Individual Meal Plan versus Personalized Online Meal Plans

Why would someone seek out my professional services to design a low carb or ketogenic meal plan for them, when there are any number of online services that will make ‘personalized’ or ‘customized’ meal plans for free- or only for the cost of a monthly membership?

There is a big difference between an Individual Meal Plan designed for someone by a professional and which is specific to their health background and risk factors, and personalizing or customizing an existing meal plan to a person’s goals, likes and dislikes, using a computerized algorithm.

There are a number of websites that encourage people to use their tools to reach their weight loss goals faster.

One email I received said recently read;

“Tell us what your health goals are and what you like to eat. In minutes, you’ll have a custom-made keto or low-carb meal plan. It’s the perfect meal plan for you.”

This site and other similar types of websites calculate the protein, carbs, fat and total calories for a person to reach their weight goals based on their own computer algorithm, and then provide recipes based on the person’s likes and dislikes that fit those “macros”. The question is will it be the perfect meal plan for you?

It may, or it may not.

Those Without Pre-Existing Conditions

If you have not been diagnosed with type 2 diabetes or pre-diabetes, have normal blood pressure and cholesterol, and have not been diagnosed with any other health conditions and just want to lose weight, then one of these online diets that can be personalized or customized with your likes and dislikes may be a good way to get started. Speak with your doctor before beginning any diet, including one I may design for you.

Some sites and algorithms may be better than others, so look around. In general, I would consider whether a website provides scholarly references in their blogs as possibly being a better place to start, over websites that don’t list their source of information (more about that in this article).

It has been my experience that ~1/3 of clients end up coming to me after doing one of these online low carb or keto diets. Some reach out when they find themselves stuck in a long-term weight-stall, after initially losing some weight. Others, especially peri- and post-menopausal women come to me after they don’t lose weight or in some cases, gain weight. The “macros” may fit the particular website’s algorithm, but not them.

There are also some people who lose weight just fine using an online diet, but end up contacting me after their follow-up lab tests indicate that their cholesterol has gone up a lot, and their doctor wants to put them on medication. Then what?

…and of course, there are those who lose weight successfully with no negative outcomes whatsoever and that is great stuff!

The question is, are online meal plans a good approach for you?

Those With Pre-Existing Conditions

If you have been diagnosed with type 2 diabetes or pre-diabetes, have high blood pressure or cholesterol, then working with a professional is important — especially if you are taking medication. As outlined in a previous article, people should not begin a low carb or very low carb (keto) diet if they are taking certain types of medication, especially:

(1) insulin

(2) medication to lower blood glucose such as sodium glucose co-transporter 2 (SGLT2) medication including Invokana, Forxiga, Xigduo, Jardiance, etc. and other types of glucose lowering medication such as Victoza, etc.

(3) medication for blood pressure such as Ramipril, Lasix (furosemide), Lisinopril / ACE inhibitors, Atenolol / β₁ receptor antagonists

(4) mental health medication such as antidepressants, medication for anxiety disorder, and mood stabilizers for bipolar disorder and schizophrenia.

When people approach me for services and are taking insulin or insulin analogues, I refer them to someone with CDE certification who can help them to adjust their dosage, as carbohydrates are gradually reduced. I am not a CDE and do not see people taking insulin or insulin analogues. That said, I have worked with people’s doctors who have gradually deprescribed insulin, as their patients begin to follow a low carbohydrate Meal Plan that I have designed for them.

For those who are taking some of the other medications listed above and with people’s written permission, I coordinate care with their doctors who oversee their patient’s care and adjust medication dosages, as the quantity of carbohydrate is gradually reduced.

This is definitely not something people should do on their own!

As outlined in the article referred to just above, depending on the medication there can be serious side effects.

But what if you don’t have any health conditions and don’t take any medications? Does that mean you are “fine”? Maybe, maybe not.

Very Few People Are Metabolically Healthy

A study published in November 2018 in the journal Metabolic Syndrome and Related Disorders found that 88% of people are already metabolically unhealthy[1].

If you have not been told you have diabetes or pre-diabetes, high blood pressure or high cholesterol, then how do you know if you are among the 12% that are still metabolically healthy?

