Homemade Yogurt – Crock-Pot and Inkbird controller method

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.

INTRODUCTION: Years ago, I used to make my own homemade yogurt using the pilot light in my gas oven to incubate it, but that was a long time ago. Unfortunately, my last few homes had electric stoves and not gas and purchasing yogurt just seemed more ‘practical’. Recently I switched from cow’s milk to goat’s milk to avoid A1 beta-casein that was negatively impacting my joints (you can read about A1 beta casein here), so I recently decided to start making my own Greek goat yogurt.  My first reason to make my own was because the goat yogurt available on the market did not have the classic thick texture of “real” Greek yogurt, and the second reason was that making my own — even with premium milk such as goat milk or A2 beta-casein milk from heirloom cows still costs half of what it does in the store. Finally, making it myself, I can control what’s in it. Mine has no skim milk powder or gelatin; it’s just full-fat milk and yogurt culture.

Homemade Goat-milk Greek Yogurt

Oven Method

The first time I made yogurt recently, I incubated it in my electric oven by preheating it to 200° F (93°C), turning the heat off and allowing it to cool to 110° F (43° C). Then I turned the oven light bulb on to maintain the ambient temperature, and since ovens are so well insulated, it worked as well as it used to in my old gas oven years ago.

Crock-pot® and Inkbird® Method

When I posted my first results, someone online suggested I used an old Crock-pot® to incubate it, but when I had investigated that idea previously, the lowest setting on mine was too hot for the purpose. The “Lo” setting ranged between 140-145°F (60-63°C) which would kill the bacterial culture, so that’s why I used my old oven method.

This person suggested I purchase an Inkbird® plug and play temperature controller that could be set up between the Crock-pot® and the power supply, in order to maintain the temperature at a steady 110° F (43°C) for the duration of the incubation time. That sounded terrific so I ordered one online.

The cool thing is the Inkbird® temperature controller can also be used to turn the same old Crock-pot® into sous-vide; which I will definitely try at some point, too!

Below are step-by-step instructions for making both regular and Greek yogurt.

Homemade Yogurt – Crock-Pot® and Inkbird® controller method

  1. Pour 3 liters of fresh goat milk (or other mammal milk) into a heavy bottom pot.
  2. Heat the milk at a medium-low heat until the milk reaches 180° F (82 ° C), stirring occasionally. It takes a while, but don’t rush it by turning it up or it will scald on the bottom of the pot, losing some of the valuable thickening protein. Once it reaches temperature,  turn the heat down just enough to maintain the temperature stable for 20 minutes.*

    * Heating the milk is essential even if the milk is pasteurized, as it transforms the proteins. Holding the milk at 180° F (82°C) for 20 minutes makes the difference between runny and full-bodied yogurt (even if you don’t strain it to make it Greek-style).
  3. Pour the hot milk into the removable ceramic insert of the Crock-pot®, then cover it and let it cool until it reaches 110-115° F (43°- 46°C) . Since this can take several hours, I use a cold water bath to speed things up if I want to get it incubating sooner and stir it with a sterilized stainless steel whisk as it sits in the cold water, to make sure it cools uniformly so the thermometer reading is accurate.
  4. Once the milk has cooled to just above 110°F (43°C), remove 1 cup of it (250 ml) to a bowl and add 1/2 cup (125 ml) of the starter you are using.  I use a previous batch of my own yogurt, but start the first batch with some fresh commercial goat yogurt. Remember that each type of milk needs a different type of starter so be sure to buy one that is made from the same type of milk as you’re using. Stir the starter and cup of warmed milk back into the Crock-pot® and stir gently to distribute it evenly.
  5. Put the insert into the base of the Crock-pot® and insert the plug of the Crock-pot® into the power receptacle of the Inkbird® thermometer controller, then plug the controller into the wall.
  6. Set the temperature on the controller to 110° F (43°C) for 12 hours and then have it go off.
  7. Insert the probe into the warm milk that has the starter added.
  8. After 12 hours, remove the probe and unplug the Inkbird®.

At this point, you have plain yogurt which can be packaged up into containers and cooled in the refrigerator for 12 hours before eating.

For Greek Yogurt

  1. Line a stainless steel colander or strainer with a clean piece of white cotton cloth and attach it firmly to the edges with clips.
  2. Insert the strainer or colander into a large bowl that will catch the large amount of whey that will drain off.  Keep in mind, about 35-40% of the finished yogurt is whey, which is what is being removed by draining.

    amount of whey after 1 hour of draining
  3. Pour in yogurt and while it is draining, cover the strainer.
  4. Let the whey drain out in the fridge or in an oven that has been warmed and cooled to 110°F (43°C) and has the light bulb on.  Remember, that while straining, the yogurt needs to be either in the fridge or at the same temperature it incubates at, to keep it out of the temperature “danger zone”.
    Mine goes into a warmed, cooled oven because my fridge always has too much food in it to accommodate a large bowl!
  5. Drain the yogurt until the mixture is the thickness you like. I drain mine for 12 hours so that it is very thick.
  6. Package it up into sterilized containers with covers and let it chill 12 hours in the fridge before eating.

    Enjoy as is, or with a sprinkle of hemp hearts and berries.

Macros – 3/4 cup / 175 ml of plain Greek Goat Yogurt

Carbohydrates: ~6 g
Protein: ~15 g
Fat: ~10 g

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Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

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Keto Marble New York Cheesecake – counter-top oven method

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.

I recently ordered a small springform non-stick pan that turned out to be smaller than I expected (7″ / 18 cm across) but it gave me an idea!  I could bake a cheesecake in my counter-top convection oven on a hot summer day like today and not even heat up the kitchen!

I began with my low carb New York Cheesecake recipe from 2017, scaled it to the smaller pan and made it keto by eliminating the sugar entirely.

It came out so amazing that I’m sharing the recipe here.

Note: I use free-range eggs with very deep yellow yolks, hence the golden colour of the “white” part of the cheesecake.

Low Carb Marble New York Cheesecake – counter-top convection oven method

Ingredients

  • Three 250 g (8 oz) pkgs cream cheese, room temperature
  • 1/4 cup (60 ml) Truvia® (can use Swerve®, if preferred)
  • 1/8 tsp salt
  • 1/2 tsp real vanilla extract
  • 3 large eggs, plus one egg yolk, room temperature
  • 50 gm (2.25 oz.) 85% cocoa Swiss dark chocolate, melted in a double boiler

Instructions

Preheat the counter-top convection oven to 450 F.  Make sure the fan on the oven is set to ‘on’.

Prepare an 7 ” non-stick spring-form pan by lining with parchment paper and spraying well with a coconut oil spray.

 

In the bowl of a stand mixer using the flat paddle (or by hand) beat the packages of cream cheese one at a time until very well blended and add the eggs one at a time, continuing to blend. Don’t over mix once the eggs are added or the cheese cake may get a large crack as it cools. Add the egg yolk, then the salt, Truvia® or Swerve® and some real vanilla and complete the stirring by hand, using a spatula.

Melt the chocolate in a double boiler until just melted.

Set aside and allow to cool a bit.

 

Remove the bowl from the stand mixer. Have the cooled, melted chocolate handy and the lined and sprayed spring-form pan. Take 1 cup of the cheese mixture and mix with the melted cooked chocolate. Stir well.

Also have read a pan that fits in the convection oven that can be filled with water (for the water bath), then pour the batter into the prepared pan and shake gently to flatten the top. Add the chocolate-cheese mixture in blotches.

Use a long thin flexible icing spatula (or butter knife, if unavailable) to gently “cut” into the blotches to make a marble pattern. Be careful not to stir it.

Bake at 450 F for 12 minutes, then lower the heat to 200 F and make for another 35 minutes. Check during the last 5 minutes so as not to over-bake it.

Turn off the heat of the convection oven and open the door slightly (not all the way, so cake does not get a draft), but leave it inside for 30 minutes, until partially cooled.

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

Transfer to the fridge to cool completely (best to cool overnight so the flavours fully develop).

Enjoy!

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

  • Carbohydrates: 4.2 g
  • Protein: 17 g
  • Fat: 46 g

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Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

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Intermittent Fasting Doesn’t Need to be Complicated

Today, a well-known dietary management group asked people on social media to name their favourite fasting protocol and what struck me was that there were as many different styles of intermittent fasting, as people.

Here are some of the answer that were posted;

  • OMAD 20:4
  • eat lunch/dinner Tues/Thurs/Sat/Sun, Fast Mon/Wed/Fri
  • 42 x 3
  • 24 hour fast 1 x week, 48 hour fast 1 x month, 4 day fast 1 x year
  • IF daily : 2 meals, alternate day, OMAD occasionally
  • 36 hrs on Mondays and Thursdays, 18:6 the rest of the days
  • OMAD three days a week. Two meals four days a week. LCHF when eating twice.
  • ADF on MWF, two meals plus snack on the off days
  • Sunday dinner to Tuesday first meal when hungry
  • OMAD with ADF and extended fasts of 72 hours to 7 days throughout the year
  • EF of 5 plus days every 5-6 week
  • 16:8 with an eating window 11 am to 7 pm
  • 42 x 3 times a week plus 18:6 on feasting days

Definition of Terms

OMAD = one meal a day
IF = intermittent fasting
ADF – alternate day fasting
18:6 = fasting 18 hours / day, six-hour eating window
20:4 – fasting for 20 hours / day, 4 hour eating window
EF of 5+ days = extended fasting for 5 or more days

Internal and External Perceptions of Intermittent Fasting

I think to someone reading this who had no experience with these different types of “intermittent fasting”, this would seem terribly complicated. And difficult.  It might even seem like an ‘initiation rite’ of sorts, or perhaps a competition as to who does the most radical type of fasting.

While fasting has therapeutic benefits of enabling insulin levels to fall, those who fashion their diets after books that have been written on fasting often see it as ‘part and parcel’ of a very high fat / moderate protein “keto diet”.

It’s important to understand, as I’ve said many times in different articles such as this one,  there are different types of “low carb” diets and different types of “keto diets”. Not all are super high fat!  Some versions do not have people eating lots of whipping cream and coconut oil and bullet-proof’ing everything and eating ‘fat-head’  bread and pizza, with tons of bacon and avocado. And not all involve “fasting”. In fact, some approaches caution against it, due to the potential of loss of muscle mass.

More than One Type of Low-Carb or “Keto” Diet

Some approaches are high protein with as much fat as people want, whereas other encourage moderate to high level of lean protein with visible fat removed. There is no one “low carb” or “keto diet”, even though when most people think of “keto” they envision the high fat version, which alternates with different types of fasting.

It is understandable though, that if someone is going to eat huge amounts of fat in a day, that it is followed by longer or shorter periods of intermittent fasting, which balance it out. It also balances out the cost of eating that way, as one only has to buy food for 1/2 the amount of time.

My Answer to the Question

I answered the question “what is your favourite fasting protocol” as follows;

My favourite fasting protocol

My favourite ‘fasting protocol’ since my type 2 diabetes is in remission isn’t really “new”.

According to circadian biologists like Dr. Satchidananda Panda of Salk Institute and Dr. Matthew Walker of University of California at Berkeley, this is probably pretty close to how mankind ate for that last few millennia; until the advent of the gas and then electric light and refrigeration.

Until we could artificially extend ‘day’ as long as we wished simply by leaving the lights on — and pushing it even further with our smartphones in bed, people ate well before nightfall and went to sleep when it got dark and didn’t eat until the first meal the following day. According to Panda, the master circadian “clock” in our suprachiasmatic nucleus of our brains are set by these ~24 hour day/night cycles and when we are first exposed to light, and the individual circadian ‘clocks’ in our organs are ‘synced’ by when we sleep and eat.

Literally, for thousands of years, people didn’t eat from after their last meal of the day (which was quite a while before they slept) and then didn’t eat until the first meal the next day (which wasn’t as soon as they opened their eyes, either!). Even after the invention of electric lighting and refrigeration, many people had a long period of time between when they finished dinner and the next morning when they ate breakfast (the meal that broke the “fast”). It would seem that our species did pretty well eating that way, and didn’t seem to suffer the metabolic diseases of overabundance we are now inflicted with.

Given our body’s circadian clocks are literally tied to these approximate 24/hour cycles, and ‘synced’ by when we eat / don’t eat and sleep, eating in accordance with these natural circadian rhythms (when it functioned best for thousands of years) just seems to make “sense”.

In light of this, my general “philosophy” for healthy individuals about when to eat and when to “fast” is simple;

  1. eat real, whole food when genuinely hungry, as part of a meal
  2. don’t eat between meals (avoids keeping insulin high, allows it to fall between meals)
  3. Don’t eat after an early-ish last meal of the day (~3 hours before bedtime) and not until the first meal the following day (whenever that is). This too allows insulin levels to fall, and enables your body to do all the wonderful “housekeeping tasks” that both Dr. Panda and Dr. Walker write and teach about.
    (Note: For those who are metabolically unwell, done with supervision, slightly longer periods of intermittent fasting up to 24 hours may be beneficial for lowering insulin resistance, without loss of muscle mass.)

More Info?

If you would like more information about the different low carb meal patterns available and which might be best for you as well as implementing times for eating and times not eating, I can help.

You can learn more about my services under the Services tab or in the Shop.

If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchf-rd/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

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References

Panda S, Circadian physiology of metabolism, 2016, Science: 354(6315) 

Krause AJ, Simon EB, Mander BAGreer SMSaletin JM, Goldstein-Piekarski AN, Walker MP. The sleep-deprived human brain. Nature Reviews. Neuroscience. PMID 28515433 DOI: 10.1038/nrn.2017.55

 

Keto Diet Doesn’t Cure Diabetes

Note: this is both a Science Made Simple article and an editorial, where I express my own opinion.

A ketogenic diet and the weight loss that can accompany it is well documented to be both safe and effective as medical nutrition therapy in the treatment of type 2 diabetes. While it can enable individuals to put symptoms of the disease into remission, it is not a ‘cure’.

An article widely circulated on social media earlier this week announced “What If They Cured Diabetes and No One Noticed?”[1] and said;

“So you’d think that if someone figured out a way to reverse this horrible disease, there would be big bold headlines in 72-point type. You’d think the medical community, politicians and popular press would be shouting it from the rooftops.

Guess what? Someone did. Yet it appears no one noticed.

The cure was simple — so simple, in fact, that it involved no medication, no expensive surgery and no weird alternative supplements or treatments.

What was this miracle intervention? Diet. Specifically, the ketogenic diet.”

Of course, the author is entitled to hold this opinion and to express it, however in my opinion, a ketogenic diet does not “reverse diabetes” — it does not “cure” it.  Furthermore, I believe the distinction between “reversing diabetes” and “reversing the symptoms of diabetes” is very important, and more than a matter of semantics.

In an article I posted last year titled The Difference Between Reversal and Remission of Type 2 Diabetes, I wrote that;

“Reversal” of a disease implies that whatever was causing it is now gone and is synonymous with using the term “cured”.  In the case of someone with Type 2 Diabetes, reversal would mean that the person can now eat a standard diet and still maintain normal blood sugar levels. But does that actually occur? Or are blood sugar levels normal only while eating a diet that is appropriate for someone who is Diabetic, such as a low carbohydrate or ketogenic diet, or while taking medications such as Metformin?

If blood sugar is only normal while eating a therapeutic diet or taking medication then this is not reversal of the disease process, but remission of symptoms.”

Addendum (July 18 2019): Type 2 diabetes is the result of beta cell failure resulting from over-taxing them with a highly refined, carb-laden diet over extended periods of time (you can read more about that here). For something to ‘cure’ type 2 diabetes, there would need to evidence of a restoration of beta-cell function. If someone was indeed ‘cured’ they would have a normal glucose and insulin response on a 3 hour glucose-insulin test (OGTT will added insulin assay at 0 hr, 1 hr and 2 hrs.).  Anything short of that is ‘remission’.

