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

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

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

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

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

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

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

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

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

Our bodies did not evolve to see those things.

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

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

wild carrot

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why does this matter?

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

References

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

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

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PART 1: The Role of Protein in the Diet

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

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

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

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

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

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

The Recommended Daily Allowance (RDA) for Protein

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

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

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

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

Recommended Daily Allowance (RDA) for Protein [slide from Dr. Donald Layman, PhD – The Evolving Role of Dietary Protein in Adult Health]
The minimum amount of protein (56 g / day) is calculated based on 0.8 g protein per kg of body weight and the maximum amount of protein (~200 g / day) is calculated based on >2.5 g protein per kg of body weight.

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

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

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

Current Dietary Intakes – the problem with carbs

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

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

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

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

Current Intake of macronutrients is as follows;

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

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

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

What is going to give us the best health?

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

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

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

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

Eating Well with Canada’s Food Guide
USDA Food Guide Pyramid

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

So how did that work out for us?

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

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

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

Let’s first look at children;

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

What about adults?

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

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

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

  1. grain based desserts and snacks
  2. yeast bread
  3. pasta
  4. pizza
  5. chicken and chicken products
  6. soda and sports drinks

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

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

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

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References

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

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

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

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

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

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Homemade Olive Oil Mayonnaise

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

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

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

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

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

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

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

This one is just perfect!

Ingredients

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

Instructions

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

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

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

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

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

Enjoy!

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

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Which Low Carb Diet?

Low Carb -HP-HF-both

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

Three Types of “Low Carb” Diets

1 – Low Carb High Protein

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2 – Low Carb High Fat

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

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

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

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

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

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

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

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

3 – Higher Protein Lower Fat followed by Moderate Protein High Fat

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

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

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

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

Human Protein Tolerance

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

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

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

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

This Dietitian’s Approach

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

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

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

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

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

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

In any case, I make the process easy.

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

Have questions?

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

To our good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

References

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

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

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

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

 

 

 

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

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

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

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

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

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

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

So how am I doing?

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

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

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

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

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

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

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

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

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

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

Have questions?

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

To our good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

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

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

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

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

Low Carb Chili – with real beans!

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

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

Black Soy Beans

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

nutritional label for Black Soy Beans

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

 

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

The rest was veggies, meat and seasoning.

Here’s the recipe:

Low Carb Chili Con Carne

Ingredients

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

Method

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

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

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

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

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

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

partially cooked beef and seasoned vegetables

7 – Empty the can of diced tomatoes on top.

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

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

Chili con Carne – ready to serve!

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

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Ideal Low Carb High Fat Keto Bread

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

One of the important services I provide to my clients are day-to-day meal ideas and recipes, as well as information on how to thrive living low carb in a high carb world.  After all, for any lifestyle to last it needs to be sustainable – enabling people to eat real food prepared in ways they enjoy.

Over the last several years, I have created dozens of satisfying low carb and ketogenic adaptations for well-loved recipes, only a few of which have found their way onto this web page. For the most part, my recipes come out of my own need following a low carb high fat / keto lifestyle, but some ideas have been generated by my client’s needs; such as the Ideal Low Carb Meal Replacement Shake that I posted yesterday.

One of the things my clients who follow a high fat moderate protein lifestyle needed was a low carb high fat keto bread that could be eaten “as is” with melted butter, made into a grilled cheese sandwich, or an egg and sausage breakfast sandwich, and which would hold up to being loaded with meats and cheese, slathered with mayo and eaten without falling apart. Storing and freezing the bread for later use was also essential. That recipe is below, along with the nutritional info per slice and macronutrient distribution.

What makes this bread “ideal” for those following a low carb moderate protein lifestyle because (1) that 2 slices can serve as a meal replacement on it’s own or with a salad, it is (2) low carb and high in healthy fat and (3) 2 slices have the equivalent protein found in an average meal on either a moderately low carb or ketogenic (keto) low carb diet. The ingredients are (4) available at any large chain supermarket and will (5) keep you from feeling hungry for a long time due to the type of protein and amount of fat it contains and (6) is quick to prepare. It (7) stores well in the fridge and (8) can be frozen for quick use later.

This bread is light and moist with a lovely, tender crust and can be topped with hot or cold meats or cheese and will hold up to lettuce, tomatoes and mayo, too.  It’s uses are as limitless as your imagination.

The recipe and instructions for making this bread are below as well as a few photos of serving uses.

Ingredients

  • ½ cup (125 ml) + 2 Tbsp (50 ml) unflavored whey isolate powder
  • ½ tsp. (2.5 ml) baking powder, sifted
  • ½ tsp. (2.5 ml) salt
  • 3 oz. (100 g) Parmesan cheese, finely grated
  • 3 oz. (100 g) three cheese mixture (mozzarella, provolone, parmesan), finely grated
  • 2 oz. (30 gm) full fat cream cheese, softened
  • 4 Tbsp. olive oil
  • 1 egg + 1 egg yolk

Instructions

1 – Preheat the oven to 375 °F (190 °C).


2 – In a small bowl, beat the egg and egg yolk and add the softened cream cheese.

 

 


3 – Drizzle in the olive oil as if making a salad dressing (so it is suspended in the egg / cream cheese mixture).

 

 

 


4 – Combine the dry ingredients in a medium size mixing bowl.

NOTE: The two bowls with wet and dry ingredients can be covered and refrigerated at this point and be combined and baked within minutes the following morning, for breakfast sandwiches or lunches.


When ready to bake:

5 – Pour the liquid ingredients into the dry ones.

Note: The dough will a thick batter.

 

 


6 – Using a non-stick pizza pan sprayed with cooking spray (or a regular baking sheet lined with parchment paper), pour the dough in the middle.

 

 


7 – Place a piece of wax paper or parchment paper on top of the dough and gently press outward with your fingers until you have a 10″ circle.

When you remove the wax (or parchment paper), scrape any batter sticking to it onto the dough.


8 – Bake the crust for 9-10 minutes or until golden brown.

Be careful not to over bake it or it will be too dry and crumbly.


9 – Remove the crust from the oven and let cool a few minutes before transferring to a board and cutting.

 


10 – Cut the bread in eight wedges.

 

 


Storage

The individual slices of bread can be placed in a freezer-weight zipper storage bag and placed in the fridge for the following day or frozen for later use.


Some Serving Ideas

Bread and Butter

This bread is delicious hot from the oven, slathered with butter.

Mixing up the wet and dry ingredients the night before, and storing the bowls in the refrigerator overnight makes it possible to prepare hot bread in the morning in less than 15 minutes, including clean up.


Croque Monsieur

A “croque monsieur” is a baked or fried ham and cheese sandwich. My version is made with smoked chicken.

I photographed this one before topping it with the second slice of bread, so you can see how well it holds up to grilling.


Egg and Sausage Sandwich

Topped with cheese, smoked ham (or smoked chicken) and a fresh easy-over egg makes this the most amazingly delicious egg and sausage sandwich imaginable!

 

Grilled Cheese

Who doesn’t love grilled cheese? This one has all the taste and ‘mouth-feel’ of a high carb version, without the carbs!

 

 

Nutrition Facts - per 1 slice Ideal Low Carb Keto Bread (each slice 1/8 of the bread)

Fat 16 gm
Carbohydrate 2 gm
Protein 11 gm
Energy 200 kcal

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Ideal Low Carb High Fat Meal Replacement Shake

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

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

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

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

Nutrition Facts - per 1 

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

These are essentially protein powder with flavouring and thickening agents.

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

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

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

What’s not to love?

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

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

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

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

 

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

 

 

Here’s the recipe:

Low Carb HIGH FAT Ideal Meal Replacement Shake

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

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

Method

  1. Place the green tea (matcha) powder and ‘daily greens’ mixture in a small stainless steel sieve and gently rub through the sieve into a small ceramic bowl, using the back of a spoon. Discard any residue from the sieve.

  2. Add the unflavoured whey protein isolate to the ceramic bowl.


  3. Using a whisk (or if you have one, a bamboo whisk available at Japanese and Korean grocery stores) add 3 Tbsp boiled water, while stirring with the whisk.  Keep stirring briskly until all the lumps are gone and the mixture is smooth.

  4. Stir in the coconut milk, blending well.

  5. Pour mixture into a tall, insulated 2-3 cup (500-750 ml) travel tumbler, add ice cold water and ice cubes and enjoy!

 

Nutrition Facts - per 2 cup (500 ml) serving

Fat 34 gm
Carbohydrate 8 gm
Protein 27 gm
Energy 446 kcal
Macronutrient Distribution – Ideal LCHF Meal Replacement Shake

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

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Your 2018 Health and Weight Loss Goals

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

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

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

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

That’s more than 2 months.

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

I can help.

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

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

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

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

Want to know more?

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

Let’s do this together!

To our health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

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References

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

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

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

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How Much and Which Types of Fat?

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

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

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

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

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

What kinds of fat?

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

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

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

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

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

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

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

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

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

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

To our good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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

Copyright ©2018 – The Low Carb High Fat Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without 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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Working on Health Goals?

 

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

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

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

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

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

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

What about you?

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

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

To your good health,

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

 

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Top New Years Resolutions

 

Have you made any New Years Resolutions? According to two University of Scranton studies done ten years apart, two of the top New Years Resolutions are to lose weight and eat healthier. The study also found that those who made New Years Resolutions were 10 times more successful at changing their behavior in the short run than those who wanted to change their behavior but didn’t actually making a resolution. The bad news was that only a week into the New Year, 50% had already given up and by the end of January, that number had risen to 83%.

Unfortunately, only 8% of people are successful in achieving these types of New Years Resolutions on their own.

The reality is that it takes approximately 66 days to create a new habit (Lally et al, 2010). That’s more than 2 months. Having the professional support of a Registered Dietitian during this critical time can make all the difference!

Like many of my clients, you have probably lost weight before — perhaps by cutting portion sizes, going to the gym or eating ‘low fat’. You dutifully ate rabbit food, cottage cheese and skimmed milk and while the weight came off, you were probably hungry, grumpy and cold, but determinedly you pressed on. Or maybe you didn’t.

What if I told you there’s a much better, and easier way to lose weight and as importantly, bring blood sugar levels and blood pressure levels down and lower high triglycerides?

There is.

I not only teach it, I am doing it.

If you want 2018 to be the year you achieve your weight loss and health goals, then let’s do this together.

Please send me a note using the “Contact Me” form on this web page to find out more.

All the best of health and happiness to you and yours in 2018!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

References

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

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

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

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Crisp Keto Pizza

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 tried a few existing recipes for low carb pizza and was quite disappointed, as they were either more like omelettes, or gritty with coconut or almond flour.  The biggest strike against them was that they were limp – definitely not the crisp, yeasty finger food I was wanting!

I decided to invent one. I knew basically what ingredients I wanted to use (based loosely on my tempura batter) and that it had to have a yeasty ‘bread’ taste. I also knew it would have some cheese in the crust (like the infamous ‘fat head pizza’) and that it had to be so overwhelmingly ‘legit’ that someone who wasn’t eating low carb or keto would enjoy it. Finally, it had to be good cold, too – after all, who doesn’t like cold pizza?

To my delight, I practically nailed it on the first try.

If you’re like me and love pizza, I hope you will enjoy this one.