Here are a few questions that you can ask yourself to help you determine if you may be part of the small metabolically healthy group of people — or part of the 88% that are already metabolically unhealthy:

Are you carrying excess weight around the middle? If you are a guy and your waist circumference > 40 inches or 102 cm or are a woman and your waist circumference >34.5 inches (88 cm) then the answer is you are already part of those who would be considered metabolically unhealthy [1].

An even easier way is to measure your waist-to-height ratio as described in this article, and if the result is more than 0.50 then you are at increased risk of cardiovascular disease[2]. If you have already been told that you have type 2 diabetes or pre-diabetes, high blood pressure or high cholesterol, then your risk is even higher.

Do you have blood pressure higher than 120/70? If either the top number (systolic blood pressure) is larger than 120 and the bottom number (diastolic blood pressure) is larger than 70, then you are part of those who would be considered metabolically unhealthy, based on this study.

Do you have high fasting blood sugar? Is your blood sugar measured first thing in the morning after not eating anything for 10 or 12 hours  > 5.5 mmol/L (100 mg/dL)? If yes, you are already part of those who would be considered metabolically unhealthy.

If your fasting blood glucose test comes back normal, does this mean everything’s “fine”? Maybe yes, maybe no. This previous article explains the different stages that exist before people are diagnosed as having pre-diabetes –when their fasting blood sugar is fine, but their ability to regulate blood sugar is already ‘not fine’.

What about your insulin response? A large-scale 2016 study found that 75% of those with normal fasting blood sugar and normal blood sugar after a 2 hour Oral Glucose Tolerance Test had abnormal blood sugar results between 30 minutes and 60 minutes — indicating that they were at increased risk of being diagnosed with type 2 diabetes, even though their 2 hour Oral Glucose Test results were still normal.

Is your three-month estimated average blood sugar (HbA1C) high? If your HbA1C is > 5.7% then you are already showing signs of being metabolically unhealthy.

Do you have “high cholesterol”? Are your triglycerides > 1.7 mmol/l ((150 mg/dl) or your HDL (good cholesterol) < 1.00 mmol/L (<40 mg/dl) if you are a man or >1.30 mmol/L (50 mg/dl) if you are a woman, then based on this study you are already considered metabolically unhealthy.

Getting an Individual Meal Plan?

If you have already been diagnosed with any of the conditions mentioned above — and especially if you are taking medication for them, then speak with your doctor about working with a Registered Dietitian such as myself to design an Individual Meal Plan for you. Some physicians and other healthcare professionals who are familiar with the therapeutic benefits of a low carb or very low carb (keto) diet refer their patients to me, and we work together to coordinate care, as described above.

I design people’s Meal Plan based on their specific macronutrient needs, taking into account their age, gender, stage of life, health history and previous diagnoses, lab work, any medications taken, food likes and dislikes, religious preferences, time constraints, as well as cooking ability. I design each person’s Meal Plan in such a way as to be as close to how they like to eat, with the “fixes” built in.

For those who don’t know if they are metabolically healthy or not, we find out in the course of me assessing them as I look at all of the parameters outlined above. If they are already showing signs of being metabolically unhealthy, then I will design their Meal Plan in such a way as to enable them to make dietary- and lifestyle changes that may delay- or even prevent diagnosis of some of the conditions mentioned above.

Final Thoughts

The “best macros” are the ones designed for each person in light of any health conditions and risk factors.

There is no one-sized-fits-all low carb or keto diet©

More Info?

If you would like more information about my services, then please have a look under the tab of that name or send me a note through the Contact Me form.

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

References

  1. Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metabolic Syndrome and Related Disorders Vol 20, No. 20, pg 1-7, DOI: 10.1089/met.2018.0105
  2. Ashwell M, Gunn P, Gibson S (2012) Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 13: 275–286

 

Copyright ©2021 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

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

How Much Protein Interferes with Ketosis or Stresses the Kidneys?

This past week there was an online post about the need to restrict protein when following a keto diet because too much protein will lead to lower levels of ketosis.  Other online sites that many people think of as credible say that eating too much protein causes the body to use glucose instead of ketones, knocking a person out of ketosis [2] — and will refer to ‘experts’ they’ve spoken to as sources. Do we need to limit protein and carbs? Who should we believe?