I feel that claiming that a keto diet ‘cures diabetes’ or ‘reverses the disease’ does the public a disservice:

  • Firstly, it implies that there is simple, free ‘cure’ that will work for everybody.  As I outline below; some people are able to achieve partial or complete remission of their symptoms following a keto diet, and others are not.
  • Secondly, it implies that there is a simple, free ‘cure’ available, but that it is being ‘withheld’ for some reason — either because doctors don’t know about or are afraid what colleagues might think, or because the agricultural and pharmaceutical industries have ‘big bucks to lose’ by people limiting their intake of bread, pasta and insulin.

There is no question that physicians (and all clinicians) need to be selective about recommending a keto diet for their patients / clients and to be able to document from the literature that it is safe, effective and best clinical practice for the condition for which it is recommended, and appropriate for the individual.

While falling markets for specific types of food products and drugs certainly have an impact on the economics of both the agricultural industry and pharmaceutic industry, it comes across like a ‘conspiracy theory’ to imply there is a ‘cure’ available out there, but that the public is being ‘denied’ access to it by “big food” and “big pharma”.

  • Finally, it implies that if people are unable to ‘reverse their diabetes’ and get ‘cured’ following a keto diet, that it is their fault; they mustn’t have done it properly.  Even if we substitute the terms and say instead “put their diabetes into remission” or “reverse the symptoms of diabetes”, it is unreasonable and unfair to assume that everyone will be successful in doing so, and if they aren’t, the responsibility falls on them.

Virta Health Data

The on-going study from the Virta Health had over 200 adults ranging in age from 46-62 years of age in the intervention group following a ketogenic diet at the end of two years. At one year, participants in the intervention group lowered their glycated hemoglobin (HbA1c) to 6.3% (from 7.7% at the beginning of the study) —  with 60% of them putting their type 2 diabetes into remission based on HbA1C levels >=6.5% (American Diabetes Association and Diabetes Canada guidelines).  HbA1C rose slightly to 6.7% at two years. The keto group did considerably better than the ‘usual care group’ whose average HbA1C actually rose to 7.6% at one-year (from 7.5% at the beginning of the study), and rose again to 7.9% at two years [3]. 

Fasting blood glucose of the intervention group following a keto diet increased slightly from  127 mg/dl (7.0 mmol/L) at one year to 134 mg/dl (7.4 mmol/l) at two years, which was considerably better than the usual care group, whose fasting blood glucose was 160 mg/dl (8.9 mmol/L) at one-year and 172 mg/dl (9.5 mmol/L) at two years [3].

Data so far from this study demonstrates that a well-designed keto diet can be very effective in reversing the symptoms of type 2 diabetes, and that it is more effective than what was ‘standard care’ (prior to the new ADA guidelines), but it is not a ‘cure’.

Dr. Stephen Phinney and the research team at Virta Health have written on the Virta Health website [3];

“A well-formulated ketogenic diet can not only prevent and slow down progression of type-2 diabetes, it can actually resolve all the signs and symptoms in many patients, in effect reversing the disease as long as the carbohydrate restriction is maintained.” [2]

That is, the Virta researchers say that a well-designed keto diet can resolve the signs and symptoms of the disease in many people, which “in effect” (i.e. ‘is like’) reversing the disease —  as long as the carbohydrate restriction is maintained. They don’t promote the diet as a ‘cure’, but as an effective treatment.

There is no question that Virta’s results are impressive — so much so that their studies have been included in the reference list of the American Diabetes Association’s (ADA) new Consensus Report of April 18, 2019, where the ADA included adopted the use of both a low carb and very low carb (ketogenic) diet (20-50 g of carbs per day) as one of the management methods for both type 1 and type 2 diabetes in adults. You can read more about that here.

In fact, the ADA said in that report that;

Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia*’

* blood sugar

A keto diet is not a ‘cure’ for diabetes. At this present time, there is no cure for diabetes. There are, however three documented ways to put type 2 diabetes into remission;

  1. a low calorie energy deficit diet [4,5,6]
  2. bariatric surgery (especially use of the roux en Y procedure) [7,8]
  3. a ketogenic diet [3]

Final Thoughts…

I believe that based on what has been published to date, it is fair to say that a well-designed ketogenic diet can;

  • prevent progression to type 2 diabetes, when adopted early in pre-diabetes
  • slow down progression of type 2 diabetes
  • resolve the signs and symptoms of the type 2 diabetes
  • serve in effect like reversing the disease, provided carbohydrate restriction is maintained

…but to claim that a keto diet ‘cures’ type 2 diabetes is simply incorrect.

A ketogenic diet is a safe and effective option for those wanting to put the symptoms of type 2 diabetes into remission.

More Info?

If you would like more information about adopting a low carb or ketogenic diet in an effort to put the symptoms of type 2 diabetes into remission or for weight loss, I’d be glad to help.

You can learn more about my services under the Services tab or in the Shop.

If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchf-rd/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

  1. Steel, P, “What If They Cured Diabetes and No One Noticed? – if the ketogenic diet can reverse diabetes, why isn’t your doctor recommending it?”, The Startup, July 13 2019, https://medium.com/swlh/what-if-they-cured-diabetes-and-no-one-noticed-keto-diet-ketogenic-virta-study-d49c195bf8f5
  2. Phinney S and the Virta Team, Can a ketogenic diet reverse type 2 diabetes? https://blog.virtahealth.com/ketogenic-diet-reverse-type-2-diabetes/
  3. Athinarayanan SJ, Adams RN, Hallberg SJ et al, Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-year Non-randomized Clinical Trial.  preprint first posted online Nov. 28, 2018;doi: http://dx.doi.org/10.1101/476275.
  4. Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia2011;54:2506-14. doi:10.1007/s00125-011-2204-7 pmid:21656330
  5. Steven S, Hollingsworth KG, Al-Mrabeh A, et al. Very low-calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and nonresponders. Diabetes Care2016;39:808-15. doi:10.2337/dc15-1942 pmid:27002059
  6. Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet2018;391:541-51.
  7. Cummings DE, Rubino F (2018) Metabolic surgery for the treatment of type 2 diabetes in obese individuals. Diabetologia 61(2):257–264.
  8. Madsen, L.R., Baggesen, L.M., Richelsen, B. et al. Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: a Danish population-based matched cohort study, Diabetologia (2019) 62: 611. https://doi.org/10.1007/s00125-019-4816-2

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Trouble-shooting Chronic Constipation on a Low Carb Diet

Constipation is one of the most common problems that people face, with between 2 and 28% of the population in Western countries reporting having this [1-3]. In 2007 in the United States, 19.4% of people reported problems with chronic constipation[4] and in Canada between 15% and 27% of people reported having sought health care support for chronic constipation in 2001 [5].

Defining Constipation

The term “constipation” means different things to different people. For some it simply means they don’t pass their stools (feces) often enough, and for others it means that when they do, their stools are hard, difficult to pass, may cause lower abdominal discomfort, or feel like they “still have to go” afterwards (incomplete evacuation).

What is considered a ‘normal range’ in the number of bowel movements per week varies considerably; from anywhere from 3 – 21 times per week, provided the stools are soft and easy to pass, but not loose or unformed. For some people, having bowel movements 3 times per week may be normal, as long as their stools aren’t hard, dry or compact and there is no abdominal discomfort. For others, 3 times per day (21 times per week) may also be considered fine, provided the stools aren’t unusually loose.

There are many factors that can contribute to chronic constipation; including some medications that people take, inadequate fiber or the wrong kind of fiber, insufficient hydration (not drinking enough water, especially when its hotter out, or exercising), high levels of estrogen and progesterone when a woman is pregnant, or disorders such as Irritable Bowel Syndrome (IBS) and diverticulosis.

The Causes of Chronic Constipation

People often think (or are told) that if they are constipated, they just need to eat more fiber, but in some cases increasing fiber from certain sources such as grains may make the problem worse. For example, some people are wheat sensitive, but not gluten-intolerant (i.e. not Celiac). That is, they are sensitive to wheat only, but not rye or barley (which also contain gluten).  Others have something called non-celiac gluten sensitivity which resolves when gluten is eliminated from the diet, yet don’t test positive for Celiac disease. These people feel better when they avoid grain-based carbs, and may opt instead for eating nutritiously-dense starchy vegetables, such as winter squash or yam, for instance. Since a low-carb diet is non-grain-based, people who experience chronic constipation due to wheat intolerance or non-celiac gluten sensitivity will start to feel considerably better eating this way. The problem may be that for those with non-celiac gluten sensitivity, other sources of gluten, such as those found in malt vinegar or low carb beer may continue to cause them symptoms.

Many people who try a “low-carb” or “keto” diet on their own often complain of being constipated and this may be for a number of other reasons.  They may be taking a medication that causes constipation as a side-effect, they may not don’t drink enough water, or it may be the result of something else.

Inadequate Hydration

I would estimate that ~80% of the people that I assess in my office have observable signs that they are aren’t drinking enough water, so this is something I would recommend most people to consider as a possible contributor to chronic constipation.

The idea that everybody needs to drink “8 glass of water per day” is a fallacy; everyone’s need for water is different. A good rule of thumb to know if you are dehydrated is just to look in the mirror. If your lips are dry and wrinkled, then you probably should aim to increase your water intake. When your lips are plump and without deep lines, you’ve probably had sufficient amount. Water is best, as coffee and tea act as a mild diuretic. They won’t dehydrate you, but you will pass the water contained in them more rapidly. “Keto water” which is water with a pinch of half-salt for electrolytes (i.e. a source of sodium and potassium) can be helpful, provided you’re not taking medications such as ACE-inhibitors (e.g. Ramipril) for blood pressure, or any other medications where potassium may be limited.

If you don’t really like plain water, a Sodastream® that enables you to make carbonated water at home may be the answer. My clients know that there is always a bottle of it on my desk, as that is how I make sure to drink enough water. A twist of lime or lemon makes a nice treat too!

What about Getting Enough Fiber?

In Canada, dietary recommendations  for dietary fiber intake varies with age and gender. Men under the age of 50 years are recommended to take in 38 gm / day of dietary fiber, and men over 50 years to take in 30 gm / day. Women under 50 years old are recommended to take in 25 gm of fiber per day and over 50 years, 21 gm per day [6].

In the US, fiber intake recommendations from the Institute of Medicine range from 19 grams to 38 grams per day, depending on gender and age [7].

While people generally think of “healthy whole grains” as good sources of fiber, many are not. For example, medium grain brown rice only has 3.4 g of fiber per 100 g, whereas wild rice (which is actually a grass and not a grain) has 6.2 g of fiber per 100 g [8]. Many vegetables and fruit such as avocado and berries are excellent sources of fiber. More on that below.

Two Kinds of Fiber – soluble and insoluble

There are two kinds of fiber; insoluble and soluble.

Insoluble fiber is what most people think about when they think of “roughage” needed to form stool and prevent constipation. It helps form the bulk of the stool. Insoluble fiber is naturally present in the outside of grains, such as whole grain wheat and the outside of oats and is also found in fruit, legumes (or pulses) such as dried beans, lentils, or peas, some vegetables, and in nuts and seeds. Many of these are eaten on a low carb diet and can provide the recommended amount of fiber (more on that below).

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

For those eating a low carb diet, getting enough fiber is not that difficult. Here are a few examples of the fiber content of foods that can be eaten;

  • Avocado – Surprisingly, avocado which is an excellent source of vegetable fat, is also high in fiber, having more than 10 gm fiber per cup (250 ml). Avocado grown in Florida which are the bright green, smooth-skinned variety have more insoluble fiber than California avocado, which are the smaller, darker green, dimpled variety.
  • Berries – Berries such as blackberries and raspberries are an excellent source of antioxidants, but also have 8 gm fiber per cup (250 ml).
  • Coconut – Fresh coconut meat has 6 gm of net carbs per 100 grams of coconut, but also packs a whopping 9 gms of fiber and is a very rich source of fat (33 gms per 100 gm coconut). It can be purchased peeled, grated and sold frozen in many ethnic stores or in the ethnic section of regular grocery stores.
  • Artichoke – Artichoke is a low-carbohydrate vegetable that is delicious boiled and it’s leaves dipped in seasoned butter. Surprisingly, one medium artichoke has over 10 gm of fiber.
  • Okra – Okra, or ‘lady fingers’ is a staple vegetable in the South Asian diet and is commonly eaten in the Southern US. Just one cup of okra contains more than 8 gm of fiber.
  • Brussels Sprouts – These low-carb cruciferous vegetables are not just for Thanksgiving and Christmas dinner.  Split and grilled on the BBQ with garlic, they are a sweet, nutty addition to any meal, packing almost 8 gm of fiber per cup.
  • Turnip – Turnip, the small white vegetable with a hint of purple is not to be confused with the pale beige, larger rutabaga. Turnip contains almost 10 gm of fiber per cup. It is delicious pickled with salt and one beet and is commonly eaten with Middle Eastern food.

Irritable Bowel Syndrome (IBS) and Diverticulosis

Unfortunately, in addition to the fact that 20-30% of people in the US and Canada experience chronic constipation, approximately 10-15% of the population have Irritable Bowel Syndrome (IBS) [9].

IBS is a functional disorder of the gastrointestinal (GI) tract  ⁠— which means there is no structural or biological abnormality that can be measured on routine diagnostic tests. These people often experience chronic constipation, sometimes alternating with bouts of diarrhea, as often experience abdominal pain and bloating, as well. You can read more about IBS here. As mentioned in the linked article, many people with IBS feel considerably better when they adopt a low-carb diet because they are no longer eating many of the foods that underlie their symptoms such as grains, milk and fruit, other than berries. Unfortunately, even after adopting a low carb diet about 15- 20% of those diagnosed with IBS still have residual symptoms. In my affiliate practice, I have years of experiencing working with those with IBS and offer a specialized package, as well as a one-hour teaching session that can help.

Another common problem is diverticulosis, which an estimated 50% of those over 50 years of age have. Diverticulosis is where your colon (large intestine) has small “pockets” in it called diverticula, which can cause a number of symptoms including chronic constipation. Like those with IBS, many people with diverticulosis feel much better when they adopt a low-carb diet because they are no longer eating foods such as wheat, dairy products with lactose or high fructose fruit that used to contribute to their symptoms. The problem is that many of the low carb vegetables that are low in carbs and may be rich in fiber also may be contributing to their symptoms. So many of my clients have recently been diagnosed with diverticulosis, that in my affiliate practice I recently added a one-hour teaching session that can be added to the end of a Complete Assessment Package, or taken as a stand-alone session to help.

Final Thoughts

In trouble-shooting constipation, I recommend that people ensure they are adequately hydrated, and that they remember to drink extra water when it’s hot out or when they’ve been ill.

Eating wide variety of low-carb veggies, including those listed above that are known to be high in fiber is also good. For those on a moderate low-carb diet (not a ketogenic diet), small amounts of yam or winter squash are other ways to get added nutrients and fiber.

Berries are a wonderful source of nutrients and anti-oxidants, can be enjoyed by those on a low-carb diet and are a wonderful source of fiber! Strawberries have 3g of fiber per cup and blackberries and raspberries have a whopping 8 g of fiber per cup, with blueberries paling in comparison with a mere 2.4 g of fiber (and are higher in carbs, too).

Of course, exercise as simple as a daily walk can often help people move their bowels and many people swear by their morning cup of coffee!

