals following a low carb or ketogenic lifestyle?

Please feel free to have a look around my website and send me a note with your questions using the “Contact Me” tab above. You can also download a complete summary of my services here.

To our 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.

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January 24, 2018July 8, 2019

A Dietitian’s Journey – remission from Type 2 Diabetes

My journey began on March 5, 2017 when I was a fat Dietitian with all the benchmark symptoms of Metabolic Syndrome including Type 2 Diabetes, high blood pressure, high LDL cholesterol and triglycerides, abdominal adiposity (i.e. “a belly”) and high BMI (high weight for height). Physically I was a mess but my biggest problem was that I was in denial. It had been months since I had monitored my own blood sugar or blood pressure even though I had been diagnosed with Type 2 Diabetes 10 years earlier. I knew better.

I would occasionally step on the scale and weigh myself, but how my clothes fit (or didn’t) already told the story. I was overweight. Actually, I was obese.

Shortly before my own turning point in March 2017, I had two girlfriends my own age – one who I knew since high school and one since university die of preventable diet-related disease within two months of each other. Both were in healthcare and took care of others practicing their profession, just as I do. I had two degrees on the wall but didn’t take care of myself.

March 5, 2017 all that changed. That was the day that the pain of remaining the same became greater than the pain of changing. So I changed. That story and the progress since then are in previous articles in A Dietitian’s Journey.

Like many others, I once believed that “Diabetes is a chronic, progressive, disease” and that it will only get worse in time. I realize now that if I had continued to eat more carbs than my body could handle, then it most certainly would have gotten worse but I have almost 11 month of evidence that supports that if I don’t, it CAN and DOES get better.

I am not “cured” by any means, but my symptoms are now in what the American Diabetes Association defines as partial remission and I may very well be able to achieve full remission, as I continue to eat a low carb diet. I will only know in time.

To achieve remission with Type 2 Diabetes (T2D) is like someone being in remission with Celiac disease; we can get well and stay well provided that we don’t eat the foods that we can’t tolerate; for a Celiac that’s gluten and for someone with T2D it is more carbohydrates than their body can handle.

I do eat some carbohydrate each day, mostly as non-starchy vegetables, the occasional berries or pomegranate seeds on a salad, as well as some nuts and seeds but I am careful to keep the amount at any one time below what my body can process while maintain blood glucose control as close to a ‘normal’ (non-Diabetic) level as possible.

This article explains how and why my body is no longer able to handle more than a small amount of carbohydrate at a time.

The good news is that I no longer meet the criteria for diagnosis with Type 2 Diabetes, as demonstrated by the Diagnostic Criteria[1] for the disease:

Abbreviations: 2hPG , 2-hour plasma glucose; A1C , glycated hemoglobin; FPG , fasting plasma glucose; IFG , impaired fasting glucose; IGT , impaired glucose tolerance; OGTT , oral glucose tolerance test; PG , plasma glucose.

Diabetes Partial Remission and Remission

It does not appear that Diabetes Canada define these concepts, however the American Diabetes Association (ADA) defines “remission” as having test results below the range for Diabetes (i.e. Fasting Blood Glucose less than or equal to 5.5 mmol/L (100 mg/dL) without taking Diabetes medications or having bariatric surgery.

“Partial remission” according to the ADA is having test results lower than the range for Diabetes i.e. Fasting Blood Glucose less than or equal to 5.5 – 6.9 mmol/L (100—125 mg/dL) or HbA1C between 5.7 — 6.4% for at least 1 year.

my Fasting Blood Glucose is less than or equal to 7.0 mmol/L , so I no longer meet the diagnostic criteria and fall in the partial remission range. As you can see from the following picture, the average of my twenty-four Fasting Blood Glucose readings from January 1 2018 – January 24, 2018 has been 6.0 mmol/L. Out of the 24 glucometer readings (with a meter that I standardized with the lab when I had my tests done), only once was my blood sugar higher than the cutoff. This would indicate that I am in partial remission, by the ADA definition.
Self monitored blood glucose – January 1 2018 – January 24, 2018 – averages
I have taken seventy-five glucometer readings during the month of January so far (see photos at the bottom of this article) and none of them were greater than or equal to 11.1 mmol/L. Here is a graph of my January results:

Self monitored blood glucose – January 1 2018 – January 24, 2018 – graph

3. My 3 month glycated hemoglobin test, also known as a HbA1C (or “A1C” for short) is less than or equal to 6.5 % which means that I no longer meet the criteria for the disease and my results fall in the range for partial remission.

non-diabetic HbA1c — Glycated Hemoglobin below criteria for Type 2 Diabetes – January 23, 2018

Cholesterol and Lipids

My LDL was at the high-end cutoff two years ago, after only 4 months on a low carb high healthy fat diet, it was approaching what is considered by the existing / popular standards of ”optimal LDL” for someone who is high risk (family history of cardiovascular disease).

My LDL was 2.60 mmol/L (1.14 mg/dl), my triglycerides (TG) were 0.64 mmol/L and my HDL was 1.97 mmol/L.

Using more significant measures, my TG:HDL ratio was 0.32 (with <0.87 considered ideal). A very low TG:HDL ratio is associated with lots of large, fluffy LDL — the kind associated the lowest risk of cardiovascular disease (CVD) such as heart attack and stroke. It is the higher density, small LDL particles that are associated with CVD.

Blood Pressure

My blood pressure has been ranging from between just below the normal range to pre-hypertension for months, but to protect my kidneys I am continuing to take a ”baby dose” of Ramipril® (2.5 mg per day) that I asked the doctor to put me on until my blood pressure is consistently below normal and the meds need to be reduced or discontinued. The dose I’m on is the smallest it comes in and my doctor has switched me to tablets, which can be split if my blood pressure is consistently on the low side.

Weight and Waist Circumference

Weight

I’ve lost 35 pounds. I feel better about how I look than I have in many years, and I am a little more than half way there. I am celebrating my progress, but not letting it be ‘enough’ because health-wise, it isn’t. To truly reduce my risk of heart attack and stroke, I need to lose another 25 pounds, or whatever weight will actually put my waist circumference at half my height.

Waist Circumference

I’ve loss 7 inches off my waist. That’s more than 1/2 a foot! Crazy, eh? I only have another 3 inches to lose off my waist for me be in the low-risk category and I am guessing that will correlate to another 30 pounds of weight loss. Maybe it will be less, maybe more, but my weight loss goal is whatever it takes for my waist to be half my height. The scale won’t determine my goal, the tape measure will.

My hard earned success in achieving partial remission from Type 2 Diabetes and these significant improvements in metabolic markers would be very short-lived if I began to eat more carbohydrates than my body can handle. I am still learning how much of which kinds of foods I can eat while maintaining my blood glucose levels but my own “n=1 results” seems to indicate that full remission of Type 2 Diabetes may very well be possible. The literature seems to support that it is possible- but whether I can achieve that level has yet to be seen. I still have much more to achieve, but I am definitely on the road to better health!

If you would like to know how I can help you on your own health and nutrition journey, please send me a note using the “Contact Me” form above.

To our good health,

Joy

You can follow me at:

https://twitter.com/lchfRD

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

P.S. For those that would like to see the “numbers” to understand my progress to date, below are 10 photographs showing all my glucometer readings since March 5, 2017 until today.