This is the post from social media that I saw this week that resulted in much discussion online, but I have edited out the name of the site because I have no issue with the website, or the author of the article.  I am only using it as an example of the type of information that is being widely circulated, often without references.  It reads;

“Too much protein can lead to lower levels of ketosis. Make sure that you track what you eat and monitor the amount of protein you’re eating. The average person only needs about 70-90 g of protein per day.”

The article from the same web site[1] , presumably to which the post refers says that ‘ideal protein intake’ depends on genetics, gender, current macro intake, insulin sensitivity, how long you’ve been on keto, activity levels, current body composition and body composition goals[1], but that there is “no need to plug all these factors into a complex algorithm to figure out how much protein you can get away with eating”. They say that “most keto dieters”  can follow the general protein recommendations they outline, namely:

Sedentary — consume 0.6 – 0.8g of protein per pound of lean body mass

Regularly active — have 0.8 – 1.0g of protein per pound of lean body mass

Lift weights — eat 1.0 – 1.2g of protein per pound of lean body mass

No references are provided in the article for the above recommendations, so how do we know?

What are evidence-based protein recommendations for those following a non-therapeutic ketogenic diet* ?

*I define therapeutic ketogenic diets as one used in the treatment of a disease, such as the classic Ketogenic Diet (KD), the Modified Ketogenic Diet (MKD), the Modified Atkins Diet (MAD). You can read more about those here.

More on that below, but first a few words about how to determine if a source of information is credible.

Scholarly Sources / References

When I cite references in my articles, it is to support the evidence for what I am writing about. As much as possible, I prefer to cite academic, peer-reviewed research papers — which means that not only are they written by experts in the field, the papers are first reviewed by other experts in the field (i.e. peer-reviewed) before the findings are published in a journal.

I also refer to published standards such as the Dietary Reference Intakes, for example and will also refer to books written by experts in the field who have previous publications in peer-reviewed journals or books for which references can be found.

I cite scholarly sources because I don’t want people to take my word for it, even though I am a published researcher with academic credentials. My readers can check the references in my articles and verify that they say what I wrote.

All too frequently, people online will say they got their information from a Mayo Clinic article, Healthline or a ‘keto’ website where the person writing the article is neither a researcher with academic credentials, nor cites scholarly sources.

There is no way to verify what is claimed as there is no trail to follow.

It may the writer’s opinion, or the opinion of an ‘expert’ they talked to, but if one can’t read the academic source of the claim, then it should be assumed to be the writer’s opinion, not evidence-based science.

Recommended Protein in a Well-Designed Ketogenic Diet

As written about in the previous article, A Keto Diet is NOT About How Much Fat it Contains, Dr. Stephen Phinney, MD, PhD and Dr. Jeff Volek, RD, PhD in their 2011 book, the Art and Science of Low Carbohydrate Living  recommend that carbohydrate intake be 7.5-10% of calories for men, 2.5-6.5% of calories for women, protein intake to up to 30% of calories during weight loss and 21% during weight maintenance and fat intake to 60% of calories during weight loss and 65-72% during weight maintenance [2].

In relation to protein intake alone, Phinney and Volek elaborate that;

“…our studies of muscle retention and function during carbohydrate restriction [27,78,87], we recommend daily protein intakes between 1.5 and 2.5 grams per day per kg of reference body weight* [5].”

*reference body weight is an estimate of lean body mass — and is essentially the midpoint of the ideal body weight IBW range, by gender. 

That book was written in 2011, so this morning I decided to look into what their current protein recommendations are — in light of their ongoing research in the field of ketogenic diets.

The excerpt below is from an article written by Dr. Stephen Phinney, MD, PHD, Dr. Jeff Volek, RD, PhD and Brittany Volk, PhD, RD on the Virta Health page, in an article titled “How Much Protein Do You Need In Nutritional Ketosis?”[4]

NOTE: While this is from an article, peer-reviewed academic references are provided and it is written by well-established researchers in the field. On that basis, I consider this to be a credible source of information.