Ingredients

  • ½ cup (125 ml) + 2 Tbsp (50 ml) unflavored whey isolate powder
  • ½ tsp. (2.5 ml) baking powder, sifted
  • ½ tsp. (2.5 ml) salt
  • 3 oz. (100 g) Parmesan cheese, finely grated
  • 3 oz. (100 g) three cheese mixture (mozzarella, provolone, Parmesan), finely grated
  • 2 oz. (30 gm) full fat cream cheese, softened
  • 1/2 tsp instant yeast, dissolved in 2 Tbsp warm water
  • 4 Tbsp. olive oil
  • 1 egg + 1 egg yolk

Instructions

  1. Preheat the oven to 375 °F (190 °C).
  2. Combine the dry ingredients in a mixing bowl.
  3. In a smaller bowl, beat the egg and egg yolk and add the softened cream cheese. Drizzle in the olive oil as if making a salad dressing (so it is suspended in the egg / cream cheese mixture. Once the yeast has proofed (foamed), mix it into the liquid. Stir well.
  4. Pour the liquid ingredients into the dry ones.

    Note: The dough will a thick batter.

  5. Using a non-stick pizza pan (or a regular baking sheet lined with parchment paper), use the back of a spoon to smooth the dough into a 10-inch circle.
  6. Place a piece of wax paper or parchment paper on top and gently roll with a rolling pin.  When you remove the wax (or parchment paper), scrape any batter sticking to it onto the dough.
  7. Bake the crust for 10 minutes or until golden brown. Don’t overcook.
  8. Remove the crust from the oven and top with your favourite pizza sauce and toppings.
  9. Once the pizza is topped, return it to the oven to bake until the  cheese is melted and it is just beginning to brown.
  10. Allow to cool a few minutes, then slide the crispy pizza to a serving board, cut, serve and enjoy!
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Keto Eggnog – for the holidays

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

What would the holidays be without eggnog? I’m not talking about the artificially yellow-coloured, carrageenan-thickened beverage from the supermarket, but real eggnog rich with egg yolks and heavy cream. That’s what I’m taking about!

Whether its for Christmas Eve or New Years, eggnog embodies the holidays.

According to Statistics Canada, during the 2014 holiday season, Canadians drank ~5.3 million litres of commercially made ‘eggnog’, but apparently a decade ago, it was closer to 8 million litres! Perhaps the mistaken belief that saturated fat is ‘bad’ for us has led to the decline, or maybe it is simply that the commercial-prepared substitute pales in comparison to real eggnog.

The National Dairy Code defines eggnog as;

“food made from milk and cream containing milk and cream which has been flavoured and sweetened. The food shall contain not less than 3.25 per cent milk fat and not less than 23 per cent total solids.”

Milk and cream?

Real eggnog is made from lots of egg yolks and cream – heavy cream and light cream. It is delicately flavoured with freshly grated nutmeg and some also add a hint of real vanilla extract (made from vanilla beans, soaked in vodka) and yes, it is often served liberally mixed with rum.

In days gone by, eggnog was made from raw egg yolks, but my recipe cooks the egg yolks over a double boiler then holds them at a high enough heat to make them safe. It is lightly sweetened and then blended with cream and spices and placed in a glass milk bottle, until well chilled.  Yes, it is enjoyed with real rum (carb free).

Here is my recipe for eggnog – just in time for the holidays!

Keto Eggnog

6 egg yolks, large (from free range chickens, bright yellow yolks)
1/2 cup heavy cream (whipping cream)
1/4 cup of Swerve® or Xyla® brand sweetener (erythritol)
1/4 tsp nutmeg, freshly grated
1 litre coffee cream (10% BF) – also called “half and half”

  1. In the top of a double boiler (not over hot water), whisk the egg yolks, heavy cream and erythritol sweetener to blend well.

  2. Bring water in the bottom of the double boiler to a gentle boil and place the top part, with the eggs on top.  From this point on, whisk constantly without stopping (otherwise you will have scrambled eggs).

  3. Whisk vigorously and constantly until the mixture is thickened and keep whisking until an instant-read thermometer inserted into the mixture reads 140°F for 3 minutes or longer.The mixture should be thick enough to completely coat the back of a spoon.


  4. Remove the top part of the double boiler and keep whisking the mixture a little while longer, as it begins to cool down.

  5. Add the freshly grated nutmeg (and splash of real vanilla, if using) and whisk another 2 minutes or so, as the mixture continues to cool.

6. When the mixture has reached room temperature, gently whisk in the coffee cream and place in a glass milk bottle or glass pitcher with a tight fitting cover, so the eggnog doesn’t absorb the smells of other foods in the fridge.Allow the eggnog to chill thoroughly before serving (with or without rum).


Enjoy!

Merry Christmas and Happy New Year!

Joy

 

 

 

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/


Reference

http://www.cbc.ca/news/canada/british-columbia/egg-nog-christmas-drink-alcohol-eggs-milk-fink-1.3871400

 

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What is Ideal Protein®?

Recently, there has been a lot of buzz about a weight-loss program called Ideal Protein® which is often talked about as being a “low carb diet” so I decided to look into what this system is, and how it works. A local pharmacy is participating in this program, so I was able to obtain information directly from the pharmacist.

Ideal Protein®, in it’s weight-loss phase (called “Phase 1”) is both a low carb and low fat diet – and is most significantly a calorie-restricted diet promoted for weight loss.

Pharmacy-based

“Lifestyle Clinics”,  many of which are located at participating pharmacies are supervised by a pharmacist (or a nurse) who oversees the promotion of the Ideal Protein® line of products required for the diet, as well as the Natura® vitamin and mineral supplements and “Ideal Salt®“, which clients are instructed to use daily.

The designated pharmacist (or nurse) reviews the sign up, but “Ideal Protein® weight loss “coaches” are the ones who review weekly “food journals” that clients are required to keep, as well as records client’s weight, body measurements and fat % readings at their weekly “check-ins”.

Restricted Foods

In addition to limiting both carbs and fats, many foods are not permitted to be eaten by those on the Ideal Protein® diet until clients achieve 100% of their weight-loss goals.

For example, no cheese or dairy is permitted during the weight loss phase, except for 30 ml (1 oz) of regular milk in coffee or tea at breakfast. Natura® supplements are prescribed to clients to ensure adequate intake of calcium and magnesium.

The only vegetables permitted during the weight-loss phase of the Ideal Protein® diet during lunch and dinner are what are called “selected vegetables”  – which exclude green and wax beans, Brussels sprouts, eggplant, heart of palm, rutabaga, snow peas, tomatillo, and tomatoes. These are considered “occasional vegetables” and are allowed to a maximum of 4 cups per week.

*NOTE: I have been advised from a pharmacist that sells these products that these vegetables have “extra carbohydrates” and “slightly higher GI (glycemic index) for the most part“,  which is the reason they are limited.

Glycemic Index (GI) is a measure of the effect of carbohydrates on a person’s blood sugar. I am more interested in a food’s Insulin Index (II) which is a measure of the effect of a carbohydrate on a person’s insulin levels.

Permitted “selected vegetables” are alfalfa, asparagus, bamboo shoots, bean sprouts, bell peppers, broccoli, cabbage, cauliflower, celeriac, celery,  chayote, chicory, collards, cucumbers, dill pickles, fennel, Chinese broccoli, green onions, jicama, kale, kohlrabi, mushrooms, okra, onions (raw only), hot peppers, radish, rhubarb, sauerkraut, spinach, Swiss chard, turnip, and zucchini / yellow summer squash.

Only unlimited “raw vegetables and lettuce” in the list below are permitted during the weight-loss phase (and only during lunch and dinner). These are arugula, bibb lettuce, Boston lettuce, celery, chicory lettuce, cucumber, endives, escarole lettuce, frisée lettuce, green and red leaf lettuce, iceberg lettuce, mushroom, radicchio, radish, romaine lettuce, spinach and watercress lettuce. All others raw vegetables and lettuce are prohibited.

Even in Phase 2, clients are instructed to only “eat the vegetables permitted” and to “continue to omit cheese and other dairy with the exception of 30 ml (1 oz.) of milk in coffee or tea only“.

Ideal Protein® “Meals”

During the weight loss phase (Phase 1), clients are instructed to have meals as follows;

BREAKFAST: 1 Ideal Protein® diet food product, with the option of having coffee or tea with 1 oz. (30 ml) milk, plus Natura® vitamin and mineral supplements.

LUNCH: 1 Ideal Protein® diet food product, with 2 cups of “selected vegetables” and unlimited “raw vegetables and lettuce” from the above list.

DINNER: clients can eat 8 oz (225g) of lean fish / seafood, lean beef, skinless poultry, lean cuts of pork, veal or wild game meat and 2 cups of “selected vegetables” and unlimited “raw vegetables and lettuce” from the above list plus Natura® vitamin and mineral supplements and omega 3 plus.

SNACK: For a snack, clients eat another Ideal Protein® diet food product and more Natura® vitamin and mineral supplements.

In “Phase 2”, which occurs after 100% of weight loss goals have been achieved, the number of Ideal Protein® diet food products required to be consumed is reduced to 2 and clients can eat the protein choice they wish from the approved list at both lunch and dinner, for 2 weeks. The “selected vegetables” and unlimited “raw vegetables and lettuce” remains the same.

In “Phase 3”,  the number of Ideal Protein® diet food products required to be consumed is reduced to 1 and clients can continue to eat the protein choice they wish from the approved list at both lunch and dinner, for 2 weeks. The “selected vegetables” and unlimited “raw vegetables and lettuce” remains the same.

It is only in “Phase 4”, the maintenance phase” of the Ideal Protein® weight loss system where clients are allowed to eat “all whole foods, including protein and fats, and do not need to eat the Ideal Protein®  products”.

Additional Instructions

Clients are instructed to follow the strict carbohydrate and fat restriction until they achieved “100% of their weight loss goals” and to “eat no more / no less” than the amount of food listed for each meal and snack. That is, “Phase 1” last as long as necessary until a person loses all the weight they planned.

They are cautioned that during Phase 1 and possibly beyond that, six symptoms may occur – especially if they “don’t follow the weight loss method as prescribed”. These symptoms are hunger, headache, nausea, fatigue, constipation and bad breath.

Restricted Calories

Ideal Protein® provides only 850-1000 calories per day, which makes it a calorie-restricted diet.

Low Carb

The Ideal Protein meal replacement packets provide ~20 gm net carbs per day and the “selected vegetables” and “raw vegetables and lettuce”provide ~ 20 gm net carbs per day. Total net carbs are ~40 gm / day.

High Protein

In the Ideal Protein® system,   the meal supplements contain ~15-20 gm protein each and 3 of those are to be eaten each day, along with 8 oz of lean animal protein per day. From the ‘meal packets’, there are 60-80 gms of protein and anywhere from 56 gm of protein (lean ground beef) to 72 gms of protein  (chicken breast).  In total, the Ideal Protein system has people eating between 120 gm – 152 gm of protein per day.

According to Statistics Canada (www.statcan.gc.ca/daily-quotidien/170620/dq170620b-eng.htm), the average protein intake for an adult is 16.5% to 17.0%. Based on Ideal Protein® system having a caloric intake of 850-1000 kcals/day, and the 3 meal supplement packets providing 15-20 gm of protein each, plus the 8 oz of lean protein (another 56-72 gms of protein), the Ideal Protein® system supplies 53 – 67.5% of calories as protein.