Blood Glucose Mar 5 2017 – January 24 2018 – pg 1

Blood Glucose Mar 5 2017 – January 24 2018 – pg 2

Blood Glucose Mar 5 2017 – January 24 2018 – pg 3

Blood Glucose Mar 5 2017 – January 24 2018 – pg 4

Blood Glucose Mar 5 2017 – January 24 2018 – pg 5

Blood Glucose Mar 5 2017 – January 24 2018 – pg 6

Blood Glucose Mar 5 2017 – January 24 2018 – pg 7

Blood Glucose Mar 5 2017 – January 24 2018 – pg 8

Blood Glucose Mar 5 2017 – January 24 2018 – pg 9

Blood Glucose Mar 5 2017 – January 24 2018 – pg 10

References

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2013;37(suppl 1):S1-S212, Chapter 3

January 23, 2018March 7, 2021

Why Grazing Can Look Like a Scene From Hoarders

INTRODUCTION: Most people know that prediabetes and diabetes is having “high blood sugar” but just how much sugar is actually in the human body? And how does grazing on food, rather than eating set meals affect this?

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

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

Where does it put it?

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

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

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

That’s it!

One heaping teaspoon of sugar in the entire adult body!

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

How Do We Understand Diabetes in Terms of Blood Sugar?

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

Someone with a fasting plasma glucose level of 7 mmol/L (126 mg/dL) meets the diagnostic criteria for Diabetes — which is just 6.25 grams of sugar or 1 -1/4 teaspoons. That is, the difference between the amount of sugar in the blood of a healthy person and the amount of sugar in the blood of someone with Diabetes is just a quarter of a teaspoon of sugar.

That’s it!

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

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

In a person with type 2 diabetes, the once tightly-controlled system that is supposed to keep the range of sugar in the blood between 3.3-5.5 mmol/L (60-100 mg/dl) is “broken” — and it may get this way by them “grazing” all day long, or eating more carbohydrate than their body can handle. When someone with diabetes eats food with carbohydrate in it, their insulin is unable to take the sugar out of their blood fast enough, so the sugar stays in their blood longer than it should. Just as with a healthy person, the body of someone with type 2 diabetes takes the sugar that results from the food they’ve eaten and ‘tops up’ their liver and muscle glycogen stores, then the rest is sent to the liver where it is converted into LDL cholesterol and triglycerides, and then the rest is stored in fat cells. But what if the person is grazing all day long? The sugar just keeps on coming!

Some people have the ability to store the excess sugar in the form of fat under the skin (called sub-cutaneous fat). In this way, obesity is a way of protecting the body from this sugar overflow. Eventually though, if the constant flow of carbohydrate continues, the ability of the body to store the excess as sub-cutaneous fat is limited and then fat around the organs (called visceral fat) increases and this is what ends up contributing to type 2 diabetes and fatty liver disease. It is easy to pack away excess carbohydrate when one is grazing instead of eating, because they don’t eat enough at anyone time to feel satiated (full).

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

The problem often is that we never get to access our fat stores because we are grazing on food with carbohydrate in it every few hours, storing the excess sugar in our fat stores. According to recent statistics, three-quarters of us lead sedentary (inactive) lives and barely get to make a dent in the energy we take in each day. We just keep getting fatter and fatter.

We eat breakfast — maybe a bowl of cereal (30 gms of carbs) or two toast (30 gms of carbs) or if we’re in a rush we grab a croissant breakfast sandwich at our favourite drive-through (30 gms of carb). Each of these contains the equivalent of a bit more than 6 teaspoons of sugar. Mid-morning, maybe we eat a fruit – say, an apple (30 gm of carbs) to hold us together until lunch — and take in another 6+ teaspoons of sugar in the process. If we didn’t bring a fruit, maybe we go out for coffee and pick up an oat bar at Starbucks® (43 gms of carbs) — the equivalent of almost 10 teaspoons of sugar. The grazing continues…

At lunchtime, maybe we’ll have a sandwich (30 gm of carbs) or some leftover pasta from the night before (30 gm of carbs) or we’ll go to the food court and have a small stir-fry over rice (30 gm of carbs) — the equivalent of another 6+ teaspoons of sugar. Then, believing grazing is better than eating 3 big meals, maybe we eat another piece of fruit mid-afternoon, this time an orange (30 gms of carb) — and we’ve provided our body with the equivalent of another 6+ teaspoons of sugar.

In the scenario above, by mid afternoon (assuming we didn’t eat any fast-food or convenience foods, but only eating the food from home) we’ve eaten the equivalence of 24 teaspoons of sugar! But isn’t grazing, and eating food we bring from home supposed to be healthier?

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

In short, a healthy person will keeps moving the excess carbohydrate they eat off to their liver and will keep making triglyceride and LDL cholesterol out of it and storing the rest as fat and a person who is not insulin resistant or does not have type 2 diabetes will have normal blood sugar level, but their high carbohydrate intake can be reflected in their “cholesterol tests” (called a lipid panel) — where we may see high triglyceride results or high LDL cholesterol results or both.

The body takes the triglycerides into very-low-density lipoprotein (VLDL) cholesterol. Think of these as “taxis” that move cholesterol, triglycerides and other lipids (fats) around the body. When the VLDL reach fat cells (called ”adipose tissue”), the triglyceride is stripped out and absorbed into fat cells. The VLDLs shrink and becomes a new, smaller, lipoprotein, which is called Low Density Lipoprotein, or LDL — the so-called bad cholesterol’. This is a misnomer, because not all LDL is harmful. LDL which is normally large and fluffy in texture is a good cholesterol (pattern A) that can become bad cholesterol (pattern B) when it becomes small and dense.

In a healthy person, LDL is not a problem because they find their way back to the liver after having done their job of delivering the TG to cells needing energy. In a person with insulin resistance however, the LDL linger a little longer than normal, and get smaller and denser, becoming what is known as “small, dense LDL” and these are the ones that put us at a risk for cardiovascular disease.

There are two important points here: (1) the only source of LDL is VLDL not the fat we take in though our diet and (2) only the “small dense LDL are “bad” cholesterol and these occur as a result of insulin resistance.

People often believe that because their blood sugar is ‘normal’ on a lab test, that there isn’t any problem, but as Dr. Joseph Kraft discovered in his 25+ years of research measuring blood glucose and insulin response in some 10,000 people, 75% of people with normal glucose levels are actually insulin resistant and are at different stages of pre-diabetes or “silent Diabetes” (what Dr. Kraft called “Diabetes in situ”).

These people (and maybe their doctors) think they are “fine” because their blood sugar seems normal. Perhaps however, their triglycerides and LDL blood tests come back high. The origin of the problem is not because they are eating too much fat, but grazing on too much carbohydrate.

The body is trying to store the excess sugar somewhere. First it stores it in glycogen, then the rest is made into triglyceride and LDL and shipped all over the body, with the rest stored as fat. The fat cells in the body keep filling up — in the muscle, in and around our organs, and some get “fatty liver disease” and some even get fat cells in their bones if their body needs a place to put it. Bone is not supposed to have fat cells it in, but the body has to store it somewhere, because the carbohydrates just keep arriving every few hours!

Think of grazing it this way;

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

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

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

This is how the system gets “broken”.

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

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

What’s the solution?

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

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

Science made simple.

Want to know more?

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

To our good health!

Joy

https://twitter.com/lchfRD

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

Reference

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

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

January 22, 2018July 8, 2019

A Dietitian’s Journey – a breakthrough

As I wrote about in a recent article, there’s more than one way to eat a low carb ketogenic diet including (1) low carb high fat (2) low carb high protein and (3) a mixed approach of higher protein lower fat during weight loss, then a moderate protein high fat during weight maintenance. Up until very recently my approach with my own weight loss has been low carb high fat – with the focus on monounsaturated fats such as olive oil, avocado oil, nut and seeds (and their oils) and omega 3 fatty acids from fatty fish. The problem has been that the last while, my weight loss and the rate at which my blood sugars were coming down has been too slow. As I do with my clients, it was time for a different approach. Since both of the other two types of low carb diet involves higher protein and lower fat I knew this is what I needed to do, but how much protein? How much fat? Do I keep carbs the same or lower them? In answering these questions, I have achieved a major breakthrough in my own ‘journey’ to better health.