For those doing all of the things above and still experiencing chronic constipation, it may be time to rule out other possible causes such as Celiac disease, or non-celiac gluten sensitivity, IBS, or diverticulosis.

I can help.

More Info?

If you would like more information about how I can help in this regard, please visit my affiliate practice, BetterByDesign Nutrition Ltd. where you can find a number of services that I offer related to Food Sensitivities / Food Allergies, Celiac Disease, IBS and Diverticulosis.

If you have questions please feel free to send me a note there or here using the Contact Me form, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

  1. Higgins PDR, Johanson JF, Epidemiology of constipation in North America: a systematic review, The American Journal of Gastroenterology 99(4); 750–759, 2004.
  2. Corazziari E, Definition and epidemiology of functional gastrointestinal disorders, Best Practice and Research: Clinical Gastroenterology, 18 (4); 613–631, 2004. 
  3. Harris LA, Prevalence and ramifications of chronic constipation, Managed Care Interface, 18 (8); 23–30, 2005.
  4. Johanson JF,  Kralstein J, Chronic constipation: a survey of the patient perspective, Alimentary Pharmacology and Therapeutics, 25(5); 599–608, 2007. 
  5. Pare P, Ferrazzi S, Thompson WG et al, An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking, The American Journal of Gastroenterology, 96(11); 3130–3137, 2001.
  6. Health Canada, Fiber, https://www.canada.ca/en/health-canada/ services/ nutrients/fibre.html
  7. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes: Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, DC: National Academies Press; 2005
  8. Source: US Department of Agriculture, Agricultural Research Service. 2014. USDA National Nutrient Database for Standard Reference, Release 27. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndl.
  9. Foundation for Gastrointestinal Disorders (IFFGD),  https://www.aboutibs.org/facts-about-ibs/statistics.html

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What is IBS and Why Do Symptoms Improve on a Low Carb Diet?

Quite a few physicians that I know that recommend a low-carb diet to their patients have mentioned to me that those who had previously been diagnosed with Irritable Bowel Syndrome (IBS) and who suffered for years reported significant improvements within a short time of adopting the dietary changes and have asked me why. That is the topic of this article.

Prior to expanding my Dietetic practice to include this low carb division a little over 4 years ago, my main focus was on helping people who were dealing with food allergies and food sensitivities; including Celiac disease, Mast Cell activation disorder (MCAD) / histamine intolerance, fructose intolerance and Irritable Bowel Syndrome  For many of my clients, it was the gastrointestinal (GI) symptoms that caused them to seek out my help in the first place.

What is IBS?

I have often thought of Irritable Bowel Syndrome (IBS) as the diagnosis that people receive when all the other possible options have been ruled out. For the most part, by the time people are told that they have IBS, they already know for sure that they don’t have Celiac disease or inflammatory Bowel Disease (IBD) such as Ulcerative Colitis or Crohn’s, and they don’t have diverticulosis ⁠—as each of those diagnoses are confirmed after a colonoscopy and/or a biopsy, and are often supported with underlying blood test results.

What makes IBS different is that it is a functional GI disorder ⁠— which means there is no structural or biological abnormality that can be measured on routine diagnostic tests.

Of course a person experiencing  a bout of diarrhea or constipation, or abdominal pain does not mean that person has a GI disorder or disease. Those symptoms could be the result of a virus, bacteria, food-borne illness (“food poisoning”) or food sensitivities. Once these have been ruled out, if the symptoms recur over and over again over time, then investigation as to what else it could be is often begun.

How is IBS Diagnosed?

While many of the symptoms of IBS and Celiac disease can be quite similar, including diarrhea and abdominal pain and bloating, there are very specific indicators that a person may have Celiac disease that clinicians such as myself notice as evidence to request further testing. The first stage in ruling out Celiac disease is an ordinary blood test looking for an antibody to gluten. If that comes back positive, then the person is referred to a Gastroenterologist for an endoscopy. If the blood test is negative, the next step may be for the person to be scheduled for a colonoscopy.

A colonoscopy which is where the inside of the large intestine (colon) is examined using a flexible probe about 1/2″ in diameter that’s fitted with a light and telescopic camera at one end and endoscopy is where a fine, flexible probe fitted with a light and telescopic camera is inserted via the mouth to view the esophagus, stomach and the upper part of the small intestine.

Celiac disease will be ruled out or confirmed using endoscopy, as the upper small intestine is where the damage to the villi (little hair-like projections on the wall that increase the surface area in order to help absorb nutrients from food) will be visible, or not.

A colonoscopy enables the Gastroenterologist to see what the lining of walls of the colon look like and to look for physiological signs of diverticulosis (little bulges or “pouches” in the colon) or signs of inflammation and damage consistent with Inflammatory Bowel Disease (IBD), such as Ulcerative Colitis or Crohn’s and to rule out colon cancer.

If the endoscopy and colonscopy come back normal, the person is often told that their symptoms of diarrhea or constipation (or both alternating), flatulence (“gas”), bloating, abdominal pain or cramping, mucous in the stool is Irritable Bowel Syndrome (IBS).

Prevalence of IBS

According to the International Foundation for Gastrointestinal Disorders (IFFGD), approximately 10-15% of the population have IBS; with 40% having a mild form, 35% having a moderate form, and 25% having severe IBS. While many people think of IBS as being a woman’s health issue, 35% to 40%  of people with IBS are men and 60-65% are women [1].

IBS is so common, that it is estimated that 12% of all visits to primary care providers (family doctors) is related to symptoms of IBS [1].

Treatment Options

Once a person receives a diagnosis of IBS the first question that is often asked is “now what?”

Physicians will sometimes suggest their patients try following a “low-FODMAP diet” but since IBS is so common, there are many different diets called by this name that differ significantly. Even if the doctor provides guidance as to which low-FODMAP diet they should follow, people often eliminate a whole host of foods and wind up eating a very limited diet, with no way of knowing which food they stopped eating actually helped.

Since I’ve been in practice in B.C (almost a dozen years), I have helped people troubleshoot which foods and beverages underlie their IBS symptoms using a systematic method that I developed, so that we can determine which changes were effective (you can read more about on that at my affiliate website by clicking here). Once we’ve determined which foods are making them feel unwell, then there are two options that I offer.  (1) Most people choose to go on to take a Complete Assessment Package and have me assess their nutrition status and design a Meal Plan for them, around the foods they can eat without symptoms while ensuring optimal nutrition. (2) Others will choose to simply avoid the foods that make them feel unwell and carry on eating the same way as they always have.

Why Eating a Low-Carbohydrate Diet often Improves IBS Symptoms?

A low-FODMAP diet eliminates sources of very specific carbohydrates that are fermented by the gut bacteria and that result in the increased gas production that underlies the classic IBS symptoms of abdominal pain and bloating, and the water flooding into the intestine in response to these fermented carbohydrates is what causes the very common symptom of diarrhea. The constipation results when the contractions of the colon are impaired, resulting in the stool sitting longer in the colon resulting in more and more of the water being re-absorbed.

When people eat a low-carb diet, they either eliminate or greatly reduce sources of fructose (the sugar found in fruit and many processed foods, especially processed condiments like ketchup) and significantly reduce one of the key sources of fructans (inulin) found in wheat; which is a highly fermentable carbohydrate. Galactans, another fermentable carbohydrate found in beans, lentils and legumes such as soy is also eliminated or greatly reduced which is why people with IBS feel so much better after beginning eating a low-carb diet!

Before I taught a low-carbohydrate approach, I used to have people take the IBS Package before the Complete Assessment Package, so we could find out what foods underlie their unpleasant symptoms and eliminate them before I designed their Meal Plan. Now, if they are planning to adopt a lower carb lifestyle anyway, then I recommend they don’t take the IBS Package, as it may not be necessary.  I recommend focus on them adopting a diet that greatly reduces the sources of the fermentable carbohydrates mentioned above, plus a few more that I tell them about and see how they feel. If their symptoms are gone, then there is no reason for them to take the IBS Package!  If however, they are feeling quite a bit better, but still have residual symptoms, then I suggest they take the IBS Package so that we can systematically determine what other non-FODMAP foods are contributing to them feeling unwell.

More Info?

If you would like more information about the IBS Package, you can find that under Services tab of my affiliate website, BetterByDesign Nutrition Ltd. and if you’re nterested in the low-FODMAP teaching, you can find that in the Shop on that site.

Of course, if you have questions please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchf-rd/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

Foundation for Gastrointestinal Disorders (IFFGD),  https://www.aboutibs.org/facts-about-ibs/statistics.html

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WHO Draft Guidelines on Saturated Fat Excludes Key Facts and Studies

An analysis was published last week in the British Medical Journal which raised several important concerns about the World Health Organization (WHO)’s draft guidelines on fatty acids; including saturated fat.

The international group of 16 nutrition experts who wrote the paper are concerned as “many governments consider the WHO dietary guidelines to be state of the art evidence, translating them into regional and national dietary guidelines” [1].

In fact, this is exactly the case in Canada. The new Canada Food Guide that was just released on January 22, 2019 relied extensively on the WHO’s 2017 Guidelines for it’s policy regarding decreasing dietary saturated fatty acids (SFA), as indicated by the table below from pg. 5 of Health Canada’s Interim Evidence Update 2018 [2]. 

Pg 5 Health Canada’s Interim Evidence Update 2018 [2]
Regarding the significance of the WHO Guidelines, the authors wrote:

“These guidelines have potential health implications for billions of people, so the consistency of the science behind such recommendations and the validity of the conclusions are crucial”.

The authors state that the WHO, in their draft guidelines released in May 2018 “excluded some important aspects and studies” concerning evidence linking saturated fat intake and cardiovascular (CVD) risk.

“They [WHO] recommend reducing intake of total saturated fatty acids to less than 10% of total energy consumption and replacing with polyunsaturated fat and monounsaturated fat to reduce incidence of cardiovascular disease and related mortality. But this fails to take into account considerable evidence that the health effects vary for different saturated fatty acids and that the composition of the food in which they are found is crucially important.”[1]

The authors point out that the composition of the food in which the fatty acid is found has a substantial effect on lipid digestion, absorption, as well as the amount of emulsified fat that is found in the blood after a meal (postprandial lipemia), which “is an independent risk factor for cardiovascular disease.”[1]

The authors point out that recently there have been several meta-analyses of observational studies and randomized controlled trials (RCTs) that found that total saturated fat is NOT associated with coronary heart disease, cardiovascular disease, and all cause mortality (i.e. deaths). In addition they report that a Cochrane analysis found no significant association between reducing saturated fatty acids and total mortality, cardiovascular disease deaths, fatal and non-fatal myocardial infarction (MIs), stroke, coronary heart disease events, and coronary heart disease deaths.

Continued Reliance on Surrogate Endpoints

The authors note that the WHO draft guidelines continue, as they have in the past, to (1) rely heavily on “surrogate endpoints” of the effect of dietary saturated fat intake on the level of lipid and lipoproteins in the blood — and (2) ignores the food source of the saturated fat.

They raise three key points;

1. Not all saturated fatty acids are equal; the amount and even the direction of the effects (raises or lowers) both surrogate and long term endpoints vary, depending on which fatty acid is involved.

2. Influence of the food source that the fatty acid is found in; the authors note that it has still not been determined whether any changes in blood lipoproteins translates into a lowering of cardiovascular risk and death, regardless of food source.

“Most trials included in the meta-analysis did not investigate whole food sources of saturated fat.”[1]

That is, the studies that WHO considered compared the effect of diets supplemented with fats rich in saturated fatty acids — not the effect of saturated fats in a specific food matrix.

One example of saturated fat in a whole food matrix cited in the paper is one of eggs; where there is “no association with coronary heart disease, and there is a reduced risk of stroke, and that randomized control trial data show that two eggs a day has beneficial effects on cardiovascular disease biomarkers“. (table 1, [1]).

3. Using LDL cholesterol concentration as a marker for cardiovascular disease risk. As I’ve written about in several previous articles, the authors note that the degree to which LDL particles are atherosclerotic is determined by, among other things, their size.

“Small and medium LDL particles show the strongest association with risk of cardiovascular disease, whereas large particles show no association.” [1]

in fact, the authors point out as I did in a recent article about red meat and white meat “raising cholesterol”, that a rise in serum LDL cholesterol concentration from total saturated fat consumption has been linked to a parallel increase in particle size “so it might not translate into an
increased risk of cardiovascular disease.”[1]

Excluding Observational Studies and Prospective Cohort Studies

The authors point out that the WHO draft guidelines exclude two types of studies from consideration; observational studies and prospective cohort studies because they argue that the quality of the evidence is lower than from
analyses of RCTs, and that it was not possible to assess the potential differential effects of replacing saturated fatty acids with different nutrients.

The problem with this is that (1) observational studies enable assessing the association between saturated fat and cardiovascular disease  rather than simply looking at the association between surrogate endpoints” (i.e. saturated fat and LDL-c) and (2) observational studies enable examining of the actual foods that people eat, rather than just individual nutrients, as

“Longstanding evidence indicates that the food matrix is more important than its fatty acid content for predicting the effect of a food on risk of coronary heart disease.”

The authors concluded;

“A recommendation to reduce intake of total saturated fat
without considering specific fatty acids and food sources is not
evidence based
; will distract from other more effective food-
based recommendations; and might cause a reduction in the
intake of nutrient dense foods that decrease the risk of
cardiovascular disease, type 2 diabetes, other serious
non-communicable diseases, malnutrition, and deficiency
diseases and could further increase vulnerability to nutrient
deficiencies in groups already at risk.

Final thoughts

This analysis adds a critical academic “voice” to the concern of limited saturated fat intake which may translate a reduction in the intake of nutrient-dense whole foods.

In fact, this was precisely the concern that I raised in my recent article about the Canada Food Guide “Snapshot” which came out at the end of June and which linked an image of ultra-processed foods with the message “limit foods high in sodium, sugars or saturated fat“.  After all, meat is high in saturated fat and cheese is high in saturated fat and sodium, but are these really the types of whole, real foods that Canadians should be advised to limit?

More Info?

If you would like more information about choosing whole, real food and limiting ultra-processed foods, I can help.

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

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchf-rd/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

  1. Astrup A, Bertram HCS, Bonjour J-P et al, WHO draft guidelines on dietary saturated and trans fatty acids: time for a new approach? BMJ 2019; 366: l4137 doi: 10.1136/bmj.l4137
  2. Health Canada. Food, Nutrients and Health: Interim Evidence Update 2018. Ottawa: Health Canada; 2019.

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Focus on Limiting Ultra Processed Food Not Saturated Fat & Sodium

Note: This article is a combination of a Science Made Simple article, with the references below and an editorial which provides my opinion.

Dietary advice ⁠— especially National Dietary Guidelines ought to give clear, consistent messages. It would seem that the new Canada Food Guide ‘snapshot’ outlined in the previous article may inadvertently cause considerable confusion as to which foods are healthy and which are not.

The new Canada Food Guide ‘snapshot’ released last week shows a photo of ultra-processed products as foods to avoid, yet the label beneath the photo reads “limit foods high in sodium, sugars or saturated fat” (see circled part of photo, below).

Canada Food Guide 'Snapshot'
Canada Food Guide ‘Snapshot’

In fact, when the image of these processed foods is clicked on the Health Canada website, it brings the reader to a page listing the “Benefits of Limiting Highly Processed foods” and has paragraphs below for Sodium, Sugars, and Saturated Fat. 

In my opinion, this conflates two issues. 

Advising people to limit ultra-processed food is not the same as advising them to limit saturated fat, sodium and sugar

There are many whole unprocessed foods and minimally processed foods such as meat, eggs, cheese, yogourt, olives and berries that have sustained humans through thousands of years of history that contain these elements and are unlikely to be responsible for our current epidemics of obesity, diabetes, hypertension and cardiovascular disease that we now face.