Costs

In terms of cost, it is ~ $500 to sign up to begin the Ideal Protein® diet, which includes a ‘coaching fee’, first round of supplements and 2 weeks worth of meal replacement and meal supplement sample products.

After sign up, the cost works out to ~$100 a week to purchase the Ideal Protein® products, plus supplements  i.e. each box of 7 Ideal Protein® “meal replacements” or diet food product (required to be eaten for meals and snacks) costs ~$30 and for weight loss, 3 boxes a week are required.

Each additional month is another ~$400.

Ideal Protein® – the company

The Ideal Protein® company is headed by Dr. Randall Wilkenson MD, who has 20 years experience specializing in allergy and environmental medicine and who now works with his son Denver Wilkenson, whose experience is in managing a weight-loss clinic in Idaho for 3 years.

Ami-Higbee, RN serves  as Clinic Director and Mike Ciell, RPh, a registered pharmacist certified in geriatric pharmacy, is VP of Clinic Operations.

At the time of writing, no Registered Dietitians are listed on the team, but they do have a ‘chef’ from Quebec who designs their recipes, almost all of which include ingredients from their Ideal Protein® product list.

According to a local pharmacist that I spoke with, Ideal Protein® has over 4000 of these “Lifestyle Clinics” worldwide.


A few thoughts…

This diet is very popular, but it is not a “low carb diet” but is a “low carb, low fat, calorie restricted diet”.

It’s easy because people don’t need to think what to to eat and can buy meal replacement products to satisfy breakfast and the protein component of lunch.  For supper, clients are provided with recipes that use the special branded products that they already purchase to make cooking easy. A snack (deemed necessary, I presume) is another food replacement product. There is limited food preparation required.

The diet system promotes fast weight loss — where both carbohydrates and fats are limited.

Since it is overseen by a pharmacist or a nurse, it has the image of being healthy. But is it “ideal”?

As discussed in an earlier article, our bodies have an absolute requirement for specific essential nutrients; nutrients that we must take in our diet because we can’t synthesize them. These are listed in several volumes called the Dietary Reference Intakes (DRIs), published by National Academies Press. There are essential amino acids, fatty acids, vitamins and minerals – and it is necessary to take in adequate protein and fat, when carbohydrate is restricted.

In the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) it reads;

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

… however, Ideal Protein® diet restricts both carbs and fats.

It restricts calories.

It restricts cheese and all dairy except for one ounce of milk per day.

It restricts which non-starchy vegetables can be consumed.

It allows no fruit.

It allows no nuts or seeds.

It offers vitamin and mineral supplements and food replacements in place of those real foods.

In the Ideal Protein® system, people are required to eat 4 times a day with carbs contained in the branded meal supplements on each occasion. Research supports that to begin to lower insulin release in insulin-resistant people requires periods of at least a 12 hour where no food is eaten, which naturally occurs after dinner before the first meal of the day breakfast). Having people eat a ‘snack’ would appear to be self-defeating.

Eating a low carb high healthy fat with 3 meals per day, with nothing between supper and breakfast supports the lowering of insulin release, improving the cells insulin sensitivity, in time.  Adding to this periods of intermittent fasting (which is not a total fast, but has no carbohydrates or significant amounts of protein) allows insulin levels to fall even further, which is often the goal of eating a low carb diet.

In the Ideal Protein® system, the meal supplements contain ~15-20 gm protein each and there are 3 of those per day and there is also 8 oz of lean animal protein per day. From the ‘meal packets’, there are 45-60 gms of protein and anywhere from 56 gm of protein (lean ground beef) to 72 gms of protein (chicken breast). In total, the Ideal Protein®  system supplies between 100 gm – 132 gm of protein per day. While carb intake in the Ideal Protein®  system is low, the body would synthesize glucose from the excess protein (called gluconeogenesis) resulting in insulin release. From my understanding, this appears to be self-defeating if the goal is to lower insulin release.

It would seem that the increased gluconeogenesis from the high protein intake in the Ideal Protein® system would not support increased insulin sensitivity as much as a low-carb-high-fat moderate protein diet, even without intermittent fasting.

Another factor is the $500 start-up cost for the first month, plus another  $400+ for each additional month to eat ‘meals’ comprised of largely of meal replacements and supplements, along with some real food.

Ideal Protein® makes it easy and promotes rapid weight loss, but is it really “ideal” for people who have made poor eating choices in the past — when they don’t learn how to make healthy meal choices while achieving weight loss? Weight loss may be quick, but weight loss also has to be sustainable.

Also, is it really “ideal” for people who are insulin resistant when it has them eating food with carbohydrate and protein 4 times per day?

I encourage my clients to eat a wide variety of real foods – foods such as dairy products including cheese,  domesticated and wild meat, poultry and fish, especially fatty fish that are rich in omega 3 fats, low-carb fruit and a vast array of low-carb vegetables. There are fats from all sources, including some healthy saturated fat, with most fat coming from healthy monounsaturated sources such as olives avocados, nuts and seeds. There are no food diaries to keep and no mandatory “weigh-ins” or “check-ins”.  My clients eat real food when they are hungry and don’t eat if they are not hungry.  Most significantly, they learn to make healthy food choices with whole, real food as they lose weight.

Each person needs to evaluate for themselves whether use of the Ideal Protein® system makes sense for them.

As I always do, I recommend that people consult with their own doctor before beginning any weight-loss program.

To your good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

 

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

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

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

 

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A Dietitian’s Journey – 9 months since beginning LCHF

LEFT: March 16 2017, RIGHT: December 18 2017

The photo on the left is what I looked like when I started my weight-loss and health ‘journey’ on March 16, 2017, 9 months ago.  The photo on the right, is me today.

Based on my BMI, I was well into the  Class I Obesity  category 9 months ago. Based on my BMI today, I am just 15 pounds from my weight falling in the normal range. 

At the beginning of March, my blood pressure ranged between Stage 2 Hypertension  and Stage 1 Hypertension – sometimes being dangerously high. Now, my blood pressure hovers around 125/80 mmHg mark, and I am still on the ‘baby-dose’ of Ramipril for now, as it protects my kidneys.

My triglycerides  and my LDL cholesterol (“bad cholesterol”) were high, certainly well above what it should have been for someone who has Type 2 Diabetes and had family risk factors. Thankfully, my HDL was good, offering some protection.

In the past 9 months, my morning fasting blood sugar has dropped from ±12 mmol/L (216 mg/dl) to anywhere from 5.8 mmol/L (105 mg/dl) to 6.5 mmol/L (117 mg/dl) – with the occasional 8.0 mmol/L (144 mg/dl) for seemingly no apparent dietary reason. For my fasting blood sugar to be in the non-diabetic range, it needs to be consistently below  5.5 mmol/L  (99 mg/dl).

When I began this journey, my HbA1C was ~ 9.5% and during the last 30 days, I am averaging ~6.3% which is in the non-diabetic range. This has been entirely achieved without any medication to lower blood glucose.

I was determined to reverse the symptoms of Diabetes, high cholesterol  and high blood pressure by changing how I ate and by introducing short periods of intermittent fasting and I have certainly made significant progress.

Weight and Body Measurements

I’ve lost ~25 lbs so far, but the changes in my body and face shape are even more noticeable, as evidenced by the photo above.

So far, I’ve lost;

  • 1″ off my upper arms
  • 3″ off my neck (!)
  •  1″ off my thighs
  • 4 1/2″ off my waist

This week, I reached the “goal weight” that I initially set for myself, but in order to attain an ideal waist circumference that is 1/2 my height, I probably have to lose another 20-25 pounds, which means I am half-way there.

I am entirely convinced that this is realistic and attainable.

Change only happens when the pain of staying the same is greater than the pain of changing.

Want to start your own weight loss and health journey? Why not send me a note using the “Contact Us” form above.

Wishing you and yours all the best for holiday season!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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

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Amazing Low Carb Mini Donuts with Eggnog Sauce

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.

These delectable mini donuts are made with the finest ingredients; real creamery butter, fresh cream and eggs and the seeds of real vanilla beans. They are light, crispy and have that cake-like texture you want in a treat and are both low carb and gluten free because instead of flour, they contain whey protein and ground almond flour.

baked low carb mini donuts

They can be baked to golden perfection, because the butter and full-fat cream result in a lovely crispy texture…

 

 

…or for those wanting a deep-fried treat, they can be baked for slightly less time and then deep-fried.

Served with a rich homemade eggnog sauce, they are a wonderful treat for the holidays!

Happy Holidays!

Low Carb Mini Donuts

(makes 32 mini donuts)

1/2 cup of whey protein, unsweetened
2 Tbsp almond flour
2 tsp baking powder, sifted
1/2 tsp Himalayan sea salt
2 Tbsp Truvia© brand or Xyla© (erythritol) sweetener
interior of 1 vodka-soaked vanilla bean (or 1 tsp real vanilla extract)

8 Tbsp heavy cream
4 Tbsp unsalted butter, melted and cooled
1 egg

  1. whisk dry ingredients together in a medium bowl
  2. beat egg, add cooled melted butter and cream, mix well
  3. preheat oven to 350º F
  4. spray two trays of mini donut pans (12 each) with coconut oil spray (or use Pam©)
  5. When oven is hot, fill each well slightly less than 1/2 full with batter
  6. Bake for 8 minutes if planning to deep fry afterwards, or 10 minutes if eating baked

Enjoy!

Eggnog Sauce

Ingredients

6 lg. egg yolks
1/2 cup heavy cream
1/4 cup Truvia© brand or Xyla© (erythritol) sweetener
1/4 cut unsalted butter, melted and cooled
1 Tbsp real rum (or rum extract, if liked)
1/4 nutmeg, grated

  1. set up a double boiler over a medium heat
  2. whisk egg yolks, heavy cream and sweetener into a small bowl.
  3. slowly whisk in cooled, melted butter (be sure butter is cooled or eggs will scramble!)
  4. add mixture to top of double boiler and whisk constantly until mixture thickens and instant-read thermometer reaches 140º F for 3 minutes (makes it safe).  Mixture should be thick enough to coat the back of a spoon.
  5. add real rum or rum extract and grate in the fresh nutmeg
  6. remove mixture from water and let cool. Serve warm or cooled.

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Joy’s Low Carb Falafel

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.

Falafel are the iconic ‘street food’ of Israel and elsewhere in the Middle East and are often eaten standing in front of the little shops that make them or sitting at picnic tables outside. Israeli Arabs and Jews often mingle at these little stands, enjoying their delectable, quick meal together. In this post, I’ll give you everything you need to know how to make delicious, authentic-tasting low carb falafel.

Joy’s Low Carb High Health Fat Falafel

For those unfamiliar with falafel, they are slightly “cone-shaped” balls of delicately spiced, ground chickpeas and/or fava beans that fried until their exterior is crispy, yet their interior remains moist, yet cooked.

falafel press

They are formed using a special falafel press, available in Middle Eastern stores or online, but a mini small ice-cream scoop could substitute, in a pinch.

 

falafel pita

Usually, falafel are served in a split pita with pickles (cucumber and beet marinated turnip), tahina sauce, cut fresh vegetables and sometimes a drizzle of an aromatic hot sauce called ‘harissa’. In my version, large washed and dried leaves from green leaf lettuce substitute for the pita and the mixture itself has the addition of ground, firm tofu to make it much lower carb! Since tofu is made from soya beans, its taste is indistinguishable in the aromatic mixture of spiced chickpeas and fava beans.