I started with carbs. In discussion with my endocrinologist, I knew she supported carbs at 10% or less of my intake so I calculated my needs based on my gender, height, weight, activity level and weight loss goal – just as I do for my clients, and then figured out how many grams of carbs I could have in a day at this level. It was even lower than the amount of carbohydrate that I had been eating (which had been lowered twice over the last 10 months – from moderate, to low and now to very low), but since this ‘very low’ limit was in line with what my endocrinologist recommended, I set my carb limit at that.

Protein, rather than fat had to be the second macronutrient I needed to set and since it was to be based on lean body mass and not my total weight, I determined my fat percentage. Then, I calculated how much protein I needed to eat per day based on the research studies. As it turned out, the lowest end of the range was considerably more than I had been eating, and only just slightly higher than what the average Canadian or American eats in a day. This was a bit of an obstacle for me, as I am not a big egg eater also not a big red-meat eater and there’s only so much chicken I can handle. I knew I wanted to continue to eat a few ounces of cheese every day as this is a major calcium source, but that meant factoring in the fat the cheese would add, which I did. Nuts again cropped up as a significant problem – not for their carb content, as much as their fat content. Eating lower fat and higher protein meant nuts and seeds were going to be limited to a sprinkle on a salad and cream in my coffee was limited to a little bit once a day. I needed to look at option that would work for me in terms of protein and since I don’t eat pork or shellfish, that left me focusing on freshwater and sea fishes as well as finding ways to include beef and lamb along with different kinds of poultry.

Even though I live on the West Coast, there are many kinds of fish available to me to eat besides the ubiquitous sockeye salmon and halibut. I began exploring what was available frozen and rediscovered sea fishes such as whole mullet, mackerel and milkfish, fresh water fish such as whitefish, as well as the bags of filleted cod for quick preparation (I avoid basa and talapia because they are high in omega 6 fat, which makes them pro-inflammatory). I cooked a whole salmon on Friday and have been eating the leftovers cold for breakfast, since I am not that fond of eggs.

I began to think of poultry beyond chicken and bought and roasted a turkey (which also left leftovers to eat for my early meal) and began to think of ways to cook quail and duck (minus all the fat).

Eating a wide variety of fish and poultry with some cheese thrown in there has provided me with sufficient protein on most days and for the occasional time that I just can’t handle eating more, I mix some cocoa powder with whey isolate and drink that.

I should add that when I eat, I am not trying to 'fulfill' my macronutrient distribution (gms of protein, carbohydrate and fat) but rather, I eat as much whole food protein at my two meals (one mid-morning and the other around supper time) then eat a good 2-3 cups of low carb veggies with the protein. I add a little bit of mayo, butter or cream to make things taste good, and don't "count" anything except carbs. In fact, I encourage my clients to do likewise. I focus on maximizing whole food protein within my Meal Plan and the fat that I end up with is what naturally comes with those. It's a very "easy" lifestyle to follow, once the calculations are done - and since I do those for my clients, it only makes sense for me to do them for myself, too. Leading by example, right?

The results have been astounding.

I’ve lost 4 pounds in 2 weeks and as significantly, I have seemingly lost most of it off my abdomen and not just the fat under the skin (sub-cutaneous fat), but the fat deep in my belly, around my organs (visceral fat).

This is HUGE because it visceral fat is most highly correlated to insulin resistance – which is what I am trying to reverse. Just look what’s happened to my blood sugar over the weekend:

My fasting blood sugar actually went down after it went up in the wee hours of the morning (the effects of Dawn Phenomena) which would seem to indicate that the loss of belly fat is indeed making me more insulin sensitive! When my early morning blood sugar goes up due to Dawn Phenomena, my cells are now more responsive to the resulting spike in insulin, and the excess sugar is now being taken into the cells, like it is supposed to!

This wasn’t a one-off thing either. This is what happened yesterday and this morning;

These changes cannot be attributed to the baby dose of Metformin that I’m taking before bed (which is lowering the magnitude of the Dawn Phenomena rise), but is reasonably related to the only other change that I have made which is the increase in the amount of protein I am eating (in grams) and the reduction in the amount of fat and carbs I am eating.

We do know that over time, the body gets adapted to the changes we make – whether dietary or exercise changes and that to continue to get results at the rate that we want, we need to change the approach. I do this in my follow-up approach with my client over their weight-loss and health journeys and it was necessary for me to this for myself, as well.

While it is much ‘easier’ for me to eat a lower protein, higher fat diet as these are the foods I prefer, my goal is to reverse the symptoms of Diabetes and put myself into remission (have normal fasting blood glucose and normal HbA1C long term).

”Let food be thy medicine and medicine be thy food.”

– Hippocrates

For me, while it is not the easiest of most natural way for me to eat, increasing the amount of protein, decreasing the amount of fat and limiting my carbs to those contained in non-starchy vegetables is allowing my body to heal in the ways in needs to – allowing food to be my medicine.

The question arises “was it the lower carbs or higher protein that has made the difference?”. I had tried a few times before to lower my carbs down to almost as low as I am now and to made up most of the extra intake (outside of my basic protein need) from fat, but this did not contribute as much to me not being hungry (i.e. satiety) as this higher ratio of protein with the rest from the same sources of fat (which is still “high” by most standards). So yes, it is partially due to the lower carb content, but reasonably to the higher protein content, as well.

My entire ‘journey’ has been (and is) about me doing whatever it takes to achieve my goals with a healthy and evidence-based diet and it’s hard to argue that with 30 years of combined research in this area that Phinney and Volek aren’t reliable in terms of evidence. It mades sense for me to do what they recommend, even it if isn’t the most “natural” way for me to eat.

My hope is that in time, when I am no longer insulin resistant, that I can switch over to a moderate protein high fat intake as Phinney and Volek recommend, but for now this is what is best because it is working and because it is in accordance with what my endocrinologist recommended, and under the supervision of my doctor.

The ironic thing is that most of my clients do really well on moderate to low carb restriction with a fairly high intake of monounsaturated and omega 3 fat and are content with their rate of progress which is great. For those that will need, in time, to make changes to the way they pursue a low carb lifestyle, I hope by me leading by example, it will be encouraging to them.

Tomorrow I am scheduled to have my HbA1C level checked which won’t factor in much of these new changes in blood sugar levels because the test looks at the amount of glucose which stays attached to hemoglobin (Hb) for the life of the red blood cell (i.e. glycated hemoglobin), which is normally about 120 days / 3-4 months. At my last test 3 months ago, my glycated hemoglobin was 7.0% and what I am ultimately aiming for is a HbA1C of <6.0%, which would be in the non-Diabetic range. Whether its this time or the next time isn’t really as significant is that it has been more than 10 months where I have diligently been working towards that goal.

I’ve successfully normalized my triglycerides and lipids and brought them into the ideal range and have substantially lowered my blood pressure – and both of these were done by diet alone. It will be interesting to see the effect of these diet changes on my HbA1C, as well as have some indication of how much more I have yet to do.

It’s all about progress, not perfection and significant progress is being made, as evidenced by this recent personal breakthrough.

If you’d like to know how I can help you achieve your health and nutrition goals, please send me a note using the “Contact Me” form on this web page.