“While a precise analysis of dose-response to varying protein intakes during nutritional ketosis has not been done in humans, we have performed a number of studies indicating that most healthy humans maintain lean body mass and function during a ketogenic diet providing between 1.5 and 1.75 grams of protein per kg of ‘reference body weight’ (Phinney 1983, Davis 1990). Furthermore, there are no convincing human studies showing any benefit from dietary protein above 2.0 g/kg reference weight for adults following a ketogenic diet.

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.
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Once through the first few weeks of keto-adaptation, there does not appear to be any reason to change one’s dietary protein intake either with further time of adaptation or cumulative weight loss. The exception would be if blood ketones remain low (i.e., below 0.5 mM) despite tight carbohydrate restriction, in which case reducing protein from the 2.0 to 1.5 g/kg or even to 1.2 g/kg reference weight range might be reasonable.”

How Much Protein Interferes with Ketosis?

There is a reason Phinney, Volek and Volk do not recommend protein intakes in excess of 2.0 grams protein / kg reference body weight per day for those following a ketogenic diet:

“Protein has a moderate insulin stimulating effect; and though less than the impact of a similar amount of carbohydrate consumption, high protein intakes can drive down ketone production in the liver (Marliss 1978). In fact, specific amino acids like alanine are potently anti-ketogenic. Additionally, when consumed to excess, protein can upset gastro-intestinal function and place a stress on the kidneys to remove the additional nitrogen.”

That is, protein intake above 2.0 grams protein / kg reference body weight per day is not recommended for those following a ketogenic diet as it may reduce the amount of ketones the liver produces, and it may put stress the kidneys to remove the excess protein. But 2.0 grams of protein / kg of reference body weight per day is a huge amount of protein (more on that, below).

The Recommended Dietary Allowance (RDA) for protein is 0.8 grams of protein per kg per day, which is the level that is sufficient to meet the requirements of 97 – 98 % of healthy people. This is not the optimum requirement but the minimum.

As outlined in a previous article based on a lecture by Dr. Donald Layman, PhD, Professor Emeritus, University of Illinois, the maximum of the range of safe intake is ~200 gram protein per day and is based on >2.5 grams protein per kilogram per day.  According to Dr. Layman, a high protein diet doesn’t start “until well above 170 g / day“.

Recommended Daily Allowance (RDA) for Protein [slide from Dr. Donald Layman, PhD – The Evolving Role of Dietary Protein in Adult Health]
Just how much protein-based food does one actually have to eat to get even 100 grams of protein, let alone more? It’s a lot more than commonly thought.

How many grams of protein is in what we call ‘protein foods’? Here are some examples from a previous article.

Egg (1 large) – 6.3 grams

Sausage, pork link (14 gm / 0.5 oz each) – 2.5 grams

American cheese (28 gm / 1 oz.) – 7 grams

Cottage cheese (250 ml / 1 cup) – 28.1 grams

Salmon (170 gm / 6 oz.) – 33.6 grams

Ham (170 gm / 6 oz.) – 35.4 grams

Tuna (170 gm / 6 oz.) – 40.1 grams

Chicken, breast (170 gm / 6 oz.) – 37.8 grams

Broiled Beef steak (170 gm / 6 oz.) – 38.6 grams

Hamburger (170 gm / 6 oz.) – 48.6 grams

Turkey, dark meat (170 gm / 6 oz.) – 48.6 grams

Pork Chop (170 gm / 6 oz.) 49 grams

Beef (170 gm / 6 oz.) – 54 grams

Final Thoughts

As outlined in many previous articles,  a low carbohydrate or ketogenic diet is defined by how little carbohydrate it contains, not how much fat or protein it has.

It is a myth that there is such as thing as THE keto diet. There are many types of keto diets, with the popularized very high fat ‘keto diet’ promoted widely in the media being one type.

It is also a fallacy that the average healthy person following a low carbohydrate or ketogenic diet for weight loss or health improvements needs to limit protein.

Each individual’s macro needs (energy, protein, fat and carbohydrate) are different and vary depending on a person’s age, gender, stage of life, health conditions and activity level, so choosing the appropriate level of protein, fat and carbs in a low carbohydrate or ketogenic diet needs to be based on those — and what a person is seeking to accomplish. Is it weight loss? Is it lowering blood sugar levels? Is it optimizing health? Different goals also influence how macros are established.