Another advantage to my recipe is that regular falafel require the addition of baking powder to make the texture light and soft inside, but this often leaves a slightly bitter aftertaste to the falafel.  In these low-carb falafel, the ground tofu makes the addition of baking powder totally necessary. The texture is just perfect!

At only 2.5 gm net carbs per piece  – and only 14 gm for the 4 falafel “sandwiches” below plus the carbs from the vegetables eaten, what’s not to love about these low carb high healthy fat falafel?

Joy’s Low Carb High Health Fat Falafel

Below is the recipe for this delectable treat!


Joy’s Low Carb Falafel Recipe

1 cup dried chickpeas, soaked overnight

1 cup of dried fava beans, soaked overnight

1/2 large onion, roughly chopped (about 1 cup)

4 tablespoons finely chopped fresh parsley

4 tablespoons finely chopped fresh cilantro (coriander leaves)

350 gm extra firm tofu

1.5 teaspoon salt

1/2-1 teaspoon dried hot Aleppo red pepper

4 cloves of garlic, crushed

1 teaspoon cumin, ground

2 tbsp sesame seeds

4-6 tablespoons chickpea flour


Falafel Garnish

leaf lettuce leaves, whole

diced tomato

sliced cucumber

sliced 1/2 sour dill pickles

large sticks of beet-pickled turnip (available at a Middle Eastern store, and easy to make homemade!)

chopped parsley

chopped green onion or milder round onion


Tahina Sauce

1/2 cup tahina sesame paste

1/2 cup warm water

1 clove garlic, crushed finely

juice of 1/4 lemon

1 tsp salt

1/4 cup extra virgin olive oil


Falafel Preparation

NOTES:

(1) This recipe works best when the mixture is made 1 day ahead and left to sit for a day in the fridge, covered.  This way, the falafel don’t fall apart when frying!

(2) I use a meat grinder attachment for a Kitchen-Aid stand mixture to grind mine, but a food-processor could work too provided the mixture is ground in small batches and remains course in texture.


  1. Put the chickpeas and fava beans in a large bowl and add enough cold water to cover them by at least 2 inches. Let soak overnight.
  2. When ready to prepare mixture the next day (a day or two before planning to make falafel), drain the soaked beans and rinse well with cold water.
  3. Put the drained, rinsed, uncooked chickpeas and fava beans though the meat grinder, being sure to use the smaller-holed press.
  4. Then, put through the extra firm tofu, onion, parsley, cilantro and garlic.

    If using a food-processor, process until coarsely textured, but not pureed!


  5. In the bowl that has received the ground mixture, mix in the salt, hot pepper, garlic, cumin and sesame seeds and sprinkle with 4 – 6 tablespoons of chickpea flour
  6. Cover bowl and refrigerate, covered, until the next day.
  7. When ready to cook, form the chickpea mixture using a falafel press or by hand into balls about the size of walnuts. Form one side into a slight cone-shape (gives more surface area when frying!).
  8. Heat 2 inches of coconut oil to 375° F degrees in a deep, heavy pot or wok and fry 1 ball to test. Once sure the oil is hot enough (not too hot, either!) fry 5 falafel at once for a few minutes on each side, or until golden brown.
  9. Drain on a layer of kraft paper lunch bags.
  10. Once all the falafel are cooked, assemble as desired, with vegetable of choice at the bottom, falafel on top and drizzle with tahina sauce, and harissa thinned with olive oil (if using).

Enjoy!

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How Much Carbohydrate is Essential in the Diet?

INTRODUCTION: I was asked a question recently on social media as to what is our body’s essential daily requirement for carbohydrate. This is a very good question – so much so, that I decided to answer it in the form of a short article. If you are considering a low carb high fat lifestyle, this is important to understand.

Our body has an absolute requirement for specific essential nutrients; nutrients that we must take in our diet because we can’t synthesize them. What these nutrients are and how much we require depends on our age and stage of life, our gender and other factors and are listed in several volumes called the Dietary Reference Intakes (DRIs), published by National Academies Press.

There are Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005), Dietary Reference Intakes for Calcium and Vitamin D (2011), Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000), Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997), Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005), Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998), Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001).

In these texts are listed the essential amino acids (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine) that must be supplied in the different kinds of protein that we eat.

These texts also establish that there are two essential fatty acids, linoleic (an omega 6 fat) and alpha-linolenic (an omega 3 fat) that can’t be synthesized by the body and must be obtained in the diet.

There are 13 essential vitamins (vitamin A, vitamin B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyrodoxine), B12 (cyanocobalamine), biotin, vitamin C (ascorbic acid), choline, vitamin D (cholecalciferol), vitamin E (tocopherol) and  folate) listed and essential minerals, including major minerals (calcium, phosphorus, potassium, sodium, chloride and magnesium) and minor minerals (chromium, cobalt, copper, fluorine, iodine, iron, manganese, molybdenum, selenium, silicon, sulfur and zinc).

But is there “essential carbohydrate”?

In Chapter 6 of the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) is the chapter titled “Dietary Carbohydrates: Sugars and Starches” (pg. 265), which indicates that the  Recommended Dietary Allowance (RDA) for carbohydrate,  considered to be the average minimum amount of glucose needed by the brain, is set at 130 g / day for adults and children.

Recommended Dietary Allowance (RDA) for carbohydrate

It is important to note that the Recommended Dietary Allowance (RDA) for carbohydrate is at 130 g / day based on the average minimum amount of glucose needed by the brain – with no consideration that the body can manufacture this glucose from both FAT and PROTEIN.

Just 10 pages later, in the same chapter of the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) it reads;

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

The lower limit of dietary carbohydrate

That is, there is no essential need for dietary carbohydrate, provided that “adequate amounts of protein and fat are consumed”.

The text goes on to say that there are traditional civilizations such as the Masai, the Greenland and Alaskan Inuit and Pampas indigenous people that survive on a “minimal amount of carbohydrate for extended periods of time with no apparent effect on health or longevity“, and that white people (Caucasians) eating an essentially carbohydrate-free diet resembling that of the Greenland natives were able to do so for a year, without issue.

That is, the minimum amount of dietary carbohydrate required is zero provided that adequate amounts of protein and fat are consumed. Phrased another way, the “minimum amount of glucose needed by the brain of 130 g / day is made by the body from protein and fat provided they are eaten in adequate amounts.

In the absence of carbohydrate, de novo synthesis of glucose

On the next page (pg. 276) of the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) it explains the process;

“In the absence of dietary carbohydrate, de novo synthesis of glucose requires amino acids derived from the hydrolysis of endogenous or dietary protein or glycerol derived from fat. Therefore, the marginal amount of carbohydrate required in the diet in an energy-balanced state is conditional and dependent upon the remaining composition of the diet.”

That is, even when minimal amounts of carbohydrate is eaten (not something I promote), the body will synthesize the glucose needed by the brain from the protein taken in through the diet (provided it is in adequate amounts) or from glycerol which is formed when fat is broken down. If the protein in the diet (exogenous protein) is inadequate however, the body’s own protein (endogenous protein) will be used.

So, no, there isn’t any “essential carbohydrate” requirement.

Even when a person is completely fasting (religious reasons, medically supervised, etc.) the 130 g / day of glucose needed by the brain is made from endogenous protein and fat.

When people are “fasting” the 12 hour period from the end of supper the night before until breakfast (“break the fast”) the next day, their brain is supplied with essential glucose! Otherwise, sleeping could be dangerous.

In previous articles reviewing long-term studies of low carbohydrate diets, safety and efficacy has been established with intakes as low as 20 gm of carbs for 12 weeks and 35 gm of carbohydrate per day for extended periods of time, provided adequate protein and fat is eaten.

I am of the opinion that in order to have a diet with the essential vitaminsminerals, amino acids and fatty acids, that a wide range of healthy foods with some carbohydrate content is required.  I encourage people to consume low carb fruit and dairy products and nuts and seeds, along with a wide range of meat, fish and poultry, eggs and even tofu, if desired. I design each person’s Meal Plan to meet their individual requirements, lifestyle as well as the foods they like and take into consideration whether they like to cook or prefer meals with the minimum of preparation required.

Have questions?

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

To our good health,

Joy

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Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

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

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

 

 

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Low Fat Calorie Restricted Diet versus Low Carbohydrate Diet – a two year study

INTRODUCTION: To date, there have been 3 long-term clinical trials (2 years) published over the past 10 years involving “low carb diets”.  In this post I review the third study which compares the effects of a low fat calorie restricted diet compared with a low carbohydrate diet and finding significantly better lipids at 1 year, before carbs were liberalized.

Purpose and Overview of the Study

The purpose of this randomized, controlled trial was to evaluate the long-term (2-year) effects of treatment with either a low-carbohydrate or low-fat, calorie-restricted diet on weight, cardiovascular risk factors, and bone mineral density — with the primary outcome being weight loss at 2 years.

All participants received comprehensive behavioral treatment to enhance weight loss associated with both diets and assessments were conducted at baseline, 3 months, 6 months, 12 and 24 months.

Inclusion Criteria

Primary inclusion criteria were age of 18 to 65 years, Body Mass Index (BMI) of 30 to 40 kg/ (m) x (m) and body weight less than 136 kg (300 pounds).

Exclusion Criteria

Exclusion criteria were participants with serious medical illnesses such as Type 2 Diabetes, lipid-lowering medications for dyspidemia, medications that affect body weight (including anti-obesity agents), blood pressures of 140/90 mm Hg or more (regardless of whether it was treated), and  pregnancy  or lactation.

Participants

A total of 307 adults (208 women and 99 men) with a mean age of 45.5 years and a mean Body Mass Index of 36.1 kg /(m) x (m) participated in this study.

Most (74.9%) participants were white; 22.1% were African American and 3% were of other race or ethnicity.

After a scripted phone screening, eligible participants attended an in-person screening during which the study’s purpose and requirements were discussed, eligibility confirmed and written informed consent was obtained.

Using a random-number generator, researchers randomly assigned participants (within each of 3 sites) to either a low carbohydrate treatment for 2 years, or a low fat calorie restricted diet for 2 years.

All participants completed a comprehensive medical examination and routine blood tests. There were no statistically significant differences between the two diet groups in any baseline variables.

The study, including recruitment and enrollment took place from March 2003 to June 2007.

Low Carbohydrate Diet

Approximately half of the participants (n = 153) were assigned to a low carbohydrate diet, which limited carbohydrate intake but allowed unrestricted consumption of fat and protein.

First 12 weeks of treatment

During the first 12 weeks of treatment, participants were instructed to limit carbohydrate intake to 20 g / day in the form of low–glycemic index vegetables.

After 12 weeks on very low carbohydrates

After the first 12 weeks, participants gradually increased carbohydrate intake each week by 5 g / day per week by consuming more vegetables, a limited amount of fruits, small quantities of whole grains and dairy products, until a stable and desired weight was achieved.

Subjects followed the guidelines outlined in Dr. Atkins’ New Diet Revolution, but were not provided with a copy of the book.

Participants were instructed to focus on limiting carbohydrate intake and to eat foods rich in fat and protein until they were satisfied.

The primary behavioral target was to limit carbohydrate intake.