As mentioned in an earlier article about distinguishing between food and food-like products there is a big difference between the three categories of food as defined by the NOVA food classification system [2,3,4]. Unprocessed Foods such as meat, chicken, fish and eggs are whole, real food in their original state and Minimally Processed Foods such as cheese, yogourt or pickled and cured fish or meat or olives are foods that have been preserved in some fashion by curing, smoking or soaking in brine. Foods such as meat, eggs, cheese and olives may be high in saturated fat or sodium but have been part of the human diet for thousands of years without compelling evidence that these pose a risk to human health.

It may be helpful to recommend that people consume pickled, cured meat and fish in smaller quantities, not because these foods are high in saturated fat or sodium, but because many are now made in less traditional ways that involve the use of chemical additives.

The primary health concern that I see it is that Ultra Processed Foods is making up more than 50% of the Canadian (and American) diet and really isn’t food at all. These are manufactured products made from a combination of refined carbohydrates (including sugar) and seed oils and are convenient, hyper-palatable and cheap — and displace real food from the diet. In fact, some of the most addictive foods available to us are ultra processed foods; including breakfast cerealmuffins, pizza, cheeseburgers, French fries and fried chicken — and desserts such as chocolate, ice cream, cookies and cake, as well as the soda we wash them down with [5]. These ultra processed foods are full of “empty calories” / have little nutritional value, and full of refined fats and refined carbs. It is for this reason ultra processed should be limited — not because it is high in saturated fat and sodium. 

Even though fruit as we now know it has been bred over the last 50-100 years to be hyper-sweet, for metabolically healthy people there is still no comparison between natural whole fruit such as berries or an apple, and sugary pop. One is real, whole unprocessed food and the other is ultra processed.

In my opinion, it makes good sense for Health Canada to show a photo of ultra-processed foods as they had (above)with advice to limit them — but because they are ultra processed, not because they are high in saturated fat or sodium.

 

Shifting the Focus off Saturated Fat Based on the Evidence

As covered in several previous article on this site, while research does indicate that dietary saturated fat raises low density lipoprotein cholesterol (LDL-cholesterol) in the blood, distinction in these studies isn’t made between the small, dense LDL sub-fraction which is atherosclerotic, and the large, fluffy LDL which is not. This recent study makes this distinction; demonstrating that saturated fat from red meat and poultry raises the large, fluffy LDL and cardio-protective HDL, but not the small dense (atherosclerotic) LDL.

Epidemiological studies that do exist provide a very mixed picture of any possible association between saturated fatty acids and cardiovascular disease (heart disease and stroke); with recent studies finding no association [6,7]. Even more compelling, the data from the Prospective Urban and Rural Epidemiological (PURE) Study which was the largest prospective epidemiological study to date involving many different countries found that dietary saturated fat was actually beneficial; with those who ate the largest amounts of saturated fat having significantly reduced death rates and that those that ate the lowest amounts of saturated fat (6-7% of calories) had increased risk of stroke [8].

In addition, according to the Canadian Heart and Stroke Foundation position statement titled “Saturated Fat, Heart Disease and Stroke“ released in September 2015 [9], different saturated fatty acids (e.g. lauric, stearic, myristic and palmitic acids) have different effects on blood cholesterol, so we can’t simply lump all saturated fats together.

Focus on Where Change is Needed

I believe that national guidelines such as Canada’s Food Guide should focus on eliminating ultra-processed foods from the diet because these form almost half of caloric intake with little nutrients and displace real, whole nourishing food from the diet.

This makes good sense.

In my opinion, the linking of ultra processed foods to saturated fat and sodium as has been done in this most recent Canada Food Guide ‘snapshot’ will end up confusing the public that things like fried chicken and cheese are both equally unhealthy because they are high in saturated fat and salt.

It would be far more helpful to highlight the benefits of whole, unprocessed foods and minimally processed foods while encouraging the public to limit ultra processed foods.

More Info?

If you would like more information about limiting ultra-processed foods, while including whole, real foods (plant-based and animal-based), I can help.

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

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchf-rd/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

  1. Health Canada Snapshot: https://food-guide.canada.ca/en/?utm_source=canada-ca-foodguide-en&utm_medium=vurl&utm_campaign=foodguide
  2. Moubarac JC, Batal M, Martins AP, Claro R, Levy RB, Cannon G, et al. Processed and ultraprocessed food products: Consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res. 2014 Spring;75(1):15-21.
  3. Monteiro CA, Moubarac J-C, Cannon G., Ng SW, Popkin B. Ultra-processed products are becoming dominant in the global food system. Obes Rev. 2013
  4. Moubarac JC. Ultra-processed foods in Canada: consumption, impact on diet quality and policy implications. Montréal: TRANSNUT, University of Montreal; December 2017Nov;14 Suppl 2:21-8. doi: 10.1111/obr.12107.
  5. Schulte EM, Avena NM, Gearhardt AN (2015) Which Foods May be Addictive? The Roles of Processing, Fat Content and Glycemic Load. PLoS ONE 10(2); e0117959. https://doi.org/10.1371/journal.pone.0117959
  6. Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. Association of dietary, circulating and supplement fatty acids with coronary risk: A systematic review and meta-analysis. Ann Internal Medicine 2014;160:398-406.
  7. Sri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nut 2010;91(3):535-546.
  8. Dehghan M, Mente A, Zhang X et al, The PURE Study – Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017 Nov 4;390(10107):2050-2062
  9. Heart and Stroke Foundation of Canada, Position Statement “Saturated Fat, Heart Disease and Stroke, September 24, 2015, https://www.heartandstroke.ca/-/media/pdf-files/canada/position-statement/saturatedfat-eng-final.ashx

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Canada Food Guide Snapshot: Limit Real Whole Food or Ultra-Processed?

Note: This article is a combination of a Science Made Simple article, with the references below and an editorial which provides my opinion.

This past Monday, Health Canada released the Canada’s Food Guide “snapshot”[1] in 28 languages which is not intended to be a stand-alone resource, but to be used as a tool to guide people to the Canada’s Food Guide website.

Canada’s Food Guide includes Canada’s Dietary Guidelines[2], the healthy eating recommendations[3], and all of the other resources and information on the Canada’s Food Guide website. Links to the guidelines and healthy eating recommendations are available in the References, below.

The “Snapshot”

Canada Food Guide "Snapshot"The main message of the “snapshot” is that “healthy eating is more than the foods you eat” ⁠— which I think is an excellent way of summarizing the guidelines and recommendations and encouraging the public to want to learn more. From that point of view, the snapshot is successful in that it is likely to guide people to the website.

The main points on the Snapshot are;

  1. Be mindful of your eating habits
  2. Cook more often
  3. Enjoy your food
  4. Eat meals with others
  5. Use food labels
  6. Limit foods high in sodium, sugars or saturated fat*
  7. Be aware of food marketing

Each of these points link to the sections of Canada’s Food Guide which address those points and in my opinion are all very helpful, except for one elaborated on below.

For example, under “Be mindful of your eating habits” is and encouragement for Canadians to be aware of;

  • how you eat
  • why you eat
  • what you eat
  • when you eat
  • where you eat
  • how much you eat

Being mindful can help you:

  • make healthier choices more often
  • make positive changes to routine eating behaviours
  • be more conscious of the food you eat and your eating habits
  • create a sense of awareness around your every day eating decisions
  • reconnect to the eating experience by creating an awareness of your:
    • feelings
    • thoughts
    • emotions
    • behaviours

As the Snapshot re-iterates, these are factors that are “more than the food you eat” and helpful for people to keep in mind.

My only issue with the “Snapshot” is the use of the image for “Limit foods high in sodium, sugars or saturated fat“, circled below.

Snapshot with “Limit foods high in sodium, sugars or saturated fat” circled

Here is that image by itself;

What I see when I look at this image is ultra-processed food (what I refer to in a previous article about the NOVA Food Classification System as “food-like products“.

These are not whole, real food, but are creations of the food industry that are intended to displace real, whole food from the diet (you can read more about that by clicking here). These are products that are “branded assertively, packaged attractively, and marketed intensively”.

In fact, this picture shows some of the most addictive foods listed in a 2015 study including chocolate, muffins, pizza, pastry and soda pop[4].

Fifteen Most Addictive Fast Foods

If the intention is for Canadians to “limit foods high in sodium, sugars and saturated fat” (not that I think there is solid, scientific evidence that healthy individuals need do so with all sources of saturated fat and sodium), in my opinion the following photo would be a more accurate reflection of the principle;

Real, whole foods that are high in sodium, sugars or saturated fat

Cheese, eggs and meat are high in saturated fat, and cured meats are high in sodium and saturated fat, and dates are certainly very high in sugar, yet are not ultra-processed foods. Are these really foods that all Canadians should limit?

Is there irrefutable scientific evidence that healthy people should limit eggs, real cheese and whole fresh meats and poultry? Is it “unhealthy” for metabolically well folks to eat dates, which are very high in sugar? Or are we conflating whole, real food with ultra-processed food?

Using the NOVA food classification (outlined in the article linked above) that foods such as cheeses, cured meats and olives or anchovies are minimally processed foods that have been processed to make them ore durable and palatable, but they are not “ultra-processed foods” akin to hot dogs, pizza and pop!

I don’t believe that it is helpful to lump “ultra-processed food” and whole, real food that are high in saturated fat, sodium and sugar, together.

In my opinion, it would far better for the image in the Snapshot to read like this;

It makes good sense to advise Canadians to limit ultra-processed food⁠ because they are high in refined carbohydrates and refined fats, and low in nutrient density ⁠— but when ultra-processed food is labelled with the advice “limit foods high in sodium, sugar or saturated fat”, whole, real foods are conflated with food-like products which displace real, whole food from the diet.

Ultra-processed food is not the same as whole, real foods high in sodium, sugars or saturated fat

More Info?

If you would like more information about limiting ultra-processed foods, while including whole, real foods that are both plant-based and animal-based, I can help.

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

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchf-rd/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

  1. Health Canada Snapshot: https://food-guide.canada.ca/en/?utm_source=canada-ca-foodguide-en&utm_medium=vurl&utm_campaign=foodguide
  2. Health Canada, Canada’s Dietary Guidelines, https://food-guide.canada.ca/en/guidelines/
  3. Health Canada, Healthy Eating Recommendations, https://food-guide.canada.ca/en/healthy-eating-recommendations/
  4. Schulte EM, Avena NM, Gearhardt AN (2015) Which Foods May be Addictive? The Roles of Processing, Fat Content and Glycemic Load. PLoS ONE 10(2); e0117959. https://doi.org/10.1371/journal.pone.0117959

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Episode #41 Die Healthier Podcast – interview with Joy Kiddie RD

The Die Healthier Podcast

On Thursday, June 20, 2019 I was invited to be a guest of Daniel Flahie and Scot Gubbels on the Die Healthier Podcast and this is how they introduce the episode;

“Joy Kiddie is a Registered Dietitian offering both in-person and distance -based consultations. She is registered with the College of Dietitians of British Columbia and the College of Dietitians of Alberta as well as a member of the Canadian Clinicians for Therapeutic Nutrition. She currently resides and practices in Vancouver, British Columbia.

We discuss several topics surrounding low-carb-high-fat eating, including ketogenic diets and vegetarian approaches. Joy does a great job of leading us through a lot of the prevailing dogma surrounding nutrition on both sides of the aisle. We also discuss her personal nutrition journey and how sleep, circadian rhythm, and blue light exposure plays a major role in our overall health and well-being.”

You can follow her and read her blog on her website: www.lchf-rd.com

You can find her on Facebook and you can follow her on Twitter @lchfRD

As always, follow us:

Scot Gubbels on Twitter @Gubbsco and on Instagram @Scottyg17

and

Daniel Flahie on Twitter and Instagram @danielflahie

Referenced Work:

Satchin Panda, PhD – The Circadian Code

Matthew Walker PhD – Why We Sleep


Note from Joy: I hope you enjoy the interview and many thanks to both Daniel Flahie and Scot Gubbels for inviting me to be a guest. Just click the MP3 player bar below to listen to the interview.

The episode can be downloaded at:

Libsyn:

http://diehealthier.libsyn.com/scot

 

ITunes:

https://podcasts.apple.com/us/podcast/41-registered-dietitian-joy-kiddie/id1414760464?i=1000442706487

 

PlayerFM:

https://player.fm/series/the-die-healthier-podcast/ep-41-registered-dietitian-joy-kiddie

If you have questions about what I do or how I might be able to support you, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

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

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

Only Half of People Have Newer Gene that Controls High Blood Sugar

The maintenance of blood sugar is very tightly regulated; with a healthy person’s blood glucose being kept in the range from 3.3-5.5 mmol/L (60-100 mg/dl) between meals, however a new study indicates that it may be newer variant of a gene that determines how well (or not) we are able to maintain these levels.

After eating, the higher levels of blood glucose that comes from the broken-down carbohydrate-based food triggers the release of insulin by the pancreas, which in turn causes the release of a special transporter called GLUT4.  The GLUT4 transporter acts like a taxi to remove excess glucose from the blood, taking it into muscle and fat tissue.

Newer Variant of an Older Gene

Between meals and with the help of a special protein (CHC22) produced by the CLTCL1 gene, the GLUT4 glucose transporter remains inside muscle and fat, so that some blood sugar will continue to circulate.

A newly published study [1] by research specialists in population genetics, evolutionary biology, ancient DNA and cell biology analyzed the human genomes to understand how the gene producing CHC22 has changed over human history [2].

By examining the genomes of 2,504 people from the global 1000 Genomes Project compared to the genomes of ancient humans, researchers found that almost half of the people in various ethnic groups have a variant of CHC22 protein that is produced by a new variant of the CLTCL1 gene that became more common as humans moved away from being hunter-gathers and began farming and raising crops. Researchers postulate that the increased consumption of carbohydrates may have been the selective force driving this genetic adaptation.

Researchers found that the newer CHC22 variant of the gene is less effective at keeping the GLUT4 glucose transporter inside muscle and fat tissue between meals, which means that the transporter can more readily clear glucose out of the blood.*

As a result, people with the newer variant of the gene will have lower blood sugar than those with the older variant of the gene.

“The older version of this genetic variant likely would have been helpful to our ancestors as it would have helped maintain higher levels of blood sugar during periods of fasting, in times when we didn’t have such easy access to carbohydrates, and this would have helped us evolve our large brains”[2] — lead author Dr Matteo Fumagalli

*Note: It’s important to keep in mind that only GLUT4 transporters are insulin dependent. There are other glucose transporters that allow glucose into the cell that don’t involve insulin, such as the GLUT1 transporter that works on a concentration gradient. That is, the effect of this gene is not on all glucose regulation, but only glucose regulation in adipose and muscle cells that use GLUT4 transporters.

The higher carbohydrate diets that came as a result of the advent of agricultural meant that this newer variant of the gene could be advantageous, as it moves the excess blood sugar from the blood into the muscle and fat tissue and having the older variant of the gene may make people more likely to develop Diabetes and may also make worse the insulin resistance that underlies the process of developing Diabetes.

“People with the older variant (of the gene) may need to be more careful of their carb intake, but more research is needed to understand how the genetic variant we found can impact our physiology”[2] — co-author Dr. Frances Brodsky 

Along with the 2015 study from Israel[3] that demonstrated substantial differences in blood glucose response between both healthy individuals and those with Diabetes predictable by their gut microbiome, this new research adds to the knowledge that multiple factors are involved with determining whether people can tolerate specific dietary carbohydrate loads.