We should not fear carbohydrates. They are part of real, whole foods such as low carb vegetables and fruit — and even higher carbohydrate vegetables such as yam or squash can be included in reasonable quantities in a well-designed low carbohydrate or non-therapeutic ketogenic diet and when we eat them in a meal can significantly lower their impact on blood sugar and insulin levels. We limit them to achieve our weight-loss and health-goals, but we need not nor should not avoid them.

There is no need to limit protein or in most cases to even count it except when ensuring it is adequate based on individual need. Older adults, for instance need more not less protein to lower the risk of sarcopenia, which is muscle loss as we age.  It is very hard to exceed the range of safe intake for protein while eating real, whole food. There are individual cases where someone may need to monitor intake such as in pre-existing chronic kidney disease, but for the average person following a well-designed low carb or ketogenic diet, this is unnecessary.

What are “the perfect macros”?  They are the one’s based on your needs and your goals.

There really is no one-sized-fits-all low carb or keto diet.

More Info?

If you would like more information about my services then please have a look under the tab of that name or send me a note through the Contact Me form.

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 ©2021 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. Clarke, Craig, ruled.me, November 30, 2020, Is Too Much Protein Bad For Ketosis [THE TRUTH], https://www.ruled.me/too-much-protein-bad-for-ketosis/
  2. Kimberly Holland, Healthline, People are Trying a ‘Lazy Keto’ Diet. Experts Aren’t Impressed, https://www.healthline.com/health-news/what-is-lazy-keto
  3. Volek JS, Phinney SD, The Art and Science of Low Carbohydrate Living: An Expert Guide, Beyond Obesity, 2011
  4. Phinney SD, Volek JS, Volk B, How Much Protein Do You Need In Nutritional Ketosis? February 21, 2018, Virta Health, https://www.virtahealth.com/blog/how-much-protein-on-keto

A Keto Diet is NOT About How Much Fat it Contains

The myth persists that a “keto” diet is all about the fat…bacon, heavy whipping cream, and fat bombs. It’s about adding butter and MCT oil to coffee, about eating fatty cuts of meat and lots of avocado. While the amount of fat is very important for therapeutic ketogenic diets written about previously, it plays no role in the definition of “keto”, as most people know it. 

What makes a diet “low carb” or “keto” is only how little carbohydrate it contains NOT how much fat it contains.

Defining “Low Carb” and “Keto” Diets

Different individuals and groups define “low carb” and “keto” (very low carb) in various ways. Feinman et al [1] defined three categories of reduced-carbohydrate diets;

(a) very low carbohydrate / ketogenic diet: carbohydrate limited to 20–50 g per day or < 10% of total energy intake

(b) low carbohydrate diet: carbohydrate limited to < 130 g per day or < 26% of total energy intake

(c) moderate carbohydrate diet: carbohydrate limited to 130–225 g per day or 26–45% of total energy intake.

In its Consensus Report of April 18, 2019, the American Diabetes Association and the European Association for the Study of Diabetes (EASD) defined a low carbohydrate diet as having 26-45% of total daily calories as carbohydrate (a combination of a low carbohydrate diet and a moderate carbohydrate diet defined by Feinman et al), and defined a very low carbohydrate (ketogenic) diet as 20-50 g carbs per day. In its 2020 Standards of Medical Care in Diabetes, the American Diabetes Association continued to define low carb and very low carb the same way.

Diabetes Canada also defines a low carbohydrate diet as less than <130 g of carbohydrate per day or <45% energy as carbohydrate, and very low carbohydrate (ketogenic) diet as <50 g of carbohydrate per day in its April 2020 Position Statement [3].

What defines a low carbohydrate or very low carbohydrate (“keto”) diet is ONLY the amount of carbohydrate it contains. There isn’t even any mention of how much fat it contains!

How Much Carbohydrate is Essential in the Diet?

The Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) which forms the basis for dietary recommendations in both the US and Canada reads;

“The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed[4].

There are essential amino acids and essential fatty acids that we need to take in through the diet because the body can’t make these, but there is no essential carbohydrate because the body can make any carbohydrate it needs from amino acids (from protein) or fat.