To our good health!

Joy

You can follow me at:

https://twitter.com/lchfRD

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January 21, 2018December 15, 2021

Low Carb Kaiser Buns

This recipe is posted as a courtesy to those following a variety of low-carb and ketogenic diets (not necessarily Meal Plans designed by me). This recipe may or may not be appropriate for you.

As mentioned in an earlier post, sometimes my recipes are developed out of my own need for a low carb product, and sometimes are initiated at a client’s request. The creation of a larger-size Kaiser bun which could also be used as a hamburger bun came at the request of someone that follows me on Facebook, and is a modification of the recipe I posted yesterday for Keto Yeast Rolls , that was adapted from a recipe from Maria Emmerich (mariamindbodyhealth.com).

This recipe produces an ever-so-slightly denser bun that will hold up to even the juiciest burgers and wettest sandwich toppings. They have a wonderful authentic bread-like texture and the yeasty smell when baking makes the process of making them just delightful.

Low Carb Kaiser bun sandwich – with smoked chicken, Emmenthal cheese, red butter lettuce and just a hint of Dijon mustard.

There is no “eggie” taste to these because they’re made with egg white and only painted with the yolks as a wash and unlike most keto bread fare, there is no cheese in this recipe so they are suitable for those that can’t tolerate dairy.

While instant yeast doesn’t require “proofing” (activation in water), it is dissolved in lukewarm water before being added to the dry ingredients in this recipe in order to impart their hallmark yeast-taste but the bulk of the leavening action comes from the beaten egg white and vinegar.

As Kaiser Rolls or Hamburger Buns these low carb buns are delicious

These buns make lunchtime a breeze because delicious, authentic sandwiches are possible and at only 10 g net carbs and almost 10 g of protein each, these rolls can fit into most a Meal Plans.

Below is the recipe with some pictures of the process.

Ingredients

2 1/2 cups almond flour

10 tbsp psyllium husk

3 egg whites, beaten to stiff peaks

2 tsp apple cider vinegar

3 egg yolks (for egg wash)

1 tbsp instant yeast

2 tbsp baking powder

1/2 cup lukewarm water

4 individual granules of sugar (yeast metabolize them)

1 tsp sea salt

3/4 cup of lukewarm water

2 tbsp sesame seeds

Method

1 – In a medium sized mixing bowl, place the almond flour, psyllium husk, baking powder and salt.

2– Dissolve the instant yeast and few grains of sugar in the 1/2 cup of lukewarm water, and allow it to proof. It will get foamy, which is what you want. (Note: The yeast feed on the sugar so it doesn’t add carbs to the rolls but feel free to leave it out if you can’t have it for whatever reason).

3– Separate the eggs whites and egg yolks into two bowls: the egg whites in a medium size bowl so they can be beaten, and the yolks in a small bowl to use as an egg wash for the rolls.

4– Beat the egg whites until soft peaks, then beat in the apple cider vinegar. Set aside.

5– Preheat the oven to 350°F, with the baking rack in the middle.

6-Pour the dissolved yeast mixture into the dry mixture, and gently fold in the beaten egg whites and the 3/4 cup of water.

7 – Beat the mixture with a stick blender until it comes together as a dough.

8 – Divide the soft ball of dough in half and roll each piece into a log and cut into 5 equal pieces. Each ball should be the same size so that the buns bake uniformly.

9 – Wet hands with water and roll each bun into a ball and then press into a three inch flat disk and place it on a lightly greased baking sheet.

10 – Brush each roll with the egg yolk wash.

11– Sprinkle with sesame seeds.

12 – Bake at 350°F for 50 minutes then turn off the oven and leave them in for 20 minutes without opening the oven door. This is an important step to ensure the inside has that real bread-like texture.

12 – Cool on a wire rack for 10 minutes and either use or pack into a large heavy weight zippered bag, remove the air with a straw, and refrigerate or freeze for later use.

Enjoy!

If you have questions about the local or long distance low carb and keto services that I provide, please visit the “Services” tab located above and feel free to drop me a note through the “Contact Me” form should you want additional information.

To our good health!

Joy

NOTE (February 27 2019): This Low Carb Kaiser Bun recipe makes 12 Kaisers, the size of hamburger buns. Over 3000 people have downloaded or printed it and to date I’ve only a handful of people who have had difficulties. If you run into a problem making these, please check that you included the correct ingredients in the quantity indicated, have followed the same preparation method listed here, that your yeast and baking powder are fresh and that your oven’s baking temperature was recently calibrated. I’m sorry, but outside of this advice I really can’t help with troubleshooting any baking challenges.

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January 20, 2018December 15, 2021

Keto Yeast Rolls (dairy free)

This recipe is posted as a courtesy to those following a variety of low-carb and ketogenic diets (not necessarily Meal Plans designed by me). This recipe may or may not be appropriate for you.

There’s nothing like the smell of yeast bread baking — and the taste of hot dinner rolls straight from the oven defies description. Whether you slather them with fresh creamery butter or pile them high with cold meat or cheese, these dinner rolls are sure to please.

They have a wonderfully crisp exterior and are easily slice in half, revealing their tender, moist bread-like texture. These are real rolls!

Warm Keto yeast rolls with fresh creamery butter

There’s no “eggie” taste because they’re made with egg whites and there’s no cheese of any kind, so the rolls can be eaten “as is”, topped with nut butter to have with coffee for breakfast or piled high with smoked chicken and Swiss cheese and eaten with a salad as a light meal.

Unsweetened nut butter makes a wonderful topping for these rolls

These are only 5 g net carbs and almost 5 g of protein each, so these little rolls pack a nutritious punch.

Mini sandwiches of smoked chicken, emmental (Swiss) cheese and a slather of real Dijon mustard with a leaf of red butter lettuce

What makes these dinner rolls very different from the standard keto fare is the smell and taste and texture of a ‘bread’ baked with yeast (although the bulk of the leavening action comes from the beaten egg white and baking powder).

I hope you enjoy these little beauties as much as I do!*

If you have questions about the remote and in-person services that I provide, please drop me a note through the “Contact Me” form located on the tab, above.

To our good health!

Joy

A larger-size Kaiser bun which is a modification of this one is posted here.

Ingredients

1 1/4 cups almond flour

5 tbsp psyllium husk

3 egg whites, beaten to stiff peaks

2 tsp apple cider vinegar

3 egg yolks (for egg wash)

2 tbsp baking powder

1 tbsp instant yeast

1/4 cup lukewarm water

4 individual granules of sugar (yeast metabolize them) — feel free to omit

1/2 tsp salt

3/4 cup of lukewarm water

1 tbsp sesame seeds

Method

1 – In a medium sized mixing bowl, place the almond flour, psyllium husk, salt and baking powder.

2- Dissolve the instant yeast and few grains of sugar in the 1/4 cup of lukewarm water, and allow it to proof. It will get foamy, which is what you want. The yeast feed on the sugar, so don’t omit it.

3- Separate the eggs whites and egg yolks into two bowls: the egg whites in a medium size bowl so they can be beaten, and the yolks in a small bowl to use as an egg wash for the rolls.

4- Beat the egg whites until soft peaks, then beat in the apple cider vinegar. Set aside.

5- Preheat the oven to 350°F, with the baking rack in the middle

6-Pour the dissolved yeast mixture into the dry mixture, and gently fold in the beaten egg whites and the 3/4 cup of lukewarm water.

7 – Beat the mixture with a stick blender until it comes together as a dough.

8 – Divide the soft ball of dough roughly in half and cut each piece into 5, or one into 5 and the other into 6. The important thing is each ball should be the same size.