Nutritional guidelines for maintaining healthy blood glucose levels are portrayed as universally applicable, however this new study and the 2015 Israeli study demonstrates that blood glucose varies significantly between individuals based on genetics as well as on gut microbiota composition, which necessitates the need for personalized nutrition in managing blood glucose levels.

More Info

If you are interested in a personalized approach aimed at helping you gain control of your blood sugar levels, I can help.

I offer both in-person services in my Coquitlam, British Columbia office as well as remote services via Distance Consultation. You can find more information about my packages under the Services tab or in the Shop and if you would like to learn more about how Distance Consultation services work, you can click here.

Have Questions?

If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

  1. Matteo Fumagalli, Stephane M Camus, Yoan Diekmann, Alice Burke, Marine D Camus, Paul J Norman, Agnel Joseph, Laurent Abi-Rached, Andrea Benazzo, Rita Rasteiro, Iain Mathieson, Maya Topf, Peter Parham, Mark G Thomas, Frances M Brodsky. Genetic diversity of CHC22 clathrin impacts its function in glucose metabolism. eLife, 2019; 8 DOI: 10.7554/eLife.41517
  2. University College London. “Gene mutation evolved to cope with modern high-sugar diets.” ScienceDaily. ScienceDaily, 4 June 2019, https://www.sciencedaily.com/releases/2019/06/190604084857.htm
  3.  Zeevi D, et al. Personalized nutrition by prediction of glycemic responses. Cell. 2015;163:1079–1094.
  4. Noecker C, Borenstein E. Getting Personal About Nutrition. Trends Mol Med. 2016;22(2):83–85. doi:10.1016/j.molmed.2015.12.010

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Lowering LDL and Saturated Fat to Lower Risk of Cardiovascular Disease

INTRODUCTION: There much debate in the health community about the effect of dietary fat — especially saturated fat on cholesterol levels and whether there is an association between dietary saturated fat intake and cardiovascular disease.

In the first part in this two-part series titled High Cholesterol and the Risk of Cardiovascular Disease, I explained what cholesterol is, the different types of cholesterol (HDL-C, VLDL, LDL-C and triglycerides (which are not actually cholesterol), what their role is, and what “high cholesterol” is.

In this article which is Part 2 in the two-part series, I will explain the association between dietary intake of saturated fat and higher levels of total LDL, and whether reducing total LDL — whether through the use of statin medication or diet lowers the risk of cardiovascular disease.


Dietary Saturated Fat and LDL

When people are told that they have “high cholesterol”, what is meant is that they have high total LDL. They are told they have high “bad” cholesterol, with no regard that there are different sub-fractions of LDL.

It is well known that eating foods high in saturated fat can raise LDL-C (total LDL cholesterol, but as covered in Part 1 of this two-part series, the first question one should ask when told they have “high LDL cholesterol” is “which LDL? The small dense ones or the large fluffy ones?”[1].

More often than not, the clinician that breaking the ‘bad news’ to the patients has absolutely no idea that there are different sub-fractions of LDL and that it is only the small, dense ones that are atherosclerotic [1].

Furthermore, there is almost a knee-jerk reaction on the part of many clinicians to prescribe statin medication in order to lower their LDL, on the assumption that lowering LDL will lower their risk of cardiovascular disease. In fact, aggressive treatment to lower total LDL-C has been at the (pardon the pun) heart of preventative cardiology for decades.

While statin medication (e.g. Lipitor®, Crestor®, etc.) is well-documented to reduce LDL-C levels, these are only surrogate markers (not direct markers) of cardiovascular disease (CVD). The assumption of an association between high LDL levels and CVD goes back as far as Ansel Keys and the Seven Country Study, and that the Diet Heart Hypothesis (covered in several previous articles) is simply an “establish fact”. But it is?

What evidence is there that lowering total LDL with statin medication lowers one’s risk of cardiovascular disease (CVD)?

The brand new guidelines on cholesterol management issued by the American Heart Association (AHA) and American College of Cardiology (ACC) which has just been published online ahead of print[2], places a renewed focus on LDL-C as a means to assess risk. In fact, these guidelines propose that non-fasting lipids be adopted as a screen in the general population, including “non-adults” (children and youth) [2]. As has been the case for decades., this is based on the assumption that total LDL (LDL-C) is an accurate surrogate marker for elevated cardiovascular risk, but does lowering LDL-C really lower CVD?

Of particular interest, the new American Heart Association (AHA) and American College of Cardiology (ACC) guidelines state that the traditional Friedewald equation which is used to calculate total LDL (i.e. LDL-C) as covered in Part 1 of this series of articles has been “prone to inaccuracy …at low-LDL-C and high triglyceride levels — yet decades of statin treatment has been based on the previous “inaccurate” Friedewald equation. The new guidelines promote the use of a new Martin/Hopkins LDL-C calculation method which is said to “perform better in these settings”. The question remains ‘does lowering LDL-C lower the risk of cardiovascular disease?’.

There are 44 randomized controlled trials of drug or dietary interventions to lower total LDL ( LDL-C) published in the literature which show no benefit in lowering rates of death [3] and most did not reduce CVD events [4].

Furthermore, despite a 37% drop in LDL-C and a 130% increase in HDL-C (so-called “good cholesterol”), the ACCELERATE double-blind randomized control  trial showed no significant reduction in CVD or death [3.4].

In addition, there does not appear to be a clear reduction in CVD deaths in Western European countries either as a result of using statins for prevention [5].

This begs the question as to whether using statin medication to aggressively lower LDL-C has any benefit.

A 2018 article published in Expert Review of Clinical Pharmacology concluded;

“For half a century, a high level of total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated and that statin treatment, in particular when used as primary prevention, is of doubtful benefit.” [6]

What about lowering the intake of dietary saturated fat? Does that lower the risk of cardiovascular disease?

A 2014 meta-analysis of data of 72 studies involving more than 600,000 participants from 18 countries published in the journal Annals of Internal Medicine in 2014 [7] concluded that total saturated fat; whether measured in the diet or in the bloodstream showed no association with heart disease [7].

Take away: While eating dietary fat may raise the level of total LDL cholesterol (LDL-C), lowering its intake does not show any benefit in reducing the incidence of heart disease, nor does lowering LDL-C using statin drugs.

Which LDL?

A brand new study published June 4, 2019 in the American Journal of Clinical Nutrition sheds some very helpful light [8].

The study enrolled 113 people and randomized them to either a high saturated fat diet (40% carbs, 24% protein, 35% fat; 14% saturated fat) or a low saturated fat diet (40% carbs, 24% protein, 35% fat; 7% saturated fat replaced by monounsaturated fat).

Each group changed their diet every 4 weeks from (a) a high red meat diet (mostly from beef), (b) a high white meat diet (chicken and turkey) and (c) a non-meat protein diet (legumes, nuts, grain and soy).

Researchers found that LDL cholesterol and Apolipoprotein B (explained in the first part of this article) were higher with red and white meat alike and that the increase “was due primarily to increases in large LDL particles” with no change in the small particles and no significant change in the total cholesterol to HDL ratio.

This is highly significant!

What this means is that yes, eating meat; whether it’s red meat (such as beef, lamb or goat) or white meat (such as chicken or turkey) DOES increase LDL but it’s the large, fluffy LDL particles that are increased; the ones that are not associated with cardiovascular disease[1]!

In fact, in the paper, the researchers acknowledge;

Large LDL particles, measured by several different methodologies, have not been associated with CVD in multiple population cohorts in contrast to the associations observed for concentrations of medium, small, and/or very small LDL… Thus, the estimated impact of red meat, white meat, and dairy-derived saturated fatty acids (SFA) on CVD risk as reflected by their effects on LDL cholesterol and ApoB concentrations may be attenuated by the lack of their effects on smaller LDL particles that are most strongly associated with CVD.

Essentially, there has been on over-reliance on total LDL cholesterol (LDL-C) as a marker of cardiovascular disease, without distinguishing the atherosclerotic small, dense LDL from the non-atherosclerotic large, fluffy LDL.

The authors conclude;

“…the impact of high intakes of red and white meat, as well as saturated fatty acid (SFA) from dairy sources, which selectively raised large LDL sub-fractions may be overestimated by reliance on LDL cholesterol, as is the case in current dietary guidelines.”

This means that eating red meat (such as beef or lamb) or white meat (such as chicken or turkey) or eating saturated fat from full-fat dairy (such as full fat milk, cheese and yogurt) are associated with increased levels of the large, fluffy LDL sub-fraction and based on multiple population studies the large, fluffy LDL subfraction has not been found to be associated with cardiovascular disease.

Simply put, this means that eating foods high in saturated fat does not raise small LDL particles (which are the atherosclerotic sub-fraction) and results in no change to the total cholesterol to HDL ratio, and increases the large, fluffy LDL-subfraction (which are NOT found to be associated with cardiovascular disease)!

While this is a small pilot study, it adds further evidence that eating saturated fat does not increase cardiovascular risk.

Note: high levels of the small, dense LDL sub-fraction is thought to be genetic, but is also associated with intake of trans fatty acids and high intake of refined carbohydrates. More on that in future articles.

More Info?

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

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

  1. Lamarche, B., I. Lemieux, and J.P. Després, The small, dense LDL phenotype and the risk of coronary heart disease: epidemiology, patho-physiology and therapeutic aspects. Diabetes Metab, 1999. 25(3): p. 199-211.
  2. Cao J, Devaraj S, Recent AHA/ACC guidelines on cholesterol management expands the role of the clinical laboratory, Clinica Chimica Acta 495 (2019) 82–84, Available online 03 April 2019.
  3. DuBroff R. Cholesterol paradox: a correlate does not a surrogate make. Evid Based Med,2017;22(1):15–9. doi: 10.1136/ebmed-2016-110602
  4. Demasi M, Lustig RH, Malhotra A, The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance, Clinical Pharmacist, 14 July 2017.
  5. Vancheri F, Backlund L, Strender L et al. Time trends in statin utilisation and coronary mortality in Western European countries. BMJ Open 2016; 6(3):e010500. doi: 10.1136/bmjopen-2015-010500
  6. Ravnskov U, de Lorgeril M, Diamond DM, et al, LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature, Expert Review of Clinical Pharmacology, 2008;11:10, 959-970, DOI: 10.1080/17512433.2018.1519391
  7. Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary RiskA Systematic Review and Meta-analysis. Ann Intern Med. 2014;160:398–406. doi: 10.7326/M13-1788

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From Injecting Insulin to a Low Carb Diet – the first two weeks

Note: This article is a personal account, and I have written consent from the person whose story this is, to share these details in this article. She hopes it encourages someone. Keep in mind, individual results following a low carb or ketogenic diet vary person-to-person.

At the end of May, a young woman was coming to see me for an assessment appointment, and as I was reviewing her chart in preparation, I noticed that she was taking insulin. It was apparent that she didn’t see the notice on  my web page that I don’t treat Type 1 Diabetics or Type 2 Diabetics on insulin, as I am not a CDE (Certified Diabetes Educator).

Discontinuing Insulin

When she arrived, we discussed some of the options she had, and she decided to go and see her endocrinologist and request that they discontinue her insulin and give her 12 weeks to follow a Meal Plan that I would design for her. She then signed and sent me the Confirmation of Non-Insulin Use Form, indicating that with her doctor’s permission and oversight, that she was no longer taking insulin. To support her in being successful, she decided to book weekly 1/2 hour check ins with me for the following 12 weeks.

Note: If you are taking insulin to manage blood glucose in Type 2 Diabetes or other medications do not attempt to discontinue these on your own, as the results can be very serious. Please read this post titled “Don’t Try This at Home – the need for medical supervision” for more information.

Last Friday was her first follow up appointment and she was very excited to show me her blood sugar results, her first week off insulin.  Here is the graph;

Week 1 - no insulin, low carbAs can be seen, her fasting blood sugar the first morning was 16.8 mmol (303 mg/dl) which went up to 18.7 mmol/L (337 mg/dl) 2 hours after her low carbohydrate breakfast.

The following morning her fasting blood glucose was 12 mmol/L (216 mg/dl) where it stayed more or less for a few days, then dropped to 9.9 mmol/L (178 mg/dl). This was after only one week.

I asked her to speak to her doctor to see if they would be willing to add a dose of Metformin at bedtime, to help control “dawn phenomenon”; the rise in glucose due to gluconeogenesis of the liver.  Her doctor agreed and this week she started that.

This morning was her second follow up appointment and again, she was so excited to show me her blood sugar results.

As can be seen, her fasting blood sugar the first morning of the second week was 10.8 mmol (195 mg/dl) which hardly went up at all to 10.9 mmol/L (196 mg/dl) 2 hours after her low carbohydrate breakfast.

The second morning of the second week, her fasting blood glucose was 9.2 mmol/L (166 mg/dl). The rest of the week, her morning fasting blood sugar ranged from 8.4 mmol/L (151 mg/dl) to 9.6 (173 mg/dl) where it stayed. This was only her second week off insulin.

Moderate Low Carb (not Ketogenic) Diet

Understand, that this young woman (aged 33 years of age) achieved these results eating a moderate low carbohydrate diet of 130 g of carbs per day — which is no where near the level of 25-35 g per day that most women would need to be at in order to be in ketosis, and she has been Type 2 Diabetic since 2017.

2 weeks graph – June 8 – 20, 2019 – moderate low carb diet

Here is the graph of her first two weeks of blood glucose results, tracked at fasting, before a meal, and 2 hours after a meal. The steady, linear drop is quite apparent.

She saw her GP yesterday and he is thrilled with her progress! He agreed to provide her with a requisition to do the fasting insulin that I requested, along with a fasting blood glucose and HbA1C — which we have agreed together to have re-run in 3 months, at the end of the 12 weeks.

For this week, no changes are being made in the number of carbs she is eating, however this may be adjusted in the future in order to achieve clinical outcomes.

These results speak for themselves in terms of the effectiveness of a  moderate-low carbohydrate diet to significantly lower blood sugar, as well as the adjunct treatment with Metformin, largely to control early morning gluconeogenesis.

These results also speak to the incredible benefits of her having the support of a healthcare team; me designing and monitoring her Meal Plan and her GP overseeing her care, along with her Endocrinologist.

In two weeks she will see her Endocrinologist again and she (and I!) are looking forward to hearing their response to her progress at that point in time. Given her results the first two weeks, I am confident that she will have much to be proud of!

When I asked her to send me her written consent to share these details in a blog article, I ask her to say a few words about what it was like for her to go from injecting insulin to control her blood sugar, to eating real, whole food to do it — and achieving these types of results.

This is what she wrote;

“I had done so much research into diet and lifestyle changes for Type 2 diabetes as I did not want to go on insulin. Prior to starting on insulin, I was put on Metformin and given the chance from my endocrinologist to change my diet. There was so much information about a low carb diet and its positive effect on blood sugar, so I gave it a try. It could be that I was overwhelmed, but I followed what I believed to be a low carb diet and did not see any significant changes to my blood sugar levels. They were all over the place with huge spikes, even when I would have zero carbs. Clearly something was not right. It gave me no motivation to continue and really made me feel defeated.

I knew I needed help and the only answer my endocrinologist gave me was a prescription for insulin.

I started insulin and was on it for 2 weeks without seeing any significant changes in my blood sugar levels again. This was not working.

So I decided to look for help on the nutrition side of it. Then I found you, Joy Kiddie. I read a little bit about your journey and it inspired me that you have been in my position and therefore would understand my challenges. Your journey gave me hope that there is still something that can be done. Meeting with you was even more of a motivation because you wanted what I wanted; lower A1C and more importantly, no insulin!

These past two weeks, following your guidance and eating a LCHF diet the right way, has been eye opening. I never thought I would get results like this in such a short time.