How Much Fat in a Keto Diet?

There is nothing magical or mystical about how much fat or protein is required in a “low carb” or “keto” diet.

Whether one starts a low carb diet at 130 g of carbohydrate per day or a “keto” diet of 20-50 g carbohydrate per day, the remainder of daily calories is provided as protein and fat.

As outlined below, the popularized “keto” diet sets the amount of fat at approximately 75% of daily calories as fat, but this is only one type of “keto” diet.

It is a misconception is that to be a “keto” diet, most of daily calories needs to be as fat. 

It is also a misconception that added fat that is part of a low carb or “keto” diet must be animal fat.  Added fat as food or to cook with, or to put on salad can be provided by high fat fruit such as avocado or olives (fruit or oil), coconut (meat or oil), and nuts and seeds. If people choose, they can be low carb or “keto” and eat a predominantly whole-food plant-based (vegetarian) meal pattern.

Popularized “Keto” Diet

The popularized “keto” diet promoted widely on the internet is described as 75% fat, 15% protein and 10% carbohydrate, but is only ONE “keto diet” and not “THE keto diet”.

There are other “keto” diets, including the low carb, high protein, moderate fat ketogenic diet called Protein Power published in 1997 by Dr. Michael Eades and his wife Dr. Mary Dan Eades [5], the 2010 New Atkins For a New You [6] — which is a redesign of the original “Atkins Diet” from the 1970s written by Dr. Eric Westman, Dr. Stephen Phinney MD PhD, and Dr. Jeff Volek RD PhD which is only a very high fat ketogenic diet (20-50 g carbs per day) for phase one which lasts only the first two weeks, and there is also Real Meal Revolution [7] by Tim Noakes, Sally-Ann Creed, Jonno Proudfoot. Phinney and Volek’s approach in their 2011 book, the Art and Science of Low Carbohydrate Living has been to establish carbohydrate intake at 7.5-10% of calories for men, 2.5-6.5% of calories for women, protein intake at up to 30% of calories during weight loss, 21% during weight maintenance and fat intake to 60% of calories during weight loss and 65-72% during weight maintenance. Fat intake at 60% of calories during weight loss is NOT the same as the 75% calories as fat of the popularized “keto” diet.

The popularized “keto” diet is based largely on the two 2016 books by Dr. Jason Fung titled the Obesity Code [8] and The Complete Guide to Fasting [9], and the 2017 book titled by Dr. Andreas Eenfeldt, the founder of the popular “Diet Doctor website”, titled A Low Carb, High Fat Food Revolution [10] — both of whom write extensively on the Diet Doctor website.

Defining “High Fat”

In the US, the recommendation has been to limit calories from fat to no more than 30% of daily calories, of which no more than 1/3 comes from saturated fat and in Canada, to limit fat to 20-35% of daily calories as fat, with no more than 1/3 from saturated fat.  By definition, diets higher than 30% fat (US) or 35% fat (Canada) are considered “high fat”.

A “keto” diet which is only 40% fat would be considered “high fat” by the USDA and Health Canada, as would a “keto” diet that is 75% fat.  

But is a diet that is 40% fat really “high fat”?

From 1949 until 1977, dietary intake in Canada was at ~40-50% of daily calories as fat,  ~20-30% of daily calories as protein, and only 20-30% as carbohydrate. Was this the original “low carb high fat” diet?

Clarifying Definitions

In anything, it is important to define terms.

A “low carb” or “keto” diet is ONLY about how little carbohydrate it has (<130 g carbohydrate per day, 20-50 g of carbohydrate per day) and has absolutely nothing to do with how much fat it has.

Or how much protein in has, for that matter.

Contrary to what some on social media want to know, there is no “protein starting point” for a low carb or “keto” diet.  Each individual’s macro needs (energy, protein, fat and carbohydrate) are different, and vary depending on a person’s age, gender, stage of life,  health conditions, and activity for example.

There is no one-sized-fits-all low carb or “keto” diet with a set amount of fat, and set amount of protein. It depends what one is seeking to accomplish. Based on the definition, a low carb or “keto” diet for weight loss could range from 40% fat to 75% fat — and up to 90% for those following a therapeutic ketogenic diet for seizure disorder or glioblastoma.