9 – Brush each roll with the egg yolk wash

10- Sprinkle with sesame seeds

11 – Bake at 350°F for 50 minutes then turn off the oven and leave them in an extra 7-8 minutes.

12 – Cool on a wire rack for 10 minutes and then enjoy!

(adapted from a recipe from Maria Emmerich, mariamindbodyhealth.com)

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January 19, 2018July 8, 2019

The Role of Protein in the Diet – the history of man’s diet

What all low carb diets have in common is that they are low in carbohydrates and high in healthy fats, but they vary with respect to the amount of protein and fat. This article is part 2 in the series The Role of Protein in the Diet and focuses on the evolutionary history of foods and how we have adapted (or not!) to these foods.

The first article in this series titled The Role of Protein in the Diet – the problem with carbs is located here.

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

It is almost universally accepted that when man was a hunter-gatherer, we ate largely an animal-based diet and this was distributed as 60% animal protein and 40% plant protein. Naturally, there was some variation, depending on where people lived. Those in the tropics tended to eat more plants and fish and the Inuit, who lived in northern climates had less green plants in their diet.

If we look at contemporary agriculture over the past 400-plus years out of the previous past thousands of years, what has absolutely changed is the appearance of cereal grains.

These were totally non-existent in the history of man’s diet previous to the agricultural revolution.

Legumes, such as peas, beans, chickpeas, lentils, etc. were also totally non-existent in the history of man’s diet previous to the agricultural revolution.

Sugars (outside of the little bit in wild honey or in the occasional fruit or berries), plant oils, alcohol and dairy products were simply non-existent before the agricultural revolution.

Our bodies did not evolve to see those things.

What does this means in terms of the foods we eat?

Let’s take fiber as an example. In the past, the plants man ate were very fibrous, both vegetables and fruit. Looking at our current cultivated plants wild cousins, provides some idea:

The earliest known carrots are thought to have been grown in the 10th century in Persia and Asia Minor and are believed to have originally been purple or white with a thin, forked root — like those shown here.

Bananas as we know them now are nothing like bananas our ancient ancestors ate. Modern bananas came from two wild varieties, Musa acuminata and Musa balbisiana, both of which were very fibrous and had large, hard seeds, like the ones seen in this photo.

The plants we ate traditionally were high in soluble fiber that were easily digested and broken down to form short chain fatty acids (SCFA) which acted in our bodies as prebiotics, as these SCFA are very good fuel for the bacteria in our colon.

The agricultural revolution changed all that, with the domestication of plants, and the shift to a diet high in cereal grains; rice, corn, spelt, etc. Debate rages about consuming more whole grain cereal grains, but those contain largely insoluble fiber, which are not well digested. They don’t break down easily to SCFA and impact our microbiome (the healthy bacteria that lives in our colon). These cereal grains typically come with a high Glycemic Index (GI) which means they have a strong effect on a person’s blood glucose level, raising it substantially.

Our bodies developed certain metabolism patterns based on the foods in our ancient diet.

Extensive and elaborate pattern for handling protein: The human body has developed very elaborate patterns for handling protein digestion, metabolism and elimination. We have a very high satiety to protein (the feeling or state of feeling full) such that we won’t over eat it. According to Dr. Layman[1] it’s the only nutrient that causes us to stop eating it.
Fat is a passive nutrient: Contrary to the common belief, fat is a very passive nutrient. It allows what happens to it, without an active response or any mechanism of resistance. Fat in and by itself has very little effect on our body. We store it effectively and break it down effectively and this is what allowed us to survive in the wilderness as hunter-gatherers.The nutrient that is odd in this mix is carbohydrates.
Little evolutionary exposure to carbohydrate: Looking at our dietary history, we have comparatively very little exposure to carbohydrates. According to Dr. Layman, carbohydrates are highly toxic to the body. Glucose has to be rapidly cleared after we eat it and the only mechanism we have to protect us from carbs is insulin (which acts to move the resulting glucose out of our blood and into our cells).

It’s important to put carbohydrates into perspective in terms of the biological systems that we have for handling them.

The traditional teaching is that carbs are handled in the muscle – which is true, if one exercises 2-3 hours per day. North Americans are typically exercising that much at in the US, 75% of people are considered sedentary – that is, they have a lifestyle with little or no physical activity.

The carbs we eat at breakfast for example, top up our glycogen stores in our muscle, making us ready for fright or flight.

So let’s say we ate atypical breakfast that has 70 g of carbohydrate in it;

1/2 cup (125 ml) of cold cereal
1 slice of whole grain toast
1 medium orange
1 cup (125 ml) of low-fat milk
2 tbsp (30 mL) peanut butter
coffee or tea

Then, we sat in front of the computer all morning, so chances are we didn’t use any of the carbs from breakfast, and our glycogen stores are still full.

We get to lunch and eat another 100 g of carbs.

Our glycogen stores are still full, so where is that glucose going to? It has to go to fat.

When we have carbohydrates in excess, we make fat out of them.

The matter of carb regulation is very important to think about, because blood sugar is one of the most tightly regulated substances in the body. We regulate our blood glucose in a very narrow range; between about 3.9-5.5 mmol/L (70-100 mg/dL).

Why does this matter?

Metabolic Syndrome (also called Syndrome X) says it matters a huge amount.

References

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

2 – Lewis, Tanya, What Fruits and Vegetables Looked Like Before Domestication, Business Insider, November 16, 2017, https://www.sciencealert.com/fruits-vegetables-looked-before-domestication

January 19, 2018July 8, 2019

PART 1: The Role of Protein in the Diet

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

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

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

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

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

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

The Recommended Daily Allowance (RDA) for Protein

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

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

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

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

Recommended Daily Allowance (RDA) for Protein [slide from Dr. Donald Layman, PhD – The Evolving Role of Dietary Protein in Adult Health]

The minimum amount of protein (56 g / day) is calculated based on 0.8 g protein per kg of body weight and the maximum amount of protein (~200 g / day) is calculated based on >2.5 g protein per kg of body weight.

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

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

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

Current Dietary Intakes – the problem with carbs

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

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

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

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

But what about current intake?

Current Intake of macronutrients is as follows;

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

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

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

What is going to give us the best health?

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

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

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

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

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

So how did that work out for us?

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

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

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

What about Canada?

Let’s first look at children;

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

What about adults?

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

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

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

grain based desserts and snacks
yeast bread
pasta
pizza
chicken and chicken products
soda and sports drinks

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

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

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

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References

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

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

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

January 17, 2018December 15, 2021

Homemade Olive Oil Mayonnaise

This recipe is posted as a courtesy to those following a variety of low-carb and ketogenic diets (not necessarily Meal Plans designed by me). This recipe may or may not be appropriate for you.

Many people buy ‘olive oil mayonnaise’ without realizing it is only canola oil mayonnaise with added olive oil. The first ingredient is canola oil. This popular brand reads “made with” in fine print.

So much for people’s good intentions of substituting a healthy monounsaturated fat for a refined, industrial seed oil like canola.

I’ve been wanting to make my own mayo for a while, but my concern was using raw egg due to the risk of salmonella contamination.

Then I found out that pasteurized eggs are available for purchase in the US although I have been unable to find them here, but there are instructions online for how to do it yourself. It’s super easy. All you need is an accurate thermometer and a few minutes of time.

Today, I pasteurized a dozen eggs and then made real mayonnaise.