Low-Fat Calorie Restricted Diet

Approximately half of the participants (n= 154) were assigned to eat a low fat diet which limited energy to 1200 to 1500 kcal / day for women and 1500 to 1800 kcal / day for men.

Approximately 55% of calories came from carbohydrate, 30% from fat and 15% from protein (comparable to the recommendations of Canada’s Food Guide for Healthy Living).

Participants were instructed to limit calorie intake, with a focus on decreasing fat intake, however limiting overall energy intake (kcal / day) was the primary behavioral target.

Group Behaviour Treatment

All participants received comprehensive, in-person group behavioral treatment weekly for 20 weeks, every other week for 20 weeks and then every other month for the remainder of the 2-year study period.

Each treatment session lasted 75 to 90 minutes.

Topics included self-monitoring, stimulus control and relapse management.

Group sessions reviewed participants’ completion of their eating and activity records, as well as other skill builders.

Participants in both groups were instructed to take a daily multivitamin supplement (provided by the study).

Physical Activity

All participants were prescribed the same level of physical activity (mainly walking), beginning at week 4, with four sessions of 20 minutes each and progressing by week 19 to four sessions of 50 minutes each.

Outcomes and Measurements

Body Weight— measured at each treatment visit on calibrated scales while participants wore light clothing and no shoes. The primary outcome was weight at 2 years.

Height — measured by a stadiometer at baseline.

The following measurements were collected at baseline and at 3, 6, 12 and 24 months:

Serum Lipoproteins — measured plasma high-density lipoprotein (HDL) cholesterol and triglyceride levels. Very-low-density lipoprotein (VLDL) cholesterol and low-density
lipoprotein (LDL) cholesterol concentrations were directly measured by β-quantification. Blood samples were obtained after participants fasted overnight (12 hours).

Blood Pressure— assessed after participants were sitting quietly for 5 minutes and using automated instruments with cuff sizes based on measured arm circumference.  Two readings of blood
pressure were obtained, separated by a 1-minute rest period with the average of the two readings used.

Urine Ketones— Bayer Ketostix were used to measure fasting urinary ketones and were characterized as negative (0 mg/dL) or positive (trace, 5 mg/dL; small, 15 mg/dL; moderate, 40 mg/dL; or large, 80 to 160 mg/dL).

Bone Mineral Density and Body Composition (percentage of body fat)—assessed using dual-energy x-ray absorptiometry at baseline and at 6, 12 and 24 months.

Attrition—There were no statistically significant differences between the two groups in terms of attrition; defined as not undergoing an assessment at a specific time point, independent of the reason.

Results

Body Weight— participants in both groups lost approximately 11% of initial weight at 6 and 12 months, with subsequent weight regain to a 7% weight loss at 2 years . There was no statistically significant differences in weight loss at any time point between the low carbohydrate and low-fat calorie restricted groups, although there was a strong trend for greater weight loss in the low-carbohydrate group at 3 months.

Urinary Ketones—percentage of participants who had positive test results for urinary ketones was greater in the low carbohydrate than in the low fat calorie restricted group at 3 months (63% vs. 20%) and at 6 months (28% vs. 9%). Researchers found no statistically significant differences between groups after 6 months and they noted that the decrease from 3 to 24 months is consistent with liberalization of carbohydrate intake over time, as part of the study protocol.

Blood Pressure—Systolic blood pressure decreased with weight loss in both diet groups relative to baseline and did not significantly differ between groups at any time.  Reductions in diastolic pressure were significantly greater (2 to 3 mm Hg) in the low carbohydrate than in the low-fat group at 3 and 6 months with a strong trend at 24 months.

Plasma Lipid Concentrations—Most of the differences in plasma lipid concentrations between the two groups were observed during the first 6 months of the diets.

LDL cholesterol: Researchers found a significantly greater decrease in LDL cholesterol levels at 3 and 6 months in the low-fat calorie restricted group than in the low carbohydrate group, but this difference did not persist at 12 or 24 months. There may be reasons for this, discussed below.

Triglyceride levels: Decreases in triglyceride levels were greater in the low-carbohydrate group than in the low-fat calorie restricted group at 3 and 6 months, but not at 12 or 24 months.

VLDL cholesterol: Decreases in VLDL cholesterol levels were significantly greater in the low-carbohydrate group than in the low-fat calorie restricted group at 3, 6, and 12 months but not at 24 months.

HDL cholesterol: Increases in HDL cholesterol levels were significantly greater in the low-carbohydrate group than in the low-fat calorie restricted group at 3, 6, 12 and 24 months.

Total-cholesterol : HDL cholesterol: The ratio of total-cholesterol to HDL cholesterol levels decreased significantly in both groups through 24 months but did not significantly differ between groups at any time. There was a trend for greater reductions in the low-carbohydrate group at 6 months and 12 months.

Summary:

The only effect on plasma lipid concentrations that persisted at 2 years was the significantly greater increases in HDL cholesterol levels among low-carbohydrate participants.

Bone Mineral Density and Body Composition:

Researchers found no differences between the two groups in changes in bone mineral density or body composition over 2 years.

Findings

  1. Neither dietary fat nor carbohydrate intake influenced
    weight loss when combined with a comprehensive lifestyle intervention.  That is, participants had similar and clinically significant weight losses with either a low carbohydrate or low-fat calorie restricted diet at 1 year (11%) and 2 years (7%). Researchers concluded that this demonstrates that either diet
    can be used to achieve successful long-term weight loss. if coupled with behavioral treatment.
  2. Researchers concluded that because both diet groups achieved nearly identical weight loss, a low-carbohydrate diet has greater beneficial long-term effects on HDL cholesterol concentrations
    than a low-fat calorie restricted diet.
  3. While researchers found a significantly greater decrease in LDL cholesterol levels at 3 and 6 months in the low-fat calorie restricted group than in the low-carbohydrate group, this difference did not persist at 12 or 24 months. Researchers  concluded that since assessment of LDL cholesterol concentration was without information on LDL particle size, no information was obtained in terms of coronary heart disease risk (small, dense LDL particles are more atherogenic than large LDL particles).
  4. The low-carbohydrate diet caused a decrease in plasma triglyceride concentration that was more than double the reduction observed with a low-fat calorie restricted diet at 3, 6, and 12 months however plasma triglyceride concentration returned toward baseline in the low-carbohydrate
    group, such that the two groups did not differ significantly at 2 years.
    [Note: The rise in triglycerides after desired weight was achieved may have been the result of the liberalization of the low carbohydrate diet by the inclusion of fruit, dairy and small amounts of whole grains which may have been responsible for driving triglyceride levels up.]
  5. The greater decline in directly measured VLDL cholesterol concentration in the low-carbohydrate at 3, 6, and 12 months was not sustained at 2 years. Researchers found no significant differences between the two groups in VLDL cholesterol. Researchers concluded that the close relationship and tracking  between fasting plasma triglyceride concentrations (which are primarily contained within VLDL) and VLDL cholesterol  concentrations supports a model in which during the first year of the study the low-carbohydrate diet (a) decreased hepatic VLDL secretion, (b) enhanced VLDL clearance, or both when compared with the low-fat calorie restricted diet.
    [Note: Again, the liberalization of the low carbohydrate diet after  desired weight was reached and the inclusion of fruit, dairy and small amounts of whole grains into the diet may have been responsible.]
  6. Plasma HDL cholesterol concentration increased by approximately 20% at 6 months in the low-carbohydrate diet group, which persisted throughout the study and was more than twice the increase observed in the low-fat calorie restricted diet group. Researchers concluded that the magnitude of the change observed in the low-carbohydrate diet group approximates that obtained with the maximal doses of nicotinic acid (niacin), the most
    effective HDL-raising pharmacologic intervention that was available at the time of the study (2010).

Conclusion

This 2-year, randomized control study of more than 300 participants found that both diet groups achieved clinically significant and nearly identical weight loss (11% at 6 months and 7% at 24 months) and that people who ate the low-carbohydrate diet had greater 24-month increases in HDL-cholesterol concentrations than those who ate a low-fat calorie restricted diet.

As well, an significant finding of this study was a very favourable lowering of LDL for the first 6 months and lowering of both TG and VLDL for the first year. It is unknown whether these results would have persisted and been sustained had the low carb group not been permitted to liberalize their diet by the inclusion of fruit, dairy and small amounts of grain products, once they achieved their desired weight loss.

These long-term data certainly provide evidence that a low-carbohydrate diet is both a safe and effective option for weight loss and that this style of eating has a prolonged, positive effect on lipid profiles – certainly while intake of carb-containing foods are restricted.

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References

Foster GD, Wyatt HR, Hill JO et al, Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial, Ann Intern Med. 2010 Aug 3;153(3):147-57

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Part II- Understanding Low Carb High Fat – the solution

INTRODUCTION – In Part I of this two-part series, I explained how the current dietary recommendations and popular beliefs about weight gain have inadvertently contributed to many of the health problems we now face.  If you haven’t yet read the first part, you can read it here and then follow the link back to continue reading this article.

In this post, I point to some previously written articles posted on this site to explain what a Low Carb High Fat style of eating is and how it serves as a solution to the problems outlined in the previous article.

Part II – Understanding Low Carb High Fat – the solution

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

What exactly is a Low Carb High Fat Diet?  This article explains the fundamental information people want to know about which food categories they can eat, such as  non-starchy vegetables, plant fat, low sugar fruit, meat fish poultry and seafood, animal fat and unsweetened beverages).

There is also a simple illustration of the food categories in a low carb lifestyle, indicating the types of food in each category. This dispels the myth that eating LCHF is in anyway a ‘restricted diet’.

This post also explains what macronutrients are and what the ratios of protein, fat and carbohydrate are on a LCHF diet. It is a basic primer about the Low Carb High Fat lifestyle.

People sometimes refer to a “low carb diet” as if it were a single entity, but there are many types of low carb diets ranging from moderate low carb (130 g carbs) to ketogenic diets (5-10% net carbs). Even amongst low carb or ketogenic diets, there are low carb high fat diets,  low carb high protein diets as well as Low Carb High Protein in weight loss and High Carb High fat in maintenance.

This article titled American Diabetes Association Approves Low Carb Diets for Weight Loss explains the basics of a moderate low carb diets (130 g carbs) which is approved by the American Diabetic Association as a weight-loss option for Diabetics.

Many people believe that saturated fat is “bad” for them but few realize that our bodies actually manufacture it. This article titled The “Skinny” on Fats explains the principles of fats while explaining the chemistry in simple terms that those with a non-science background can understand.  These ‘basics’ enable people to understand the controversy around saturated fat and to be able to talk about them with family members, friends, and their healthcare professionals.

People are used to thinking about food in terms of its ability to provide energy for their body but many don’t realize that their bodies can be fuelled by either carbohydrates or fat.  This article titled Humans – the perfect hybrid machine explains how in times past it was perfectly normal for us to experience a cycle of “feasting” and “fasting” – running on our own fat stores during the times between eating and how currently, we rarely are able to access our own fat stores, because of the constant supply of carbohydrate-rich food.