People are always looking for the “formula for success” when it comes to weight loss but there isn’t one, except the one that works best for them.

More Info?

If you would like more information about my services then please have a look under the tab of that name or send me a note through the Contact Me form.

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 ©2021 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. Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ,Westman EC, et al. Dietary Carbohydrate Restriction as the First Approach in Diabetes Management: critical review and evidence base. Nutrition. 2015;31(1):1–13
  2. Evert, AB, Dennison M, Gardner CD, et al, Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report, Diabetes Care, Ahead of Print, published online April 18, 2019, https://doi.org/10.2337/dci19-0014
  3. Diabetes Canada, Diabetes Canada Position Statement on Low Carbohydrate
    Diets for Adults with Diabetes: A Rapid Review Canadian Journal of Diabetes (2020), doi: https://doi.org/10.1016/j.jcjd.2020.04.001.
  4. National Academies of Sciences, Engineering and Medicine, Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids, 2005, https://www.nap.edu/catalog/10490/dietary-reference-intakes-for-energy-carbohydrate-fiber-fat-fatty-acids-cholesterol-protein-and-amino-acids
  5. Eades M, Dan Eades M (1997), Protein Power: The High-Protein/Low-Carbohydrate Way to Lose Weight, Feel Fit, and Boost Your Health–in Just Weeks! Bantam; New edition edition (1 December 1997)
  6. Westman E, Phinney SD, Volek J, (2010) The New Atkins for a New You – the Ultimate Diet for Shedding Weight and Feeling Great, Atria Books February 17, 2010)
  7. Volek JS, Phinney SD, The Art and Science of Low Carbohydrate Living: An Expert Guide, Beyond Obesity, 2011
  8. Noakes T, Creed S-A, Proudfoot J, et al, (2013)The Meal Real Revolution, Quivertree Publications
  9. Fung J (2016) Obesity Code, Greystone Books, Vancouver
  10. Fung J, Moore J (2016), The complete guide to fasting : heal your body through intermittent, alternate-day, and extended fasting, Victory Belt Publishing
  11. Eenfeldt A, Low Carb, High Fat Food Revolution: Advice and Recipes to Improve Your Health and Reduce Your Weight (2017), Skyhorse Publishers

One Client Journey – down over 200 pounds

Introduction: It’s been almost three years since I started working with my client Karen D. in February of 2018 and in that time she has lost over 200 pounds. Yes, two hundred pounds!

When she came to see me the first time, I was only one year into my own weight-loss and health-recovery “journey”,  and was still very much overweight and metabolically unwell, but had come to understand from the scientific literature that a well-designed low carbohydrate diet was both safe and effective for weight loss, as well as for helping put some metabolic conditions into remission.  

In April 2019, Karen private messaged me on social media and sent me a photo of herself, after she had lost 150 pounds. It was both delightful and very rewarding to receive this from a client and to see that she had continued to apply what she had learned, and was doing exactly what she set out to do. She gave me permission to share it on social media with only her first name and initial of her last name, which I did. All people knew is that this was what one client had accomplished in a year.

Last week instead of private messaging me an update,  Karen decided to post a compilation photo of herself under one I had posted of myself on Facebook.  Even though I had not spoken to her in over a year, there was her picture for everyone, including me, to see! Wow!! Karen had lost more than 200 pounds, and had every reason to be proud of her accomplishment! 

In response to her initiative to share her progress publicly on Facebook, I ask Karen if she would be willing to tell her story in her own words from a client perspective and she agreed — and her reason for doing so is this;

“I don’t want others living the same life I was stuck in”.

So, if you think you can’t “do it” and that your weight loss goals are “impossible”, this post is for you.

This is one client story. This is Karen’s journey.


Karen D. – January 2018, 440 pounds

“I started keto on my own in January 2018, but it really stressed me out. There is so much information ‘out there’, and everything contradicted itself. It didn’t make sense to me. Macros, IF, fat bombs…..even in my coffee. Seriously, don’t mess with my coffee.

I needed help!