There are only two things to keep in mind to be successful. Be sure to have all your ingredients at room temperature before you begin and use “light” or “light-tasting” olive oil. There are several brands, including in-house brands of this that come from Italy. While I love cold-pressed extra virgin olive oil on everything else, I’ve read in multiple places and been told by a girlfriend that makes her own mayonnaise that the result is too heavy and bitter if made with cold pressed oil.

This one is just perfect!

Ingredients

1/4 cup light olive oil
1 cup light olive oil
1 large egg, pasteurized
1/2 teaspoon Keen’s hot mustard
1/2 teaspoon salt
1/2 tsp white vinegar
1/2 lemon, juiced

Instructions

1 -Place the egg, mustard and salt in a tall, thin metal pitcher and stir in only 1/4 cup of olive oil. Mix thoroughly.

2 -Insert a stick blender and turn it on high, then very slowly drizzle in the remaining cup of olive oil.

Note: don’t rush this part, because adding the olive oil too fast will result in the mixture separating.

3 -After all the oil has been added and the mixture is emulsified, add the vinegar, lemon juice and stir gently with a spoon to blend.

4 – Store the mixture in the refrigerator in an airtight container.

Enjoy!

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Note: This is the link that I used for pasteurizing eggs. I calibrated a new thermometer with boiling water (100° C) to be sure temperature readings were accurate and would encourage you to do the same. Temperature accuracy is critical here, as is time. Please read their disclaimer at the bottom and their note for pregnant women avoid raw eggs.

January 16, 2018May 14, 2021

Which Low Carb Diet?

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

Three Types of “Low Carb” Diets

1 – Low Carb High Protein

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

On the popular low carb site, Diet Doctor, Dr. Naiman oulines how much fat, protein and carbohydrates he believes that a person should eat on a low carb ketogenic diet[2], depending on whether they are doing it for weight loss or weight maintenance.

Super easy low carb macros – Dr. Ted Naiman – January 27 2018 (Twitter)

For someone seeking fat loss, Dr. Naiman recommends ~120 gm of protein, ~30 gm of net carbs, ~120 gm of ‘whole food fats’ (fat found naturally in food) and ~30 gm of added fat (such on top of vegetables, salads and cooking). He bases his protein calculations on 1 g protein per pound of ideal (or desired) body weight, while keeping net carbohydrate as low as possible and eating whole food fats (fats inherent with meat, fish or poultry) but avoiding added fat, if trying to get leaner. To the left is an illustration he recently posted on social media.

But how much food does one have to eat to get 120 gm of protein? A lot as you’ll see below.

Another proponent of a low carb high protein approach is Dr. Tro Kalayjian, a board certified Internal Medicine physician who currently practices in Greenwich, Connecticut. He lost 145 pounds over a two-year period following a low carb high protein diet and like Dr. Naiman does a great deal of high intensity interval training (HIIT) and resistance training (RT). Dr. Kalayjian does ~10 hours of HIIT and RT training a week with a goal of increasing muscle mass (hypertrophy) and body recomposition, so what he eats himself is very different than what he recommends to his patients. He eats 200-350 g per day when doing heavy weight training, trims his meats and doesn’t eat the skin, and eats a variety of nuts and uses olive and avocado oil as desired. Dr. Kalayjian recommendations to his patients however depends on (1) what their goal is, (2) what their current medical / metabolic status is and (3) any lifestyle details that will impact their dietary requirements.

How many grams of protein is in what we call ‘protein foods’? Here are some examples;

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

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

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

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

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

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

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

This is what Dr. Naiman’s 120 gm of protein would look like, broken up over a day. Three eggs for breakfast would supply <20 gm of protein and eating 227 gm (8 oz) of beef at lunch would provide 50 gm of protein, so the person would need to eat another 227 gm (8 oz) of beef at supper just to make their 120 gm of protein for the day. Now, remember, this is for an individual whose ideal body weight is only 120 pounds!

This approach may be quite appealing to some, but is eating higher protein in the range of 120 gm per day) appropriate for most people?

The Recommended Daily Intake (RDA) for protein is only 56 gms per day – which represents the minimum requirement that individuals need for health and people in both Canada and the US are eating only 70 gms of protein per day (barely over the minimum requirement) but is this optimum? Some very prestigious nutrition experts think not. More on that in a series of upcoming articles.

2 – Low Carb High Fat

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

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

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

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

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

If you are considering engaging in any intermittent fasting protocol, please discuss this with your doctor first. Dosages of medication for blood sugar and blood pressure very often need to be adjusted downwards with regular short fasts and this can only be done by your doctor.

It’s important to note that Fung’s “fasts” are not water-only fasts, but allow the drinking of protein-rich ‘bone broth*’ , as well as other beverages.

NOTE: An article on making a 18 hour bone broth along with nutritional analysis is located here.

3 – Low Carb Higher Protein Moderate Fat

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

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

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

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

Human Protein Tolerance

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

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

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

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

This Dietitian’s Approach

For the first few years of my low carb practice, my starting approach (for those without hereditary cholesterol or triglyceride issues) was closer to Dr. Fung’s approach than to either of the others, with several modifications. One of those modifications is around the types of fat that are central in the diet. Like Fung, I encourage people to eat fat that naturally comes with food (egg yolk, for example) but I don’t encourage the amount of saturated fat that many of his blogs reflect. I encourage my clients to consider rich sources of monounsaturated fats such as avocado, nuts and seeds and their oils as their primary fat source with omega-3 poly-unsaturated fat from fatty fish such as salmon, tuna, mackerel and sardine, a close second.

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

As I continue to read though the literature on the topic, I am tending to a higher protein and lower fat ratio with 1 g – 1.5 g per kg of ideal body weight, the carbs that come naturally with plenty of non-starchy vegetables and the fat that is found naturally in the lean fish, poultry and meat, with minimal added fat if someone is trying to lose weight. Based on a 2000 calorie per day diet, this would be closer to 30% protein, 60-65% fat, with 5-10% net carbs. Everybody’s needs are different, so what is best for one person may not be best for another. I also tend to think more protein during the weight loss phase such as Phinney and Volek suggest makes sense, with adjusting the amount of protein intake downward (to ~21-23% of caloric intake, based on 2000 calories per day) after weight loss has occurred. Sometimes which approach a person will take depends on factors such as food preferences, cooking skill and lifestyle factors and these need to be factored into people’s decisions.

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

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

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

In any case, I make the process easy.

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

Have questions?

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

To our good health!

Joy

You can follow me at:

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References

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

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

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

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

January 15, 2018July 8, 2019

A Dietitian’s Journey Progress Report – is the glass half empty or half full?

Ten months ago, it was urgent. I had to make a choice between going on several types of medication to lower my crazy-high blood pressure, and high blood sugars, triglyceride and LDL cholesterol or to immediately change my lifestyle. I chose to change my lifestyle. This is a progress report, going into the final two months of my first year at this.

As with other changes we undertake, there are two ways to look at things; how far we’ve come or how far we have to go. I choose to look at my progress as both. I am certainly not “there” yet, but I am nowhere near where I was!

Back in early March of this year, when I faced my own personal health crisis, it had been two years since I had any lab work done and ages since I was monitoring my blood sugar myself, even though I was Diabetic for the previous 10 years. It really was a case of classic denial. I didn’t want to know how bad it was. That day because I didn’t feel well, I faced the truth. I took my blood pressure (multiple times, because I couldn’t believe the readings!!) and I took my blood sugar. My blood pressure was so high, for certain had I gone to see my doctor at that point, he would have prescribed at least one type of medication, maybe two. Suffice to say it was dangerously high.