I used to hate checking my blood sugar levels and poking my poor fingers just to see a discouraging number. Now, I could check all day long because I see numbers that I never thought I would.

Seeing the levels come down and that linear decline in the graph just encourages me to continue down this path and work with you to create a healthier lifestyle.

I cannot wait to see what next week brings!”

For the last 4 years I have been working with those with Type 2 Diabetes and seen so many significantly improve their blood glucose management, and lose weight. Working with this young woman has inspired me to consider learning about insulin management and writing the CDE (Certified Diabetes Educator) certification exam next year while I will  continue to partner with people’s GPs and Endocrinologists (as is my current practice) to wean them off insulin while using a well-designed low carbohydrate diet to effectively manage their blood sugar. The literature, including the studies from Virta Health demonstrate it can be done safely and effectively and the American Diabetes Association recognize both a low carbohydrate meal pattern, and a very low carbohydrate (ketogenic) meal pattern as Medical Nutrition Therapy in the management of pre-diabetes, as well as Type 1 and Type 2 Diabetes in adults.  For more information on this, please see several articles from April 2019, under the Science Made Simple tab including this one.

My hope is that  in the days ahead, Diabetes Canada will arrive at a similar conclusion as the American Diabetes Association, the EASD, Diabetes Australia and others and recognize a low carbohydrate and ketogenic diet as options for those with Diabetes in Canada. Towards that end, I want to be credentialed as a Certified Diabetes Educator in order to be able to support those using insulin.

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

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

 

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High Cholesterol and the Risk of Cardiovascular Disease

INTRODUCTION: There is much debate in the scientific community about the effect of dietary fat — especially saturated fat on cholesterol levels and risk of cardiovascular disease. To best understand this complex topic, I have broken the subject into two articles. In this first part, I explain the different ways cholesterol values are assessed, what they are used for and what they mean. In the next part I will explain whether lowering LDL and dietary saturated fat lowers the risk of cardiovascular Disease.


What is Cholesterol?

Cholesterol is a essential structural component of all the cell membranes in the body and is used in the making of steroid hormones such as cortisol and aldosterone by the adrenal glands, sex hormones such as estrogen, testosterone and progesterone by the gonads, and is also used in the making of bile acid. Approximately 80% of cholesterol made daily by the body occurs in the liver and  intestines, with the remainder being made in the adrenal glands and reproductive organs.

Different Types of Cholesterol

Triglyceride isn’t actually a type of cholesterol, but is measured on lipid panels along with cholesterol.

Triglyceride is made up of three fatty acids (hence “tri-“) attached to a glycerol molecule (also known as glycerine), which is a sugar alcohol. Some triglyceride is taken in through the diet and the rest is manufactured by the body during lipogenesis (literally meaning the ‘making of fat’). Lipogenesis is how the body stores the excess carbohydrate we eat in our diet that isn’t immediately needed for energy.  Yes, excess dietary carbohydrate is stored in the body as glycogen and when glycogen stores are full, it is stored as fat.

As for cholesterol itself, there are several different types found in the blood;

  • high density lipoprotein (HDL)
  • low density lipoprotein (LDL)
  • very low density lipoprotein (VLDL)

Most people think of high density lipoprotein (HDL) as “good cholesterol” and low density lipoprotein (LDL) as “bad cholesterol” but there are actually two sub-fractions of LDL; the small, dense LDL sub-fraction which is associated with atherosclerotic plaque, and the large, fluffy LDL sub-fraction which is considered protective against cardiovascular disease[1].

This is important, because when people are told they have “high cholesterol“, this is usually implies that they have high LDL. This is often presented to them as them having a high level of “bad” cholesterol.

High Cholesterol

A couple of things need to be clarified about “high cholesterol”;

Firstly, “high LDL” cholesterol means high total LDL cholesterol. When blood tests are said to indicate “high LDL” a good question to ask is which LDL cholesterol is high; the small dense ones or the large fluffy ones?”. More on this below.

Secondly, it is important to note that lab tests don’t actually measure total LDL but calculate it from the Friedewald formula; which (in mg/dl) is calculated by total cholesterol (TC) – HDL lipoprotein (HDL)-cholesterol – triglycerides (TGs) / 5. 

When people are told that they have “high LDL” results on a blood test, they are often presented with a recommendation to begin statin medication, but does high total LDL provide sufficient information about cardiovascular risk? More on this below. The use of statin medication will be covered in the subsequent article.

Very low density lipoprotein (VLDL) is produced in the liver and the best way to understand its role is to think of it as a “taxi” which the liver makes and then release into the bloodstream to shuttle triglycerides around to the various tissues.  VLDL cholesterol on blood test results isn’t actually measured either, but estimated as a percentage of the triglyceride value. High VLDL is said to be a risk for cardiovascular disease but as elaborated on below, a more accurate measure is the ratio of Apopoprotein B (the lipoprotein in VLDL) compared to the Apoprotein A (the lipoprotein in HDL). 

Where does LDL come from?

Once a large amount of triglyceride has been unloaded in the tissues by the VLDL “taxi”, it becomes a new, smaller lipoprotein called low density lipoprotein, or LDL which contains mostly cholesterol and some protein.

Some LDLs are removed from the circulation by cells around the body that need the cholesterol contained in them and the rest is taken out of the circulation by the liver.

A key point here is that the only source of LDL is VLDL. This is important.

LDL is what is left once the VLDL which is made by the body has offloaded its triglyceride ‘passenger’ to the tissues.

LDL and Heart Disease

Research has often reported that elevated LDL-cholesterol is a risk factor for cardiovascular disease, including heart disease and stroke and it has been assumed that lowering LDL-cholesterol in the blood would decrease cardiovascular deaths and illness. It is this premise that lead to recommendation of treatment of high LDL with statin drugs.

One major problem is that these studies looked at total LDL which doesn’t distinguish between the small, dense sub-fractions of LDL that are atherosclerotic, and the large, fluffy ones that are not [1].

Total LDL (LDL-C) calculates (not measures!) the total content or concentration of cholesterol within all the LDL particles.

LDL particle number (LDL-P) measures the particle concentration.

Since the amount of cholesterol in each particle varies, measuring LDL-C does not necessarily reflect the actual number of particles  — but an increased number of LDL particles occurs in patients with lots of small, dense particles.

Therefore, LDL-particle number (LDL-P) is a more accurate predictor of cardiovascular events than total LDL (LDL-C).

An NMR lipid profile test directly measures the number of LDL particles (as well as HDL particles). For LDL particles, a value of less  than 1.000 in nmol/L is considered ideal, a value of 1000-1299 is considered moderate,  a value of 1300-1599 is considered borderline high, and a value >1600 is considered high.

Apolipoprotein B:Apolipoprotein A1

Apolipoprotein B (apo B) is the main lipoprotein in VLDL, and subsequently in LDL after the VLDL has offloaded its triglyceride to the tissues. Apolipoprotein B is correlated with the actual number of LDL-particles, which makes it a very good assessor of the risk of cardiovascular disease, 

Apolipoprotein A1 (apo A1) is the main lipoprotein in HDL (commonly called “good” cholesterol).

An Apo B / Apo A1 ratio of > 0.9 is considered at risk for CVD.

Measuring Apo B to Apo A1 requires special blood tests, but a proxy can be calculated by dividing triglycerides (TG) by HDL-cholesterol (HDL-C) from a standard lipid panel. Studies have found this to be a very good assessor of cardiovascular risk.

Triglyceride:HDL Ratio

In Canada (as well as Europe), values are expressed as mmol/L and the ratios are interpreted as follows [2];

TG:HDL-C < 0.87 is ideal

TG:HDL-C > 1.74 is too high

TG:HDL-C > 2.62 is much too high

In the US, values are expressed in mg/dl and the ratios are interpreted as follows [2];

TG:HDL-C < 2 is ideal

TG:HDL-C > 4 is too high

TG:HDL-C > 6 is much too high

Several studies have found that TG:HDL-C ratio also reflects particle size;

One study from 2004 reported that almost 80% of people with a TG:HDL-C ratio of greater than 3.8 (when values are expressed in mg/dl) had mostly small, dense LDL particles, indicating cardiovascular risk. This same study found that more than 80% with a TG:HDL-C ratio of less than 3.8 (when values are expressed in mg/dl) had mostly large, fluffy LDL particles, indicating lower cardiovascular risk[3].

A 2005 study [4] reported that a TG:HDL-C ratio of 3.5 or greater was highly correlated with atherosclerosis in men, as well as insulin resistance and metabolic syndrome.

A recent 2014 [5] study found that a high TG:HDL-C ratio was a strong independent predictor of cardiovascular disease, coronary heart disease and all-cause mortality both before- and after adjustment for age, smoking, BMI and blood pressure.

Based on this metric, lower cardiovascular risk would be associated with lower triglycerides, raising HDL or both.

But how?

Lowering TG:HDL-C ratio

Losing weight will lower triglycerides, however low-fat diets are not usually helpful in this regard because they are often also high in carbohydrate[2].

Decreasing intake of carbohydrates especially fructose which is found in fruit, as well as processed products made with high fructose corn syrup has been anecdotally reported to decrease hunger, making weight loss easier. Most importantly, clinical studies using well-designed low carbohydrate diets (already covered in several previous articles) are associated with both a lowering of triglycerides and a increase in HDL.

Lowering the risk of cardiovascular disease through weight loss, along with a lowering of triglycerides and an increase in HDL is where I can help.

UPDATE (June 23, 2019): Part 2 of this article titled Lowering LDL and Saturated Fat to Lower the Risk of Cardiovascular Disease is available by clicking here.

More Info?

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

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchf-rd/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

  1. Lamarche, B., I. Lemieux, and J.P. Després, The small, dense LDL phenotype and the risk of coronary heart disease: epidemiology, patho-physiology and therapeutic aspects. Diabetes Metab, 1999. 25(3): p. 199-211.
  2. Sigurdsson AF, The Triglyceride/HDL Cholesterol Ratio, updated January 12, 2019, https://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/
  3. Hanak V, Munoz J, Teague J, et al, Accuracy of the triglyceride to high-density lipoprotein cholesterol ratio for prediction of the low-density lipoprotein phenotype B, The American Journal of Cardiology, Volume 94, Issue 2, 2004, Pages 219-222, https://doi.org/10.1016/j.amjcard.2004.03.069
  4. McLaughlin T, Reaven G, Abbasi F, et al. Is there a simple way to
    identify insulin-resistant individuals at increased risk of cardiovascular
    disease? Am J Cardiol. 2005;96(3):399Y404.
  5. Vega GL, Barlow CE, Grundy SM et al, Triglyceride to High Density Lipoprotein Cholesterol Ratio is an Index of Heart Disease Mortality and of Incidence of Type 2 Diabetes Melletus in Men, Journal of Investigative Medicine & Volume 62, Number 2, February 2014

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How to Distinguish Food from Food-like Products

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

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


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

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

And it’s not only adults.

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

It’s not only obesity.

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

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

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

Too Many Carbs?

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

Industrial Seed Oils (Polyunsaturated Vegetable Oil)

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

Manufactured Food-like Products

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

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

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

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

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

The NOVA Food Classification system – defining “processed food”

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

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

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

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

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

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

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

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

Foundations for Healthy Eating using Degree of Food Processing

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

“Everyday Foods”

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

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

“Sometimes Foods”

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

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

Ultra-Processed Food

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

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

Fifteen Most Addictive Fast Foods

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

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

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

National Food Guidelines as foundations for healthy eating

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

New Canada Food Guide (2019)

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

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

 

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

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

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

Does eating cheese really undermine healthy eating?

Or a rib steak?

Or milk?

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

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

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

Choosing Healthy Food

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

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

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

More Info?

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

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

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchf-rd/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

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

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A New Little Black Dress – a Dietitian’s Journey continues

May 25 2008 and June 15 2019

Yesterday I had an occasion to wear a new little black dress that I had bought, and remembered the last time I wore one. Ironically, it was for my Master’s convocation just over 11 years ago, and the dress was a size 16. My degree was in Human Nutrition, yet I was very overweight and had pre-diabetes.

The degrees on the wall did not help me understand why ⁠— despite my best efforts to “exercise more and eat less”, I was still overweight.  Despite my research related to the neurotransmitter dopamine, it was not known at the time how dopamine is involved in the potent joint reward system of eating foods that are a combination of both carbohydrate and fat (you can read more about that here). 

I did not understand why following the advice of my physician didn’t help.  I ate according to the (then) Canadian Diabetes Association (now called Diabetes Canada)’s recommendation to eat 65 g of carbohydrate at each meal and 25-45 g of carbs at each snack ⁠— along with lean protein and monounsaturated and polyunsaturated fat and participated in exercise several days each week. I ate “plenty of healthy whole grains” and “lots of fruit and vegetables“, along with low fat dairy,  yet a year later progressed to Type 2 Diabetes; what I was told was a “progressive, chronic disease”.

My studies didn’t help me understand the impact of high levels of circulating insulin on obesity and the effect of the after-meal and after-snack rise in insulin and then it’s drop shortly later on hunger. The reality was, the advice we were taught to “eat less and move more” did nothing to address the underlying issue of being hungry every few hours. In fact, the detrimental effects of high circulating levels of insulin weren’t taught; only the effects of high blood sugar.

My studies didn’t help me understand that “plenty of healthy whole grains” for someone who is already insulin resistant, with high levels of circulating insulin isn’t helpful.  I didn’t understand how eating plenty of fruit was further contributing to my problems;  both because of it’s high carbohydrate load, as well as it being a high source of fructose. I drank 3 glasses of low-fat milk daily, but didn’t understand the effect of all of those extra carbohydrates on my blood sugar, as well as underlying insulin response.  It was not part of what I studied ⁠— either in my undergraduate degree or Master’s studies, because it simply was not well known.

It is only recently (April 18, 2019) that the American Diabetes Association (ADA) issued their Consensus Report which indicated that “reducing carbohydrate intake has the most evidence for improving blood sugar” (you can read more about that here). In fact, the ADA now includes both a low carbohydrate eating pattern and a very low carbohydrate (keto) eating pattern as Medical Nutrition Therapy for the treatment of those with pre-diabetes, as well as adults with Type 1 or Type 2 Diabetes.

While these are not currently part of Diabetes Canada‘s options, they are recommendations available to those in the United States.

In fact, the European Association for the Study of Diabetes (EASD) also classifies low carb diets as Medical Nutrition Therapy (see here) and Diabetes Australia released their own updated position paper for people diagnosed with Diabetes who want to adopt a low carbohydrate eating plan. 

Many studies already demonstrate that a well-designed low carbohydrate diet is both safe and effective for the treatment of obesity and Diabetes (you can find a convenient list of studies under the Physician and Allied Health Provider tab), but much of this has only come to light in the years since I graduated with my Master’s degree.

In the last 4+ years since I first learned about the therapeutic use of a low carbohydrate diet, I have read scores of studies in an effort to become well-informed and continue to do so in order to stay current with the emerging evidence. Under the Science Made Simple tab, you can read some of the almost 170 articles I have written so far, many of them fully referenced.

April 2017 – April 2019

On March 5, 2017 I began what I have called “A Dietitian’s Journey” where over the subsequent two years, I put my Type 2 Diabetes into remission, lowered my dangerously high blood pressure and achieved a normal body weight and optimal waist circumference. You can read my story under A Dietitian’s Journey.

I have been in maintenance mode for more than three months and have been able to maintain my weight loss and health gains with little effort. My ongoing personal articles since being in maintenance appear under Making Health a Habit which can be read here.