In one way I felt ‘lost’, but I did know that not eating lots of “complex carbohydrates” was right for me. I knew that keto was the right option, but this high fat thing scared me, largely because of my history of having had eating disorders since I was 12 years old.

There was something about this way of eating that made me feel like I had control over food for a change, instead of food having control over me but I didn’t feel like I grasped it enough to be successful.

I researched dietitians that specialized in low carb eating, as I’d seen dietitians before that just pulled out the Canadian Food Guide and told me to eat oatmeal for breakfast. I came across Joy.  Boy did I get excited! You see, I have severe anxiety and always feel like I’m doing something wrong. When I tried to do keto on my own, it was hard to know if it was wrong, or I just felt it was. I needed clear answers and directions.  And I was desperate. I had to loose weight.

I started at over 440lbs, last time a scale was able to weigh me. I’d been successful at loosing some weight on my own since January but I was on a mission. I was going to do it this time. For me, for my kids, for everything I had. The prospect of working with Joy meant clear answers to my questions, directions on how to really achieve my goals, and SUPPORT! I was going to have help, and not have to try to figure this out myself!

How I felt leading up to seeing Joy (from my Facebook)

Leading up the appointment was nerve racking for me. As a morbidly obese person, you get used to being told how far gone you are and how your health is at jeopardy.  Just asking for help sometimes is scary as you don’t know how judged you are going to be. I had so many questions that I wanted to ask, and was just hoping I’d really be “heard”.

My biggest question as a client was “why do I have to eat so much fat?” Is that really necessary?

And my second big question as a client was “do I really need to track my macros?” because that flares up my eating disorders.  I end up punishing myself if I see how much I’ve actually eaten.

It was the day of my appointment and I arrived at Joy’s office. She greeted me so warmly. Off to a good start. Honestly, the first bit is a bit of a blur as my anxiety was pretty high. I remember us talking about my health,  my back, my fibromyalgia, my families health diseases.  But I also remember how encouraging Joy was about the success I had already accomplished on my own. She was excited for me. I was freely able to talk about my eating disorders and we were able to come up with solutions with my meal plan to help me, not freak out over the calories and macros! And we discussed ‘fat’. Enough fat for flavor,  enjoy your food, have that piece of avocado, but I had enough fat on me that my body will take that for fuel. It was not necessary to eat high fat.

[more info about that here]

Joy put together a meal plan for me that made sense and that eased my fears as her client. She explained to me what my body needed, and I needed her explanation. It gave me ‘permission’ not to have to eat all that fat, and I was able to get my head to wrap around this way of eating. Now it made sense. I had the tools and I had the backup!

When I started seeing and feeling the results, it created the motivation to continue. 

This is me after I lost the first 50 pounds.

June 1, 2018, down 50 pounds

 

 

 

 

 

 

 

 

And this is what I wrote on my Facebook:

Eating low carb is a very anti-inflammatory way of eating, so my body just started to feel so much better without all the sugar.  I was starting to see huge changes in the way my body moved and looked. I was experiencing amazing non-scale victories that just kept me driven to keep going and wanting more.

January 1, 2019, down 100 pounds

It wasn’t always easy. Sure, there where set backs and temptations. It took a great mind-change to see things differently.

 

 

Karen D. down 150 pounds January 2018 – April 25, 2019

I didn’t make alternative foods. Didn’t try to find alternative to chips and rice and pasta. I just didn’t eat them anymore.

If I accidentally ate an ingredient that wasn’t keto friendly, that didn’t mean I ruined my whole day and should start over tomorrow. It just meant one bad thing went in my mouth.

Same as if I gave into temptation.  “Give yourself a break“, I would say to myself. “We aren’t perfect,  don’t make your success suffer because of one small stumble. Why start over tomorrow when you can continue today?”

This is me today.

I’m passionate about this because I’m working on my journey, and it has changed my life.

I went from being bed-bound for sometimes weeks at a time, to living a full life now.

I’m working hard to regain my life to the fullest and know that it is something that is possible for anyone who wants to do it.

I still have a bit to go before I’m at my ideal weight, but I can see the finish line. I’m going to be there soon.”

~ Karen D, January 3, 2021

A picture tells a thousand words (January 2018 – January 2021)

More Info?

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To your good health!

Joy

 

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