My blood sugar back in March of this year was high, but what else could it be eating a carb-based diet. I had started eating low carb two years earlier, but life circumstances got in the way for a time and I failed to go back and pick up where I left off. As I could have predicted they would, things only got worse. My fasting blood sugar was between 13.0 mmol/L (234 mg/dl) and 9.0 mmol/L (162 mg/dl). That’s nuts!

I was obese (BMI > 30). I’d joke about being the “fat Dietitian” but it wasn’t funny. For the previous two years, I was teaching others to eat low carb high healthy fat in order to lower their weight and reduce their insulin resistance, but I was in classic denial when it came to myself. Yes, I knew I was fat, but I was in denial as to just how much risk I was at for a heart attack or stroke.

My LDL was high and even though my high HDL acted as a protective factor, in the context of me being Diabetic, obese and having very high blood pressure, the only place it was going to go was higher – unless I changed my lifestyle permanently. That day I did. For me, there really can’t be any turning back as it really is a matter of life and death. I am no longer in denial.

So how am I doing?

The weight has been coming off, slowly but surely. I haven’t made any major progress in the last month, but then again I didn’t gain anything of significance over the holidays. That’s a good thing. Okay, it’s a very good thing. Looking at it with the ‘glass’ being half empty I am still only 1/2 way to where I need to be to have my waist circumference 1/2 my height. Looking at it with the ‘glass’ being half-full, I’ve lost 30 pounds. I feel better about how I look than I have in many years, and I am only half way there. I am celebrating my progress, but not letting it be enough because health-wise, it isn’t. To truly reduce my risk of heart attack and stroke, I need to lose another 30 pounds, or whatever weight will actually put my waist circumference at half my height.

I’ve loss 6 inches off my waist. That’s 1/2 a foot! Crazy, eh? I only have another 4 inches to lose off my waist for me be in the low-risk category and I am guessing that will correlate to another 30 pounds of weight loss. Maybe it will be less, maybe more, but my weight loss goal is whatever it takes for my waist to be half my height. The scale won’t determine my goal, the tape measure will.

My blood pressure has been ranging from between just below the normal range to pre-hypertension for months, but to protect my kidneys I am continuing to take a “baby dose” of Ramipril® (2.5 mg per day) that I asked the doctor to put me on until my blood pressure is consistently below normal and the meds need to be reduced or discontinued. The dose I’m on is the smallest it comes in and my doctor has switched me to tablets, which can be split if my blood pressure is consistently on the low side.

As covered in an earlier update, my triglycerides and cholesterol are now in the ideal range simply from the dietary changes I have made.

My blood sugar has been a bit frustrating, because overall it isn’t going down nearly as fast as I thought it would, or as I’ve observed other people’s to do. Everybody’s different and mine is just taking this long despite all the things I am doing right. I started out eating “low carb” (50 gm carbohydrate per day) and as it turned out it wasn’t low carb enough, perhaps because of how long I’d been Diabetic and just how insulin resistant I really am. A few months ago, I added regular intermittent fasting (IF) – fasting 23 hours from the end of supper to the beginning of supper the following day (drinking ‘bone broth’ and tea and other appropriate beverages while fasting). I have done one slightly longer fast, with careful monitoring. Along with IF, a number of months ago I also lowered my carb intake to â‰¤ 35 gm of carbs per day and monitor my blood sugar 5-7 times per day to make sure it doesn’t dip too low. During the day time, towards the end of a 24 hour fast, my blood sugar will be in the low 4’s mmol/L (~81 mg/dl) just before I eat again, but in the morning, the lowest it has ever been is 5.8 mmol/L (105 mg/dl). No matter what I do the night before (i.e. exercise, eat very low carb) my blood sugar begins rising around 3 am and continues rising until 6 or 8 am, even though I am fasting. It is classic “dawn phenomenon” and it has been incredibly frustrating.

My HbA1C has dropped from ~9.0 % (at the beginning of March) to 7.5 % (July 25 2017) to 7.0 % (October 11 2017) in 7 months, but for the last 3 months it has remained stubbornly at 6.8 % – almost exclusively because my fasting blood sugar remains high. This led me to a decision to ask my doctor to trial me on a “baby dose” of Metformin® only at night to see if it will help bring down my fasting blood sugar and more importantly, the corresponding insulin resistance, while I continue to eat a very low carb (ketogenic) diet and practice intermittent fasting.

After reviewing the over 400 glucose readings I took from March 5, 2017 onward and seeing that my HbA1C remains only slightly lower the last 3 months despite all my lifestyle changes, my doctor agreed to trial me on the lowest dosage of Metformin® over the next 3 months (the dose given to youth with high blood sugar). It will be interesting to see its effect as of January 6, 2018. What many people may not realize is that while Metformin® is now a pharmaceutical (medication), it was initially derived from a plant called “goat’s rue” or the French lilac and has been used since the Middle Ages to treat the symptoms of Diabetes. It’s not unlike acetylsalicylic acid (ASA), which is the active compound in Aspirin® which was originally isolated from white willow bark. Aspirin® and Metformin® are both natural in origin.

In addition to its natural origins and long-standing safety record, studies indicate that people with Diabetes who take Metformin® have lower incidence of cancer and dementia and in animal models, increased longevity has also been reported. Given all of these factors, it seemed reasonable for me to ask my doctor to trial me on a small dose of Metformin® to see if it keeps my liver from manufacturing too much glucose in the early hours of the morning, thus lowering my overall insulin resistance, while I continue to eat ketogenically and practice intermittent fasting. My doctor agreed. While it is too soon to know how much impact this small dose will have, from January 6th until today, my blood sugar is averaging 6.5 mmol/L, yet still rising from 3 am until 6 am. I will give it a few more weeks and then possibly ask my doctor to try me on the same dosage of slow-release Metformin®, to see if my morning blood sugar is improved.

It may seem strange to some that I would add medication after successfully having lost so much weight, having brought my lipids into the ideal range for non-Diabetics, and having lowered my blood sugar to the ideal range for Diabetics (â‰¤ 7.0%) solely by adopting a low carb lifestyle and practicing intermittent fasting. I view much it like wearing a brace or using a cane after injuring one’s knee. It’s not a permanent measure, but support and protection while the healing continues to take place.

This is my journey, and my progress and challenges are as individual as I am. Everyone is different and the degree of carb reduction and whether or not intermittent fasting may be helpful for you is something that will only be known it time as we work together. One thing is for certain is that unless one starts the process of working towards achieving their health and wellness goals, things will not improve on their own.

Have questions?

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

To our good health!

Joy

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January 11, 2018December 15, 2021

Low Carb Chili Con Carne – not too good to be true!

This recipe is posted as a courtesy to those following a variety of low-carb and ketogenic diets (not necessarily Meal Plans designed by me). This recipe may or may not be appropriate for you.

What if I told you that it is possible to enjoy real Chili Con Carne on a low carb high fat plan? Would you be interested?

This Chili is rich with ancho chili peppers, diced onion and green pepper, with plenty of fresh minced garlic. Along with a hint of ground cumin, a healthy dash of oregano and salt, these classic chili seasonings are simmered gently with browned, medium ground beef, canned diced tomatoes and beans…real beans!

Beans? How can it be low carb with beans??!

Ahhh, that’s because these beans are black soy beans. Yes, they’re a thing!

Black Soy Beans are soybeans that have a black seed coat on the outside of the bean. Inside, they are the same colour as regular yellow soybeans, although they are smaller than yellow soybeans. Though they look quite a bit like Black Turtle Beans, don’t mix the two up, because Black Turtle Beans are high in carbs, as are all legumes and pulses (another word for “beans”).