This article, titled Evidence for Remission of Type 2 Diabetes Symptoms using LCHF begins with a brief history of the Low Carb Diet and its role the primary approach to managing Diabetes prior to the discovery of insulin. It also talks about its role in managing seizure disorder and outlines how a Low Carb approach was central to the very first weight loss diet book written ~150 years ago.  It mentions the “Atkins Diet” which first came on the scene in the early 1970s and then introduces the research of Stephen Phinney (a medical doctor and PhD research scientist) and Jeff Volek, a Registered Dietitian with PhD whose work centers on using a low carb diet as a therapeutic tool for managing insulin resistance.  It presents the findings of Phinney and Volek’s most recent study which demonstrates that after 6 months following a low carb diet >75% of people in this study had HbA1c that was no longer in the Diabetic range (6.5%). It provides some evidence that yes, the symptoms of Type 2 Diabetes can to go into remission by following a Low Carb lifestyle.

Finally, the last article titled Are Low Carbohydrate Diets Safe and Effective provides compelling evidence from a two-year study which found that compared to a Mediterranean Diet and Low Fat diet, weight loss was greatest in those that followed a Low Carb diet. Of significance, subjects in in the LCHF group in this study also had lower fasting plasma glucose, lower HbA1C, significantly lower triglycerides, significantly higher HDL and lower C-reactive protein .

More Info

Want to know how I can help you adopt a low carb lifestyle?

I provide LCHF in-person services to those in the Greater Vancouver BC area and LCHF Distance Consultation services to those living elsewhere in the province, or from other provinces and territories in Canada. Please have a look at the “My Services” tab above for a list of the LCHF services that I provide.

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

To our good health!

Joy

You can follow me at:

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Part I – Understanding Low Carb High Fat – the problem

INTRODUCTION – If you are one of those that is considering adopting a low carb high fat lifestyle and want to understand the reasons behind ‘why’, this post is for you. It will guide you through a handful of previously written articles on this site so that you’ll understand how the current dietary recommendations and popular beliefs about weight gain have inadvertently contributed to many of the health problems we now face.

As in anything, before considering a solution to a problem, we first need to understand the problem.

Part I – Understanding Low Carb High Fat – the problem

In 1977, the US and Canada changed their Dietary Recommendations  encouraging us to eat 45-65% of daily calories as carbohydrate and to limit all kinds of fat to 20-35%. Of relevance, in the early 1970s, prior to these changes only ~8% of men and ~12% of women were obese – and now almost 22% of men and 19% of women are obese.

The article titled Obesity Rates in Canada and Changes to Canada’s Food Guide will walk you through the changing recommendations of Canada’s Food Guide (CFG) over the years, as well as the corresponding and  simultaneous increase in the rates of overweight and obesity.

Unfortunately the dietary changes of 1977 have given us 40 years of data showing ever-increasing rates of obesity, overweight and Diabetes. It is quite literally an “epidemiological* experiment gone wrong”.  This article titled Canada’s Food Guide – an Epidemiological Experiment Gone Terribly Wrong will help you understand some of the shortcomings of the guide, as it stands now.

*Epidemiology is the study and analysis of the patterns, causes, and effects of health and disease in populations.

We’ve been told for years that the problem is that we “just need to eat less and exercise more“.  If it were really that simple then 4.7 million adults in Canada wouldn’t be classified as obese and more than 40% of men and 27% of women classified as overweight.  This article titled Why do we Gain Weight – the Myth of “Calories in, Calories out” will explain why this model doesn’t work.

We’ve also been told that people are overweight because “they lack self control” but this article titled Weight Gain as a Hormone Imbalance not a Calorie Imbalance explains how body weight is regulated automatically under the influence of hormones – hormones that signal us to eat and indicate when we are satiated. These hormones also signal our bodies to increase energy expenditure and when calories are restricted, they will slow energy expenditure. It’s not a matter of people “trying harder” but eating in such a way as to regulate these hormones.

In Part II titled Understanding Low Carb High Fat – the solution, I explain what a Low Carb High Fat style of eating is and how it serves as a solution to the health problems we now face.

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Four Diets over Two Years – long term findings

INTRODUCTION: To date, there have been 3 long-term clinical trials (2 years) published over the past 10 years involving “low carb diets”.

The first long-term study that was presented in the previous article (which can be read here) clearly demonstrated that a low carb non–calorie-restricted diet was both safe and effective and produced the greatest weight loss, lower FBS and HbA1C, the most significantly lower TG and higher HDL and lower C-reactive protein (when compared with a low-fat calorie-restricted diet and a Mediterranean calorie-restricted diet).

In this, the second of the three long term studies, researchers looked at the effectiveness of four dietary interventions with different composition of fat, protein and carbohydrate – including one “low carb” diet..

Did this study demonstrate that a “low carb” diet was safe and effective to result in weight loss?

Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates

Participants

This study involved over 800 overweight and obese subjects, of which 40% were men. Subjects were between the ages of 30 and 70 years and had a Body Mass Index (BMI) of 25-40, where BMI is the weight in kilograms divided by the square of the height in meters.

BMI =25.0-29.9 is considered overweight
BMI = 30.0-34.9 is Class I obesity
BMI = 35.0-39.9 is Class II obesity
BMI ≥ 40.0 is Class III obesity

Major criteria for exclusion from this study were the presence of Diabetes or unstable cardiovascular disease, the use of medications that affect body    weight and insufficient motivation as assessed by interview and questionnaire.

Of the 811 subjects that began the study, at the end of two years, 645 subjects remained enrolled. Approximately 80% of the participants were white, 15% black, 4% Hispanic and the remaining 1% Asian.

The Four Diets – high/low fat, high/low protein

The 811 overweight adults were randomly assigned to one of four diets:

  1. Low Fat, Average Protein: fat: 20%, protein: 15%, carbohydrate: 65% (202 subjects)
  2. Low Fat, High Protein: fat: 20%, protein: 25%, carbohydrate: 55% (202 subjects)
  3. High Fat, Average Protein: fat: 40%, protein: 15%, carbohydrate: 45% (204 subjects)
  4. High Fat, High Protein: fat: 40%, protein: 25%, carbohydrate: 35% (201 subjects)

Two Diets were Low Fat but Two were not High-Fat Diets

The researchers stated that “two diets were low-fat and two were high-fat”, but it is important to note that none of the diets were “low carb high fat”/ ketogenic diets, which are ≥ 65% fat (not 40% fat). Two of the diets were higher in fat than the recommended dietary intake (in both the US and Canada).

Two Diets were Average Protein but not High Protein

The researchers said that “two diets were average protein and two were high protein” and while the ‘average protein intake’ in the US in 2008 was ~15%  (16.1% for men and 15.6% for women), diets such as two of the ones in this study that have only 25% protein are really at the very lowest range of what are considered high-protein diets – which normally contain between  27 – 68 % protein. Also important to note, a “low carb high fat”/ ketogenic diet usually has ~20% protein (considered ‘moderate protein’) and are not high protein diets.

Two Diets were High Carb and One Diet was Moderate Carb

The first and second dietary interventions would both be considered high carb, as they fall within the range of the dietary recommendations in both  Canada and the USA, 45-65% carbohydrate, with one being higher protein and one being average protein.

The third diet would be consider “moderate carb” according to Diabetes Canada’s standards, at 45 % carbohydrate, and higher fat and higher protein.

One Diet was Low Carb but not Ketogenic – and not Low Carb High Fat

The fourth diet could be considered ‘low-carb’ at 35% carbohydrate, but it is not a ketogenic diet, as the percent of carbohydrate is too high. A ketogenic diet has between 5-10% carbohydrate.  It was not a “high fat diet”, as the fat is only 40%, not ≥ 65% fat.

None of the dietary interventions in this study was ‘low-carb high fat’ or ketogenic, however one diet was “low carb”.

Other Study Goals and Information

Other goals for all the dietary interventions were that the diets had;
– 8% or less of saturated fat
– 20 g or more of dietary fiber
– 150 mg or less of cholesterol per 1000 kcal

Each participant’s calories represented a deficit of 750 kcal per day
from baseline, as calculated from the person’s resting energy expenditure and activity level (which should have promoted a weight loss of ~ 1.5 pounds per week).

Blinding between the groups was maintained by the use of similar foods in each of the dietary interventions.

Staff as well as participants were taught that each diet adhered to principles of a “healthful diet” and that each had been recommended for “long-term weight loss”.

Group dietary counselling sessions were held once a week, 3 of every 4 weeks during the first 6 months and 2 of every 4 weeks from 6 months to 2 years; individual sessions were held every 8 weeks for the entire 2 years. Behavioral counseling was integrated into the group and individual sessions to promote adherence to the assigned dietary intervention.

Participants were instructed to record their food and beverage intake in a daily food diary and in a web-based self-monitoring tool that provided information on how closely their daily food intake met their dietary intervention’s goals for macronutrients and calories.

The goal for physical activity was 90 minutes of moderate exercise per week. Participation in exercise was monitored by questionnaire and by
the online self-monitoring tool.

Measurements

Body weight and waist circumference were measured in the morning before breakfast on 2 days at baseline, 6 months, and 2 years, and on a single
day at 12 and 18 months.

Levels of serum lipids, glucose, insulin, and glycated hemoglobin (HbA1C) were measured via fasting blood samples, and 24-hour urine samples, and measurement of resting metabolic rate were obtained on 1 day, and blood-pressure measurement on 2 days, at baseline, 6 months and 2 years.

Results

Weight loss and Waist Circumference

The amount of weight loss after 2 years was similar in participants assigned to a diet with 25% protein and those assigned to a diet with 15% protein.

Weight loss was the same in those assigned to a diet with 40% fat and those assigned to a diet with 20% fat.

There was no effect on weight loss of carbohydrate level through the target range of 35 to 65%.

Most of the weight loss occurred in the first 6 months, however 23% of the participants continued to lose weight from 6 months to 2 years.

The change in waist circumference did not differ significantly among the diet groups.

At 2 years, 31 to 37% of the participants had lost at least 5% of their initial body weight, 14 to 15% of the participants in each diet group had lost at least 10% of their initial weight, and 2 to 4% had lost 20 kg or more.

Risk Factors for Cardiovascular Disease and Diabetes

All the diets reduced risk factors for cardiovascular disease and Diabetes at 6 months and 2 years.

At 2 years, the two low-fat diets and the highest-carbohydrate diet decreased low-density lipoprotein (LDL) cholesterol levels more than did the high-fat diets or the lowest-carbohydrate diet, 5% vs 1%. And at 2 years, the highest carbohydrate decreased LDL more (6%) versus the lowest carbohydrate diet (1%).

The lowest-carbohydrate diet increased HDL cholesterol levels more (9%) compared with the highest-carbohydrate diet (6%).

All the diets decreased triglyceride (TG) levels similarly, by 12 to 17%.

All the diets except the one with the highest carbohydrate content decreased fasting serum insulin levels by 6 to 12% – and the decrease was larger with
the high-protein diet than with the average-protein diet (10% vs. 4%).

Blood pressure decreased from baseline by 1 to 2 mm Hg, with no significant differences among the groups.

The metabolic syndrome (defined as elevated fasting blood glucose, elevated blood pressure and abnormal triglycerides or cholesterol levels) was present in 32% of the participants at baseline, and the percentage at 2 years ranged from 19 to 22% in the four diet groups.

Diet Adherence

Mean reported intakes at 6 months and at 2 years were not at the target levels for macronutrients (fat, protein and carbohydrate). This limits the applicability of the data.