I continue to maintain my original Dietetic practice that focuses on food allergy and food sensitivity (including Celiac disease, Irritable Bowel Syndrome, Inflammatory Bowel Disease) through BetterByDesign Nutrition, and through continued reading in the scientific literature, I am now able to provide a range of options for weight loss and improvement in many metabolic conditions, including Type 2 Diabetes, hypertension and abnormal cholesterol that I was unable to offer a few years ago.  Through BetterByDesign Nutrition, I offer variety of evidence-based approaches, including a Mediterranean Diet, a plant-based whole foods approach (vegetarian or including meat, fish and poultry), as well as a low carbohydrate approach and through this division, The Low Carb Healthy Fat Dietitian I focus exclusively on using a low carbohydrate or ketogenic approach.

If you would like to learn how I might be able to help you, you can learn more about my services under the Services tab or in the Shop.

If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

 

To your good health!

Joy

NOTE: This post is classified under “A Dietitian’s Journey” and is my personal account of my own health and weight loss journey that began on March 5, 2017. Science Made Simple articles are referenced nutrition articles, and can be found here.

You can follow me on:

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

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

 

Half a Million Visitors!

Today, the Low Carb Healthy Fat Dietitian web site greeted its 500,000th visitor. That’s half a million people!

When I launched this division of my practice a year and a half ago, I could not have possibly imagined that so many people would have visited the site in such a short period of time.

I am truly humbled that this web site is of interest to so many people, including many clinicians.

Top Five Articles to Date

Out of the almost 170 Science Made Simple articles that I have written so far, the top five are;

  1. When Normal Fasting Blood Glucose Results aren’t Necessarily Normal (November 26, 2018) – When people have a fasting blood glucose test and the results come back normal they’re told or assume that everything’s fine. But is it?
  2. New Study: Dietary Saturated Fat is not Associated with Increased Risk of Cardiovascular Disease (CVD) (April 7, 2019) – A new meta-analysis of 43 studies did not find that higher saturated fat intake is associated with higher risk of cardiovascular disease (CVD) events.
  3. Low Carb Diet in 2019 American Diabetes Association’s Standard of Care (December 18, 2018) – The ADA states that a low-carbohydrate diet is safe and effective in adults to lower blood sugar, reduce Diabetes medication usage and support weight loss.
  4. Importance of Waist Circumference and Waist to Height Ratio (May 22, 2018) – Waist to height ratio is a much better predictor of cardiovascular risk and shorter lifespan than BMI. This article explains how to properly measure this.
  5. American Diabetes Association Low Carb Recommendations – one page printout (December 19, 2018) which has since been updated by this one – A one page downloadable printout that you can give your doctor or healthcare provider.

You may want to read some of the above articles or to browse through the many other Science Made Simple articles available by clicking here.

If you want to read about something in particular, feel free to use the search bar located in the lower left corner of each page to search for articles by subject.


Most Popular Recipes

Hands-down, the most popular recipe I have posted in the year and a half since The Low Carb Health Fat Dietitian was launched has been Keto Yeast Rolls, with almost 32,000 people, as well as the slightly larger-sized Kaiser bun recipe that is posted here.

The second most popular has been Low Carb Beer Batter Fish, with almost 11,000 visitors.

 


A Dietitian’s Journey

A Dietitian’s Journey is my own (n=1) personal account of following a low carbohydrate diet in order to improve my previous ill-health.

My journey began March 5, 2017 at which time I was obese, had been Type 2 Diabetic for 8 years, had very high blood pressure as well as abnormal cholesterol and triglycerides, along with mast cell disorder (which increases both blood sugar and blood pressure). I was most unwell.

I am now in remission of Type 2 Diabetes, have almost-normal blood pressure, ideal cholesterol and triglycerides and have achieved my waist-to-height goal by losing 55 pounds and have been in maintenance mode for several months.


From an Idea to Practice

I first heard about the therapeutic use of a low carbohydrate diet almost 5 years ago from a retired physician-friend and while she was my initial source of research articles on the topic, so much has been published since! Keeping up with the literature in the field and writing articles in plain, non-technical English so that people without a science background can understand has taken up much of my free time.

As my practice has expanded, most of my time is dedicated to seeing clients, but when a new study is published or landmark decisions are made (such as professional associations adopting low carb or ketogenic diets) I take the time to write about it.

With low carbohydrate and ketogenic meal patterns now recognized as Medical Nutrition Therapy by the American Diabetes Association and corresponding groups in Europe, the UK and Australia, it is a very exciting time to be a clinician working in this area.

More Info?

If you would like more information about the services I provide and their costs, you can find this under the Services tab and in the Shop.

If you would like to know how I can help support your own weight-loss or health-recovery goals or to help you reduce risk of chronic disease, please send me a note using the Contact Me form above.

To our good health!

Joy

You can follow me on:

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

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

3 Months in Maintenance Mode – making health a habit (short video)

Today is exactly 3 months since I completed my health recovery and weight loss journey, and this short video update is about how I navigated the transition from “weight loss mode” to “maintenance mode”. This is the 14th entry in the series titled “Making Health a Habit”, which can be found here.

Making Health a Habit picks up where A Dietitian’s Journey left off and provides general health information about lowering insulin resistance, keeping blood sugar at a healthy level, or maintaining (or building) muscle mass, or may simply be my opinion on different matters related to a low carb or ketogenic diet. Making Health a Habit are short videos (< 5 minutes in length) or short blogs on health-related topics and are quite different than Science Made Simple articles which are longer,  research-focused articles.

Feel free to leave your thoughts on social media after watching the video.

In addition to helping people begin their own weight loss and health recovery journeys, I also provide follow up services to support them to be successful over the months, and sometimes year or two it takes and to help them make the transition to maintenance mode.

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

P.S. As mentioned in the video, here is the selfie I took this morning, of what I looked like after 3 months in “maintenance mode”.

To your good health!  

Joy

 

You can follow me on:

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

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

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

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

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

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

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

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

Guideline 1 – Real, whole food

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

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

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

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

Yes!

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

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

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

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

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

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

Example of whole, real food (low carb omnivore)

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

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

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

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

Guideline 2 – Limit Processed or Prepared Food

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

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

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

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

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

Guideline 3 – Know How to Prepare and Cook Food

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

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

I agree.

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

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

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

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

Some Final Thoughts…

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

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

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

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

More Info?

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

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

To your good health!

Joy

You can follow me on:

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

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

References

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

 

The Problem with Counting Net Carbs

People who eat a low carb or ketogenic diet often ask me about calculating “net carbs” and are surprised by my reply, as it differs from what they’ve read online. The commonly held advice is to subtract “fiber” from the total amount of carbohydrate on the label to arrive at “net carbs” can lead to an underestimation of nutrient intake, as well as possibly an underestimation of the effect of the food on blood glucose and insulin release when those foods are processed into other foods by grinding and/or heating.

As with other meal pattern types, a “whole foods” approach when following a low-carb lifestyle is preferable. That doesn’t mean that people shouldn’t enjoy the occasional low-carb treat, as long as they understand that a baked good prepared from almond flour is not equivalent in terms of nutrient availability to the whole almonds from which it is made.

“Net Carbs” and the Perils of Food Processing

As covered in detail in two previous articles called The Perils of Food Processing (Part 1 is here and Part 2 is here),  I showed that both the amount and type of food processing applied to a food impacts the amount of nutrients available for absorption by the body, as well as having varying effects on the body’s insulin and blood sugar response. 

“Food processing” in this context means that amount that a food undergoes cutting or grinding and/or cooking in someway, including baking. Mechanical processing, such pounding or grinding food is an ancient form of food processing which has an effect on how many nutrients are available to be digested.

That is, the nutrients available to the body when food is eaten raw and whole versus raw and pounded is significant, and this holds true whether the food is animal protein such as meat or a starchy vegetable such as sweet potato. It is also true for foods such as almonds.

The availability of carbohydrate and energy is different for whole, raw almonds versus ground almonds such as almond flour — a staple in low carb and keto baking. More on that, below.

Changes in Insulin and Blood Glucose Response Resulting from Food Processing

As covered in the first article linked to above, mechanical processing of a food doesn’t change the amount of carbohydrate that is in it. That is, when we compare 60 g of whole apple with 60 g of pureed apple or 60 g of juiced apple, there is the same amount of carbohydrate in each. The Glycemic Index of these three are very similar so this isn’t very helpful to inform about the blood glucose response to actually eating these different foods.

When these foods are eaten, the insulin response and blood glucose response 90 minutes later is significantly  different.

As can be seen by the graph on the right, in healthy individuals blood insulin level goes very high with the juiced apple and in response, blood glucose then goes very low, below baseline. The response seen with the juiced apple is typical of what is seen with ultra-processed carbohydrates. 

The Effect of Mechanical Processing of Fruit on Blood Glucose Response – Gabor Erdosi – Food News 2018

The same effect that is true for fruit is true when grain is ground; plasma insulin response increases the smaller the particle size of the grain.

The Effect of Mechanical Processing of Wheat on Blood Glucose Response – Gabor Erdosi – Food News 2018

Whole grain releases less insulin than the same amount of cracked grains, which is less than the same amount of course flour. The highest amount of insulin is released in response to eating the same amount of fine flour.

What is true for wheat is also true for rice and of interest, there isn’t a big difference between the insulin response with brown rice versus white rice.

The Effect of Mechanical Processing of Rice on Blood Glucose Response – Gabor Erdosi – Food News 2018

While there is no difference in the Glycemic Index or Glycemic Load of whole wheat versus ground wheat or whole rice versus ground rice, there is a huge difference in the insulin response with difference types of mechanical processing.

Also as outlined in the previous articles (links above), the amount of fiber that was in the grain did not make a difference in the amount of insulin released, only the amount of mechanical processing of the grain. So, eating brown rice versus white rice won’t change the amount of insulin that is released.

Remember, insulin is a hormone that signals the body to store energy (calories), so increased insulin response in response to grinding food is important.

In short, it is the amount of cell disruption caused by grinding that increases insulin and glucose response; not the specific amount of carbohydrate in the whole food, nor the amount of fiber in the food.

For those with Type 2 Diabetes or pre-diabetes, applying “net carb” calculations to foods that have been ground is a problem; as it does not take into account the increased insulin release and resulting change in glucose response, as well as the change in energy availability caused by the grinding.

NOTE (June 2 2019): The fiber in the whole food and the ground food remains unchanged and is indigestible by the body, although it is digested by the gut microbiome into fatty acids. While fiber may slow the gastric emptying of the ground product (compared to the same product with the fiber removed), in and by itself the presence of fiber in the ground product compared to the whole food does not reduce the impact on insulin and glycemic response that the grinding causes. 

The Effect of Cooking on Nutrient Availability

Also as documented in the first of the two articles on food processing, cooking also has an effect on nutrient availability. When grains are cooked they become much more digestible – meaning that more of the nutrients are available to be absorbed. In the case of potatoes, there is double or triple the amount of energy (calories) available to the body when they are cooked versus when they are raw and these calories are now available to the body where they weren’t when they were raw.

When foods that are high in fat (lipid) such as peanuts are cooked, the amount of energy the body is able to derive from the food, increases.

The Effect of Cooking Lipid (fat) and Protein-rich Foods on Nutrient Availability – Gabor Erdosi Food News 2018
Does Food Processing Affect Almonds?

Yesterday, in preparing to write this article, I was curious if there was any information available specifically about almonds as almond flour is used in most low-carb and “keto” baked goods.

I went looking and found a September 2016 article in the International Journal of Food Science and Technology titled “A review of the impact of processing on nutrient bioaccessibility and digestion of almonds”[1] which documents the most common processing technique used on almonds and their effect on the digestion of nutrients.

In short, lab studies and animal and human studies demonstrate that there are marked differences in the way various forms of almonds (whole raw, whole roasted, blanched, milled flour) are digested and the amount of different macronutrients that are absorbed.

What is true with grinding grain, apples and peanuts holds true for almonds.

It is reasonable to assume that the body’s release of insulin and the corresponding glucose response is similarly changed by the increased bioavailablity of nutrients in those processed foods.

Ultra-processed foods, whether fruit, grains, or nuts are not treated by the body the same as whole, unprocessed foods. The macronutrient availability (i.e. amount of carbohydrate and energy) in whole, unprocessed foods is not the same as in the same foods that have been ground and/or heated, and the amount of insulin released and glucose absorbed can differ too.

Final Thoughts on “Net Carbs”

One cannot simply subtract the fiber that is contained in the whole, unprocessed food from the total carbohydrate content of the processed food and arrive at “net carbs” because the amount of macronutrient absorption of the food is increased due to the cell disruption of grinding and heating. For those with Type 2 Diabetes or pre-diabetes, one also needs to factor in the differential impact on insulin and blood glucose release that results from the food processing.

One can subtract the fiber in whole, raw almonds and arrive at “net carbs” on the assumption that the fiber is indigestible by the body and that the other nutrients listed on the label apply to the food in it’s current form, but roasting and grinding those same almonds into almond butter or grinding those almonds into almond flour and then baking (i.e. cooking) them into a host of low carb or keto ‘treats’ on the basis of their low “net carb” content can significantly underestimate their total macronutrient content. 

Should one choose to use the idea of “net carbs”, it should be applied only to whole, unprocessed (not ground or heated) foods.

Ultra-processed foods, irrespective of the carbohydrate content of the original whole, unprocessed foods from which they are made are not equivalent in nutrient availability or the body’s response to them as to whole, unprocessed foods. 

While low-carb and keto ‘treats’ may be nice as “sometimes foods”, they are not ideal as “everyday foods” if weight loss and lowering blood glucose and insulin response are goals.

More Info?

If you would like to know more about following a low carbohydrate lifestyle or to adopt it for health reasons, I can help. You can learn more about my services under the Services tab or in the Shop. If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

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

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

Reference

  1. Grundy MM, Lapsley K, Ellis PR. A review of the impact of processing on nutrient bioaccessibility and digestion of almonds. Int J Food Sci Technol. 2016;51(9):1937–1946. doi:10.1111/ijfs.13192          

How Reliable is Glycemic Index for Predicting Blood Sugar Response?

In my last post, I shared some infographics developed by Dr. David Unwin, a UK General Practitioner that help communicate the concept of Glycemic Index (GI) & specifically Glyemic Load (GL) in terms of how they impact blood sugar compared to teaspoons of ordinary table sugar.

Below is one of those infographics;

Infographic for health professionals to show how the glycemic index helps inform dietary choices (from Unwin D, Haslam D, Livesey G. It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited. Journal of Insulin Resistance. 2016;1(1))

Glycemic Response Represented as Teaspoons of Sugar

(Reference “from bit.lv.carbs-vs-fat”)

The infographic to the left has been making the rounds recently on social media and is based on the idea that high Glycemic Index (GI) foods can be represented by the effect those foods have on people’s blood sugar, compared to teaspoons of sugar.

It is not dissimilar to the infographic that I designed below for the previous article , based on Dr. Unwin’s work (1).    

The problem is, these tools are only as useful as Glycemic Index is reliable, so the questions is, is GI (and GL which is derived from it) reliable for predicting blood sugar response?

That is, if the Glycemic Index (GI) values (1) change between individuals for the same amount of the same food or (2) if they change value within the same individual when they are assessed at different times, then they cannot be relied on to predict blood sugar response in an individual.

Is Glycemic Index Reliable for Predicting Blood Sugar Response?

A study published in  the American Journal of Clinical Nutrition (2) reported that individual response to individual carbohydrate-containing food vary so much that Glycemic Index values may not be useful in indicating blood sugar response in individuals.

The Study 

Randomized, controlled, repeated tests on 63 healthy adults participated in 6 testing sessions over a twelve week period and fasted and abstained from exercise and alcohol before each session.