Black Soy Beans are so low in carbs and so high in fiber, that they have a mere 1 gm of carbohydrate for a 1/2 cup serving – and there is only one can of these beauties in the entire pot of chili.

Canned tomatoes are fairly low in carbohydrate too, and there was only one 796 mL (28 oz) can of those in the entire recipe.

The rest was veggies, meat and seasoning.

Here’s the recipe:

Low Carb Chili Con Carne

Ingredients

2 tbsp. coconut oil
1 kg (2.2 lbs) medium ground beef
1 large onion, diced
1 large green pepper, diced
1 tbsp. ancho chili pepper, ground
1 tbsp. fresh garlic, minced finely
1/2 tsp cumin, ground
1 tsp. oregano (Mexican or Greek), rubbed
sea salt, to taste

Method

1 – In a heavy dutch oven or cast iron casserole, melt the coconut oil over a medium-high heat.

2 – Add the diced onion and saute until translucent, but not browned. (Don’t let the pan get too hot.)

3 – Add the diced green pepper and saute until wilted.

4 – Add the ancho chili pepper and gently saute until all the vegetables are soft and well coated with the pepper, then add the salt, cumin and oregano.

5- Sprinkle the freshly minced garlic on the top and continue sauteing gently until it begins to become translucent.

6 – Gently crumble the ground beef on top of the cooked, seasoned vegetables and continue to saute over a medium high heat until the beef begins to brown.

partially cooked beef and seasoned vegetables

7 – Empty the can of diced tomatoes on top.

7 – Then empty the can of black soy beans with the liquid, on top of the tomatoes.

8 – Gently stir until well mixed, then simmer over a low heat for at least an hour (preferably until the liquid is thick and flavourful.

9 – Serve the chili in individual soup bowls, topped with your favourite chili toppings. Some popular ones are diced avocado, minced green onions, shredded mozzarella and a dollop of sour cream. Top with Mexican habanero sauce if desired and enjoy!

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January 4, 2018December 15, 2021

Ideal Low Carb High Fat Meal Replacement Shake

This recipe is posted as a courtesy to those following a variety of low-carb and ketogenic diets (not necessarily Meal Plans designed by me). This recipe may or may not be appropriate for you.

One of the services that I provide my clients are meal planning ideas and recipes – only a few of which end up on this web page. One of the meals that people find the most challenging is breakfast, for several reasons. First of all, many have been used to eating cereal or toast in the morning and now that they’re following a low carb / keto lifestyle they are at a little bit of a loss for what to eat.

The other challenge that many have in the morning is a lack of time. They’re busy and sometimes don’t have the time to cook, but still need to eat!

While it may be tempting to grab a box of commercially available low-carb ‘specialty products’ available at a pharmacy or health-food store, these cost ~$4.50-$5.00 each packet and contain a variety of flavour (natural and artificial), colour, preservatives and thickening agents such as xanthan gum. Some of these types of products are not only ‘low carb’, but ‘low fat’ and/or calorie-restricted, as well. Typical nutrition information for these types of meal replacement shakes or bars are as follows;

Nutrition Facts - per 1 

Fat 0 gm
Carbohydrate 1-2 gm
Protein 18 - 20 gm
Energy 80 - 82 calories

These are essentially protein powder with flavouring and thickening agents.

For those following a low carb high fat ketogenic style of eating, this smoothie is very easy, healthy, and that can be used “as is” or as the basis for a whole host of other low-carb shakes as limitless as your imagination. It contains no flavour, colour, preservatives or thickeners and costs almost half ($2.50 per serving) of what a commercially available packet would cost.

What makes this shake “ideal” as a meal replacement for whose lifestyle is low carb high fat is that it (1) has the equivalent protein found in an average meal on either a moderately low carb or low carb high fat diet. The ingredients are (2) available at most large chain supermarkets and the shake (3) requires no special equipment to make. It has ingredients that are (4) documented to help promote weight and abdominal fat loss* and that will (5) keep you from feeling hungry for a long time due to the type of protein and amount of fat it contains, and is (6) high in antioxidants. Best of all, (7) it can be made in minutes!

*see Role of Green Tea Powder (Matcha) in Weight and Abdominal Fat Loss

What’s not to love?

The ingredients are available at most large supermarkets and it really doesn’t matter which brand of matcha, ‘daily greens’ mixture or whey protein you buy, but I’ve mentioned a few things that I look for when purchasing these ingredients, to help guide you.

There are many different brands of matcha available (the best ones come from Japan and Taiwan) and almost all large food chains produce their own brand and/or sell a variety brands of ‘daily green’ mixtures and whey protein isolate. I recommend that you read the labels to be sure they don’t contain any added sugar or sugar alcohols (erythritol, xylitol, etc.) as these will add needless carbs. These products are usually stocked with either ‘natural foods’ or in the pharmacy section of the store.

I always buy whatever brand of boxed coconut milk is available as it does not require preservatives (canned ones do). Any brand from Thailand, Indonesia or Malaysia that is pure coconut milk and not thickened with carrageenan, guar gum or xanthan gum is good. I usually have 10 boxes of 250 ml and 500 ml pure coconut milk on hand so I can make these shakes or my ‘matcha smoothie recipe‘ (which is great on intermittent fast days as an alternative to ‘bone broth”as there is almost no protein or carbs in it).

If you’re in a rush, this shake can be made quickly in a bowl and poured over ice and enjoyed…

…or if you have a few extra minutes and a blender, it can be whirred with a little extra ice to make a wonderful meal replacement smoothie.

Here’s the recipe:

Low Carb HIGH FAT Ideal Meal Replacement Shake

1 tsp (2.5 ml / 2 gm) powdered green tea (matcha) powder
1/2 scoop (5 g) ‘daily greens’ mixture, mixed berry
1 scoop (30 g) whey protein isolate, unflavoured
1 cup* (250 ml) boxed coconut milk (without preservatives or added gums)
1 cup (250 ml) iced-cold water
4-8 ice cubes

[*NOTE: for those in the weight loss phase of a Phinney and Volek style LCHF eating plan, it will be necessary to limit the amount of coconut milk in this drink.]

Method

Place the green tea (matcha) powder and ‘daily greens’ mixture in a small stainless steel sieve and gently rub through the sieve into a small ceramic bowl, using the back of a spoon. Discard any residue from the sieve.
Add the unflavoured whey protein isolate to the ceramic bowl.
Using a whisk (or if you have one, a bamboo whisk available at Japanese and Korean grocery stores) add 3 Tbsp boiled water, while stirring with the whisk. Keep stirring briskly until all the lumps are gone and the mixture is smooth.
Stir in the coconut milk, blending well.
Pour mixture into a tall, insulated 2-3 cup (500-750 ml) travel tumbler, add ice cold water and ice cubes and enjoy!

Nutrition Facts - per 2 cup (500 ml) serving

Fat 34 gm
Carbohydrate 8 gm
Protein 27 gm
Energy 446 kcal

Macronutrient Distribution – Ideal LCHF Meal Replacement Shake

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January 4, 2018July 8, 2019

Your 2018 Health and Weight Loss Goals

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

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

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

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

That’s more than 2 months.

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

I can help.

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

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

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

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

Want to know more?

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

Let’s do this together!

To our health!

Joy

You can follow me at:

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References

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

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

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

January 3, 2018July 8, 2019

How Much and Which Types of Fat?

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

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

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

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

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

What kinds of fat?

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

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

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

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

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

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

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

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

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

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

To our good health!

Joy

You can follow me at:

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

January 2, 2018July 8, 2019

Working on Health Goals?

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

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

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

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

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

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

What about you?

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

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

To your good health,

Joy

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