In the Low Fat, Average Protein group (fat: 20%, protein: 15%, carbohydrate: 65%), carbohydrate intake decreased from baseline by 12.8% and by 9.3% from baseline at 2 years and fat intake decreased from baseline by 11.8% at 6 months and 12.0% at two years. As it should have, protein intake hardly changed at 6 months (0.2%) but by 2 years it had increased by 2.1% to 19.6%.

In the Low Fat, High Protein group (fat: 20%, protein: 25%, carbohydrate: 55%) at 6 months carbohydrate intake decreased from baseline by 7.4% and at 2 years, it decreased from baseline by 6.8%. Protein intake increased from baseline by 3.9% at 2 years it had increased by 2.5% – but it is important to note that such a modest increase meant that this group did not consume a diet of 25% protein (but slightly less than 19% at 6 months and 17.5% at 2 years). Fat intake decreased from baseline by 11.8% at 6 months and 12.0% at two years.

In the High Fat, Average Protein group (fat: 40%, protein: 15% carbohydrate: 45%), at 6 months carbohydrate intake  decreased from baseline by 5.0% and at 2 years, it decreased from baseline by 2.4%. Protein intake hardly increased from baseline at 6 months (0.5%), but at 2 years it had increased from baseline by 2.1%. Fat intake in this group was supposed to have increased, but actually decreased from baseline by 3.8% at 6 months and decreased from baseline by 2.1% at two years.

In the High Fat, High Protein group (fat: 40%, protein: 25%, carbohydrate: 35%) – which was the only intervention that was “low carb”, at 6 months carbohydrate intake only decreased from baseline by 0.2% and at 2 years, it decreased from baseline by 0.4%. In fact, carbohydrate remained at ~ 43% the entire time. Protein intake was supposed to increase substantially, but only increased from baseline by 4.3%, and at 2 years it had had only increased from baseline by 3.4%. It is important to note that such a modest increase in protein meant that this group did not consume a diet of 25% protein but ~19.3 % at 6 months and ~18.4% at 2 years. Fat intake in this group was supposed to have increased, but actually decreased from baseline by 3.7% at 6 months and decreased from baseline by 3.4% at two years.

Neither of the “high protein” groups achieved anywhere near 25% of daily calories as protein.

Despite the intensive behavioral counseling in this study, participants did not achieve the goals for macronutrient intake of their assigned group and while some data in this study is helpful, the one group that was supposed to be “low carb” (high fat, high protein) was none of those!

Researcher’s Conclusion

The researchers concluded;

“we did not confirm previous findings that low-carbohydrate or high protein diets caused increased weight loss at 6 months”

High Protein Diet “Fail”

The reason that this study failed to confirm whether a high protein diet causes increased weight loss at 6 months is because neither of the two “high protein” diet groups in this study ate anywhere near the target protein level of 25%, but rather ate between 17.5%-19% protein,  which is remarkably close to the average protein intake of 15%  (16.1% for men and 15.6% for women). Subjects also ate no where near the lower limits of a “high protein” diet, which is 27-68% of daily calories as protein.

Low Carbohydrate Diet “Fail”

The reason that this study failed to confirm that a low carbohydrate diet causes increased weight loss is because the one group of the four diet interventions that was supposed to eat what the researchers defined as “low carb” (35% of calories as carbohydrate) ate ~43% of calories as carbohydrate the entire duration of the study. This as a moderate carb diet, not a low carb diet.

Final Thoughts

In this long term study, researchers set out to look at the effectiveness of four dietary interventions including a “low carb” diet group, however poor study design failed to produce even one of the four groups that ate low carb.

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References

Sacks FM, Bray GA, Carey VJ et al, Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates, N Engl J Med. 2009 Feb 26;360(9):859-73

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Are Low Carbohydrate Diets Safe and Effective

INTRODUCTION: In a recent article, I established that low carbohydrate diets are not new and that recently published six-month results of a non-randomized, parallel arm, outpatient intervention demonstrated it was so effective at improving blood sugar control in Type 2 Diabetes, that at the end of six months >75% of people had HbA1c that was no longer in the Diabetic range (6.5%).

But what about the long term safety and effectiveness of low carb diets?

To date, there have been 3 long-term clinical trials (2 years) published over the past 10 years that included a low-carbohydrate treatment group and in this series of three articles, I will look at the methodology and findings of each.

Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

The first study published in 2008, with research conducted between July 2005 and June 2007 was a 2-year Dietary Intervention Randomized Controlled Trial (DIRECT) to compare the effectiveness and safety of (1) a low-fat calorie-restricted diet, (2) a Mediterranean calorie-restricted diet and (3) a low-carbohydrate non–calorie-restricted diet.

The criteria for recruitment to the study was age between 40 and 65 years and a body-mass index (BMI) – which is the weight in kilograms divided by the square of the height in meters of at least 27, or the presence of Type 2 Diabetes (according to the American Diabetes Association criteria) or coronary heart disease regardless of age and BMI.

Subjects were randomly assigned within strata i.e. gender, age (below or above the median), BMI (below or above the median), history of coronary heart disease (yes or no), history of Type 2 Diabetes (yes or no), and current use of statins (none, <1 year, or ≥1 year).

Subjects in each of the 3 diet groups were assigned to subgroups of ~18 participants (total of 6 subgroups in each group) and each diet group was assigned a Registered Dietitian that met with their groups in weeks 1, 3, 5, and 7 and after that at 6-week intervals, for a total of 18 sessions of 90 minutes each.

Low Fat Diet– Participants were counseled to consume low-fat grains, vegetables, fruits, and legumes and to limit added fats, sweets, and high-fat snacks. For the low-fat, restricted-calorie diet they were instructed to consume up to 30% of calories from fat, 10% from saturated fat and up to 300 mg cholesterol/day, with 1500 kcal for women and 1800 kcal/day for men.

Mediterranean Diet– The moderate-fat, calorie-restricted diet is rich in vegetables and low in meat, with poultry and fish replacing beef and lamb. Subjects were instructed to consume 35% of calories from fat; the main sources of added fat were from 30-45 grams of olive oil and a handful of nuts (5-7, less than 20 grams) per day. Subjects were instructed to restrict energy to 1500 kcal for women and 1800 kcal/day for men.

Low Carbohydrate Diet- This low-carb, non-calorie restricted diet was modeled after the Dr. Atkins Diet and aimed to provide 20 g/day of carbohydrates during the induction phase (first 2 months), and returned to this level of carb restriction after each religious holiday. At other times participants were instructed to increase carbs gradually up to maximum of 120 g/day to maintain the weight loss. Total calories, protein and fat intake from any source (except trans fats) were not limited.

Adherence to the diets was evaluated by a validated food-frequency questionnaire (127 food items with portion-size pictures) at baseline and at 6, 12, and 24 months of follow-up, and the questionnaires were self-administered electronically. A validated questionnaire was also used to assess physical activity.

Weight – The participants were weighed without shoes to the nearest 0.1 kg every month.

Blood Samples – Blood samples were obtained by at 8 a.m. after a 12-hour fast at baseline and at 6, 12, and 24 months.

Results – Dietary Intake, Energy Expenditure, and Urinary Ketones

At baseline, there were no significant differences in the composition of the diets consumed by participants assigned to the low-fat, Mediterranean, and low-carbohydrate diets.

Daily energy intake as assessed by the food-frequency questionnaire, decreased significantly at 6, 12, and 24 months in all diet groups as compared with baseline and there were no significant differences among the groups in the amount of decrease.

The low-carbohydrate group had a lower intake of carbohydrates and higher intakes of protein, total fat, saturated fat, and total cholesterol  than the other groups.

The Mediterranean-diet group had a higher ratio of monounsaturated to saturated fat than the other groups, and a higher intake of dietary fiber than the low-carbohydrate group.

The low-fat group had a lower intake of saturated fat than the low-carbohydrate group.

Physical Activity – The amount of physical activity increased significantly from baseline in all groups, with no significant difference among groups in the amount of increase.

Urinary Ketone Production – The proportion of participants with detectable urinary ketones at 24 months was higher in the low-carbohydrate group (8.3%) than in the low-fat group (4.8%) or the Mediterranean-diet group (2.8%).

Note: of interest, participants in all groups produce urinary ketones.

Weight Loss

A phase of maximum weight loss occurred from 1 to 6 months and a maintenance phase from 7 to 24 months.

All groups lost weight, but the reductions were greater in the low-carbohydrate and the Mediterranean-diet groups than in the low-fat group.

The overall weight changes among the 322 participants at 24 months were −4.7 (10.3 lbs) ±6.5 kg (± 14.3 lbs) for the low-carbohydrate group, −4.4 (9.68 lbs) ±6.0 kg (± 13.2 lbs) for the Mediterranean-diet group and
−2.9 (6.38 lbs) ±4.2 kg (± 9.24 lbs) for the low-fat group.

Lipid Profiles

Changes in lipid profiles during the weight-loss and maintenance phases are as followed;

HDL cholesterol increased during the weight-loss and maintenance phases in all groups, with the greatest increase in the low-carbohydrate group (0.22 mmol per liter (8.4 mg per deciliter) compared to the low-fat group which increased by 0.16 mmol per liter (6.3 mg per deciliter).

Triglyceride levels decreased significantly in the low-carbohydrate group 0.27 mmol per liter (23.7 mg per deciliter) as compared with the low-fat group 0.03 mmol per liter (2.7 mg per deciliter).

Of significance, LDL cholesterol levels did not change significantly within any of the groups, and there were no significant differences between the groups in the amount of change.

Overall, the ratio of total cholesterol to HDL cholesterol decreased during both the weight-loss and the maintenance phases. The low-carbohydrate group had the greatest improvement, with a relative decrease of 20% as compared with a decrease of 12% in the low-fat group.

High-Sensitivity C-Reactive Protein, High-Molecular-Weight Adiponectin, and Leptin

The level of high-sensitivity C-reactive protein (an assessor of inflammation often used to may be used to evaluate risk of cardiovascular disease.) decreased significantly in the low-carbohydrate group (29%), and also in the Mediterranean-diet group (21%) during both the weight-loss and the maintenance phases, with no significant differences among the groups in the amount of decrease.

The level of high-molecular-weight adiponectin (which regulates glucose levels, as well as fatty acid breakdown) increased significantly in all diet groups, with no significant differences among the groups in the amount of increase.

Circulating leptin, which reflects body-fat mass, decreased significantly in all diet groups, with no significant differences among the groups in the amount of decrease.

Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin

Fasting Blood Glucose

Among the 36 participants with Type 2 Diabetes, those in the Mediterranean diet group and low carb diet group had a decrease in fasting plasma glucose levels of 2.1 mmol/L (32.8 mg per deciliter) and 0.1 mmol/L (1.2 mg/dl) respectively, whereas those in the low-fat group had an increase 0.7 mmol/L (12.1 mg/dl).

There was no significant change in fasting plasma glucose level among the participants without Type 2 Diabetes.

Fasting Insulin

Insulin levels decreased significantly in participants with Type 2 Diabetes and without Type 2 Diabetes in all diet groups, with no significant differences among groups in the amount of decrease.

HOMA-IR

Not surprisingly, since HOMA-IR is determined from fasting blood glucose and fasting insulin, among subjects with Type 2 Diabetes the decrease in HOMA-IR at 24 months was significantly greater in those assigned to the Mediterranean diet (-2.3) and low carbohydrate diet (-1.0) than in those assigned to the low-fat diet (-0.3).