During each session participants ate either (1) white bread (test food) or (2) a standardized glucose drink (reference control).

Blood sugar values were measured at several points over the next 5 hours, and Glycemic Index was derived by testing the test food and reference in the same participant according to standard method. This is usual practice to control for the variability between people which may be caused by biological differences.

Results

Out of the 63 participants, in 22 participants blood sugar response was classified as “low”, in 23 participants it was classified as “medium” and in 18 participants it was classified as “high’ for the same amount of bread. That is, white bread fell in all three Glycemic Index categories with different individuals.

In addition, responses within the same individual varied by as much as 60 points between tests.

Interpretation of the Results

The study indicated (as I also covered in a previous two-part post on the effect of food processing on blood sugar response) that blood glucose response is affected by differing physical structure of similar foods, the effect of food processing and preparation methods, as well as meal consumption patterns (single or mixed meals).

The study authors concluded that the high inter- (between people) and intra-individual (within the same person) variation that was observed in the GI value of foods essentially resulted in the results being of no practical value.

“In summary, our data indicate substantial variability in GI value  determinations for white bread despite the use of standardized methodology and multiple testing in a large number of healthy volunteers. The high degree of variability demonstrates that there is potential to misclassify foods into the 3 commonly used GI categories (low, medium, and high), which would result in the inability to distinguish between foods, thus invalidating the practical applicability of the GI value.

 

The authors also indicated that this variability was also partly explained by differences in baseline HbA1c (i.e. glycated hemoglobin) which is an estimate of 3 month average of blood glucose control, as well as the insulin index (the differing insulin response to foods which was covered in this previous article), which both affect the GI value. 

Individual Glycemic Response

It should be noted that inter-individual and intra-individual variation in glycemic response isn’t only to white bread, as in this small study.

A 2015 study from Israel (3) involving 800 people who were monitored with continuous glucose monitors (CGMs) indicates that there isn’t a ‘universal’ blood sugar response to either low Glycemic Index foods or high Glycemic Index foods – that glycemic (blood sugar) response is very individual. 

“We continuously monitored week-long glucose levels in an 800-person cohort, measured responses to 46,898 meals, and found high variability in the response to identical meals, suggesting that universal dietary recommendations may have limited utility.”

Some Final Thoughts…

One cannot reliably predict that a specific amount of carbohydrate-based food will raise a person’s blood sugar the same amount as a certain number of teaspoons of sugar, because each carbohydrate-based food will have different effects on different people, and different effects within the same individual at different points in time.

More Info?

If you would like to know how to determine how you respond to specific carbohydrate based foods and how to know which carbohydrate-based foods spike your blood sugar and which don’t, I can help.

You can learn more about my services including individual hourly appointments and packages under the Services tab or in the Shop.

If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

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

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

Reference

  1. Unwin D, Haslam D, Livesey G. It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited. Journal of Insulin Resistance. 2016;1(1), a8. http://dx.doi.org/10.4102/jir.v1i1.8
  2. Matthan NR, Ausman LM, Meng H, Tighiouart H, Lichtenstein AH. Estimating the reliability of glycemic index values and potential sources of methodological and biological variability. Am J Clin Nutr. 2016;104(4):1004–1013. doi:10.3945/ajcn.116.137208
  3. Zeevi D, Korem T, Zmora N, et al. Personalized Nutrition by Prediction of Glycemic Responses. Cell. 2015 Nov 19;163(5):1079-1094.

How Carb-Containing Food Affects Blood Sugar Compared to Table Sugar

According to Dr. David Unwin, a UK general practitioner (family doctor) and published researcher whose practice focuses on helping people put their diabetes and pre-diabetes into remission,  blood sugar (glycemic) response to carbohydrate containing foods is what matters in both diabetes and obesity, and is even more than the absolute amount of carbohydrate in those foods. For Dr. Unwin, the challenge was to represent the effect of high Glycemic Index (GI) foods on people’s blood sugar in terms that could be easily understood. This article is about some of the infographics that Dr. Unwin has developed to help people more easily understand the concept of Glycemic Load*. 

*Note: I think it is important to cover a range of ways that credible individuals view important concepts. Dr. Unwin’s view of blood sugar response as it relates to Glycemic Load (GL) is only one of the ways that glycemic response is understood. The most obvious limitation is that GI measures blood sugar response as if the food is eaten alone, which rarely occurs.

UPDATE (May 14, 2019) Findings of a lack of reliability in Glycemic Index values is outlined in the next article, which can be accessed by clicking here.


In two earlier articles, I explained what the Glycemic Index (GI) and Glycemic Load (GL) are, as well as the challenges with using them.

In short, the Glycemic Index (GI) ranks the carbohydrate content of food in terms of their effect on blood sugar compared to a meal of pure glucose (which is counted as 100).

Using the Glycemic Index often causes confusion because it fails to compensate for the density of each carbohydrate in a particular portion of food. That is why Glycemic Load (GL) was created, which is given as grams of glucose for a specified portion of a food. The problem is, most people have no understanding of glucose and it’s metabolic effects and as Dr. David Unwin, a General Practitioner explained in the paper below (1), many healthcare professionals also have misconceptions about the effect of food-based carbohydrates on blood sugar, as compared to glucose.

Blood Sugar Response as a Patient tool

Dr. Unwin thought that in order to best use Glycemic Load to explain blood sugar response, that it would be more helpful for patients with pre-diabetes or diabetes to be able to understand the effect on blood sugar of eating specific by comparing them to the more familiar sugar, ordinary table sugar.  Dr. Unwin developed some infographics that explain glycemic response in comparison to one (4 g) teaspoon of table sugar.

While table sugar is made up of both glucose and fructose, patients are able to understand the table sugar analogy without being confused by what glucose is (the standard used in the Glycemic Index and Glycemic Load). 

Glycemic Load translated to Blood Sugar Response as a tool for Healthcare Practioners

Dr. Unwin’s and his colleagues had noted that healthcare professionals were making decisions based on Glycemic Index (GI) and assumed that carbohydrate-based foods have a lower GI than table sugar, which is not necessarily the case.

For example, the GI of table sugar is 65, but foods such as basmati rice (GI 69), whole wheat bread (GI 74) and baked potato (GI 86) have higher GIs. This incorrect assumption about many carb-based foods by healthcare professional affected food choices being recommended by them and which were then adopted by their patients, adversely impacting their blood sugar levels.

While Dr. Unwin expressed that health practitioners would be better to refer to Glycemic Load (GL) which takes into account the carbohydrate content of the food in terms of a likely portion size for that food, the concept of GL is not easily understood by their patients. That is where Dr. Unwin’s infographics may play a role.

Blood Sugar Response – a tool for people with diabetes and pre-diabetes

Below is one of the infographics developed by Dr. Unwin to explain Glycemic Index in terms of standard serving sizes (i.e. Glycemic Load) with a corresponding explanation of how that quantity of common foods affects blood sugar compared to one (4g) teaspoon of ordinary table sugar.

Infographic for health professionals to show how the glycemic index helps inform dietary choices.

In the infographic below, I’ve taken just 3 of the foods above and represented these three foods (1) visually (2) in imperial quantities and (3) in metric quantities.

Visual representation, imperial and metric portion sizes of 3 foods (Joy Y. Kiddie, MSc, RD)

In my experience people rarely eat the common portion size of foods, whether it is the recommended portion size listed in national food guides or in the Glycemic Index.

Common Portion Sizes rather than Normal Portion Sizes

As a Dietitian, I’ve come to realize that while the standard portion for cooked rice is given as a 1 cup (150 g) serving, many people eat more than 1 cup of rice at a time. In fact, the standard portion of rice in the old Canada’s Food Guide (which had recommended portions) was 1/2 cup (125 ml), which is half this amount!

The standard portion of spaghetti in the old Canada’s Food Guide was 1/2 cup (125 ml) which is half the amount listed in the GI portions and one has to ask how many people really limit their servings to 1 cups of spaghetti?  It is my experience that most people who are not restricting portions often eat 2 cups of spaghetti or more; which raises blood sugar as much as 13.2 tsp of sugar; and that is not yet counting the sauce that goes on the spaghetti!

Some adults eat only 3 small boiled baby potatoes at a time too but even if they do, that raises blood sugar as much as 9.1 tsp of table sugar!

Below are some other infographics developed by Dr. Unwin that demonstrate ordinary foods in terms of their effect on blood sugar compared to a teaspoons (4g) of ordinary table sugar.

I find the similarity between white bread and brown bread interesting. Not much difference, and if one makes a sandwich or 2 pieces of toast for breakfast, whether its white or brown bread, it raises blood sugar as much as 6- 1/2  and 7- 1/2 tsp of sugar…and that is before putting anything on the bread! 

Infographic for health professionals to show how bread products affect blood sugar (Dr. Unwin, from Public Health Collaborative https://phcuk.org/nice/)

Below is an infographic for servings of cereal, but again how many people limit themselves to 30g (1/2 cup) of cereal for breakfast? In my experience, most adults eat 1 cup of cereal as a serving, often more.

Infographic for health professionals to show how cereal products affect blood sugar (Dr. Unwin, from Public Health Collaborative https://phcuk.org/nice/)

Below is one of Dr. Unwin’s infographics with respect to fruit.

Again, the serving size here is much smaller than what is a “usual” serving in my experience.  For example, most people I’ve worked with eat a whole large banana, which is double this serving (and has the same blood glucose response as 11- 1/2 tsp of sugar).

Th fruit infographic below will also help explain why I recommend berries such as strawberries in 1/2 cup servings (which only affect blood glucose as much as a little over a tsp of table sugar).

Infographic for health professionals to show how various fruit affect blood sugar (Dr. Unwin, from Public Health Collaborative https://phcuk.org/nice/)

Some final thoughts…

As mentioned above, there are different views regarding how different carb-containing foods impact blood glucose levels. Dr. Unwin’s infographics are certainly helpful for people to better understand the concept of Glycemic Load.


If you have been recently diagnosed as having pre-diabetes or as having type 2 diabetes (T2D) and would like to work on reversing the symptoms by adopting a low carbohydrate lifestyle, I can help.

You can learn more about my services including individual hourly appointments and sessions as well as packages above under the Services tab or in the Shop.

If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

About Dr. Unwin

Dr. David Unwin, MD, is a UK general practitioner (family doctor) known for pioneering a low-carb approach to managing diabetes in the UK who won the prestigious NHS Innovator of the Year award in 2016 for his work with diabetes patients. He serves as medical advisor to the Low Carb Program which is an online platform approved by the NHS and aimed and helping individuals put type 2 diabetes and prediabetes into remission.

In 2017-2018, Dr. Unwin’s practice saved £57,000 ($99,445 CDN / $74,077 USD) on drugs for type 2 diabetes, hypertension and other conditions by offering patients a dietary alternative to medications.

In 2018, Dr. Unwin was named the 9th most influential General Practitioner (GP) in the UK by GP magazine and has written several peer-reviewed papers related to low-carbohydrate diets.

You can follow me on:

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

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

Reference

Unwin D, Haslam D, Livesey G. It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited. Journal of Insulin Resistance. 2016;1(1), a8. http://dx.doi.org/10.4102/jir.v1i1.8

Cancer Cases Related to Excess Weight Will Triple Over Next 20 Years

A new study published today in Preventive Medicine estimates that excess body weight, including overweight and obesity is expected to become the second leading cause of preventable cancer in Canada, after tobacco over the next 20 years.

Cancer Rates Expected to Triple

The results of the new ComPARe study (Canadian Population Attributable Risk of Cancer) stemming from research conducted by the Canadian Cancer Society and a Canadian team of experts in epidemiology, biostatistics, cancer risk factors, and cancer prevention provides estimates of the number and percentage of more than 30 cancer types in Canada. 

It found that if current trends continues, it is expected that new cancer cases related to overweight or obesity will triple over the next 20 years, from the current 7,200 cases per year to 21,200 cases per year. These figures are due to overweight and obesity alone and do not include the increase number of cancer cases that are expected due to smoking, physical inactivity / sitting too much or alcohol consumption.

Excess body weight increases the risk of esophageal and endometrial cancer by about 50% and increases the risk of kidney, gallbladder, stomach and liver cancers by 20-30%.  Achieving and maintaining a healthy body weight can substantially lower the risk of these, and other cancers.

UPDATE (May 8, 2019 5:00 PM): It is not body weight per se that increases the risk of cancer. There are several proposed mechanisms where excess body weight may increase cancer risk, including alterations in the levels of hormones and growth factors, chronic inflammation, excess insulin and leptin. It is thought that excess insulin may help promote cancer cell growth and cause insulin resistance, which increases the risk of colon, endometrial and kidney cancers in particular.

The study estimates that if Canadians maintained a healthy body weight (BMI ⩽  25), that approximately 110,600 cancer cases could be prevented by the year 2042.

If you’d like to know how I can help you with symptoms of overweight or obesity (or some of the metabolic disorders that often accompany them), please let me know.

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

To our good health!

Joy

You can follow me on:

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

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

Reference

Brenner DR, Poirier AE, Ruan Y, et al, Estimates of the current and future burden of cancer attributable to excess body weight and abdominal adiposity in Canada, Preventive Medicine, Vol 122, 2019, Pg. 49-64, https://www.sciencedirect.com/science/article/pii/S0091743519300908

Visible and Audible Difference – making health a habit (comparison videos)

Friday, I wore the same jacket during my morning walk and “Making Health a Habit” video as I did during my very first “A Dietitian’s Journey” video in March 2017, but the difference between the two videos is remarkable; not only visibly but there is an audible difference, too.

I don’t look the same…

…and listening to the two videos (links below) I don’t sound the same!

For me, this is what the difference between chronic disease and remission of metabolic disease looks like. Of course, everybody’s “journey” is different, but in order to arrive at one’s destination, the journey needs to begin.

I’ve said it a few times on podcasts, in videos and in blogs but for me, I changed how I ate and my activity level “as if my life depended on it” because for me, it did. It wasn’t just a vanity issue about how I looked; but about having very high blood pressure and Type 2 Diabetes that was not being controlled. March 5, 2017 was the turning point for me and I have not looked back.

I don’t talk about being on a “diet”, but rather about the way I now eat because in order to keep obesity, Type 2 Diabetes and high blood pressure in remission requires me to make my health a habit. If I don’t, it is only a matter of time until the chronic diseases return.

If I can help you begin on your own health and wellness journey or to maintain your accomplishments, please let me know.

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

If your physician has recommended or prescribed a low carbohydrate or ketogenic diet, please let me know when you contact me.

To our good health!

Joy

You can follow me on:

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

May 3, 2019 – Friday’s video

March 16, 2017 – my first video

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

What about “cheat days” (short video)

I often get asked about what I do about “cheat days” and this is a short video on how I navigate through it. Keep in mind this is what I choose to do and why, and is not in anyway prescriptive. This is one of many choices available and why I choose this approach. Everybody’s needs are different.

This is the 13th entry in the series titled “Making Health a Habit”, which can be found here.

Making Health a Habit picks up where A Dietitian’s Journey left off and provides general health information about lowering insulin resistance, keeping blood sugar at a healthy level, or maintaining (or building) muscle mass, or may simply be my opinion on different matters related to a low carb or ketogenic diet. Making Health a Habit are short videos (< 5 minutes in length) or short blogs on health-related topics and are quite different than Science Made Simple articles which are longer,  research-focused articles.

Feel free to leave your thoughts on social media after watching the video.

If you would like some help navigating through whether or not to take “cheat days” and if so, how based on your own health, I’d be glad to help.

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

To our good health!  

 

Joy

You can follow me on:

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

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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