Glycated Hemoglobin (HbA1C)

Among the participants with with Type 2 Diabetes HbA1C at 24 months decreased most noticeably in the low-carbohydrate group (0.9 ±0.8%), and moderately in the Mediterranean-diet group (0.5 ±1.1%) and low-fat group (0.4 ±1.3%). The changes were significant only in the low-carbohydrate group.

Changes in Biomarkers According to Diet Group and Presence or Absence of Type 2 Diabetes (figure 4, from publication)
DISCUSSION

In this 2-year dietary-intervention study, the low-carbohydrate diets was found to be both an effective and safe alternative to the low-fat diet for weight loss.

In addition to producing weight loss in moderately obese subjects, the low-carbohydrate demonstrated some marked beneficial metabolic effects including;

  • lower fasting plasma glucose: 0.1 mmol/L (1.2 mg/dl)
  • lower HbA1C: -0.9 ±0.8%
  • significantly lower triglycerides: -0.27 mmol per liter (23.7 mg per deciliter)
  • significantly higher HDL: +0.22 mmol per liter (8.4 mg per deciliter)
  • lower C-reactive protein: -29%

These results suggest that a low carbohydrate, non-calorie restricted diet that provides 20 g of carbs per day during the induction phase of 2 months, with slightly higher amounts of carbohydrates with the addition of nuts, low-carb vegetables and small amounts of fruit until goal weight is achieved (~30-50 g carbs) is both safe and effective over a two-year period.

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References

Astrup A et al, Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008 Nov 13;359(20):2169-70.

free pdf available here: www.nejm.org/doi/full/10.1056/nejmoa0708681

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first. If you are taking medication to lower blood sugar or blood pressure, you should be monitored by your physician while following a low carb diet, as medication dosages will need to be adjusted – often soon after beginning.

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

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

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Evidence for Remission of Type 2 Diabetes Symptoms using LCHF

INTRODUCTION: A low carbohydrate, high fat diet is not new, in fact eating this way was the standard recommendation for treating Diabetes prior to the discovery of insulin.

More than 150 years ago, the first weight-loss diet book, written by William Banting, ironically a distant relative of Sir Frederick Banting, the co-discoverer of insulin focused on the limiting the intake of carbohydrates, especially those of a starchy or sugary nature. The book was titled Letter on Corpulence – Addressed to the Public (1864) and summarized the advice of the author’s physician, Dr. William Harvey that had enabled Banting to shed his ‘portly stature’.

In clinical practice, a ketogenic diet (very low carbohydrate, high fat, adequate protein) was successfully used in the Mayo Clinic nearly 100 years ago by Dr. R. Wilder as a treatment for epilepsy and continues to be used at Johns Hopkins University and other centers for this purpose.

In 1963, Dr. Robert Atkins in his own search for a weight loss plan came across an article in the Journal of the American Medical Association titled A New Concept in the Treatment of Obesity [1].  After he successfully lost weight by following its recommendations, he decided to enroll 20 overweight business executives in a 20 week trial. All lost weight and follow up records indicated that they continued to keep it off for at least a year. After establishing his medical practice in New York City, Dr. Atkins made some adjustments to the plan and incorporated it into his practice, helping his own patients successfully lose weight. In 1972, Atkins published his book Diet Revolution which was immediately successful but very controversial. Criticism of Atkins and his diet continues to this day.


Anecdotal evidence which relies on personal testimony is fine as encouragement (hence my blog A Dietitian’s Journey) and the clinical experience of physicians such as Dr. Jason Fung, a nephrologist from Toronto is excellent, but clinical use of a low carbohydrate diet to target the reversal of symptoms of Type 2 Diabetes requires scientific studies.

Enter Phinney and Volek.

Stephen Phinney, MD, PhD is a medical doctor and scientist with 40 years experience and is Professor of Medicine Emeritus at University of California, Davis. Dr. Phinney is an internationally recognized expert on obesity, carbohydrate-restricted diets, diet and performance and essential fatty acid metabolism and has held clinical faculty appointments at MIT, the Universities of Vermont, Minnesota and California at Davis. He has designed, conducted and published data from more than 20 clinical protocols involving diets, exercise, oxidative stress and inflammation and his design of clinical nutrition trials has led to more than 87 peer-reviewed papers and book chapters on clinical nutrition and biochemistry.

Jeff Volek, PhD, RD is a Registered Dietitian with a Doctorate degree and is professor in the Department of Human Sciences at The Ohio State University. Dr. Volek’s work has contributed to the existing science of ketones and ketogenic diets, their use as a therapeutic tool to manage insulin resistance. For the past 20 years, Dr. Volek has researched how humans adapt to diets restricted in carbohydrates, with a focus on both the clinical and performance application of nutritional ketosis. He has published more than 300 peer-reviewed scientific manuscripts and five books.

The Art and Science of Low Carbohydrate Living

In 2011, Phinney and Volek published their fully referenced expert guide titled The Art and Science of Low Carbohydrate Living documenting the clinical benefits of carbohydrate restriction and its practicality as both a sustainable and enjoyable lifestyle. While primarily a book directed towards healthcare professionals and those with a science background, it provides ample scientific evidence behind the use of a low carbohydrate diet to target the reversal of symptoms of Type 2 Diabetes.

In the January-June issue of JMIR Diabetes, Phinney and Volek along with a host of other physicians, Registered Dietitians and nurses published initial 10 week results of a nonrandomized, parallel arm, outpatient intervention using a very low carb diet which induced nutritional ketosis*. Each participant was provided with intensive nutrition and behavioral counseling, digital coaching and education platform and physician-guided medication management.

Nutritional ketosis was defined as a dietary regimen resulting in serum ketone levels of β-hydroxybutyrate between 0.5 and 3.0 mmol·L−1

There were 238 participants in the intervention, all participants had a diagnosis of Type 2 Diabetes (T2D), mean age was 54 years old (with participants ranging in age from 46 – 62 years). The majority were women 67% with 33% men. Average weight was 257 pounds (117 kg) with participants ranging from 200 pounds to 314 pounds (117±26 kg). Average Body Mass Index (BMI) was 41 kg·m-2 (class III obesity) ±9 kg·m-2. Average HbA1c was 7.6% ±1.5%. The majority of participants (89%) were taking at least 1 glycemic control medication.

Each participant received an Individualized Meal Plan for nutritional ketosis, behavioral and social support, biomarker tracking tools, and ongoing care from a health coach with medication management by a physician.

Subjects typically required <30 g·day−1 total dietary carbohydrates. Daily protein intake was targeted to a level of 1.5 g·kg−1 based on ideal body weight and participants were coached to incorporate dietary fats until they were no longer hungry. Other aspects of the diet were individually tailored to ensure safety, effectiveness and satisfaction, including consumption of 3-5 servings of non-starchy vegetables and enough mineral and fluid intake. The blood ketone level of β-hydroxybutyrate was monitored, using a portable, handheld device.

Ten Week Outcomes

Medication Use

At baseline, 89% of participants were taking at least one medication for Diabetes.

At 10 weeks almost 57% had one or more Diabetes medications reduced or eliminated.

64% of insulin, sulfonylurea, SGLT-2 inhibitor, DPP-4 inhibitor and thiazolidinedione prescriptions were eliminated in 10 weeks.

Glycosylated Hemoglobin (HbA1C)

At baseline, the average HbA1c level was 7.6% ±1.5%, with less than 20% having a HbA1c level of <6.5% (with medication usage).

After 10 weeks, HbA1c level was reduced by 1.0% and the percentage of individuals with an HbA1c level of <6.5% increased to more than 56%.

Note: 48% achieved this level while taking only Metformin (n=86) or no Diabetes medications (n=39). That is, >15% achieved this level by diet alone.

Weight Loss

Mean body mass reduction was 7.2% from a baseline average of 117 kg (257.4 pounds) ±26 kg / 57 lbs.


Six month outcomes

After 6 months, 89% of participants were still enrolled in the study. Results indicate that nutritional ketosis was quite effective in improving blood sugar control and weight loss in adults with Type 2 Diabetes, while significantly decreasing medication use.

Glycosylated hemoglobin (HbA1C)

At 6 months, HbA1C was reduced to 6.1% ±0.7% from 7.5% ±1.3% in a sample of 108 participants who elected to test HbA1c at 6 months.

Twenty-two of the 108 started with a HbA1c <6.5%, and at 6 months, 76% reduced their HbA1c below the threshold for diabetes diagnosis (6.5%).

Weight Loss

Patients lost 11.5% (±8.8%) of their body weight with 81% having attained a clinically significant weight loss (more than 5% of their body weight).

Medication Reduction

Most medication eliminations were maintained through 6 months along with reduced HbA1c and weight.

 

 

Participants also experienced a 20% reduction in triglycerides with an average value at follow-up in the healthy range below 1.69 mmol/L (150 mg/dL) [3].

Discussion

Improvements in blood sugar control in adults with Type 2 Diabetes (T2D) have been associated with weight loss of greater than 5% [4], which is why a weight loss component is part of many treatment plans.

As noted by the researchers, it is often assumed that it is the weight loss that leads to the improvements in blood sugar control, but it is possible that improvements in blood sugar control occur simultaneously with- or before significant weight loss is achieved.

In their 10-week outcomes, weight and HbA1c reduction seemed to occur simultaneously, but the researchers noted that there were significant reductions in HbA1c occurring even before the full life cycle of red blood cells (approximately 100 days), in which HbA1C is measured.

The researchers referred to other research which demonstrated that improvements in blood sugar control occur prior to significant weight loss [5]. In that study, patients with Type 2 Diabetes who consumed a very low carbohydrate (ketogenic) diet of 21g of carbohydrate per day had significantly improved insulin sensitivity concurrent with significantly lower plasma glucose and HbA1c, but had only a 5 lb (2kg) weight loss after two weeks ( 1.8%) [5]. This suggests that it is not only the weight loss that was resulting in better insulin sensitivity.

The researchers also referred to other studies which reported that early improvement in blood sugar control is also highlighted by how quickly insulin and some oral anti-diabetic medications must be reduced or eliminated when a very low carbohydrate diet is begun, with most reductions and eliminations occurring in the first 3 weeks [5,6] when there is only a modest reduction in weight.

The researchers noted;

this suggests that weight loss may not be the driver of improved blood sugar control, but may be a positive side effect that is achieved concurrently with a well-formulated, very low carbohydrate diet.”

Medical Involvement

People with Type 2 Diabetes who take medication to lower blood sugar require the involvement of their physician as they follow a low carb- or ketogenic diet, as an adjustment in medication is often needed soon after beginning, due to blood sugar levels coming down. I would consider it prudent that regular daily glucose monitoring take place for (a) fasting blood sugar, at least once (b) just before a meal, and at least once (c) 2 hrs after a meal and again (d) at bedtime.

For those taking medication to lower blood pressure, the involvement of one’s physician is also needed, as blood pressure often drops with– or soon after blood sugar levels come down. The doctor may need to adjust medication dosages several times before attempting to trial eliminating them.

If you are taking medications to lower blood sugar or blood pressure, please speak to your doctor before beginning to eat low carb.

For those with Type 2 Diabetes but not taking any medication to lower blood sugar, regular daily glucose monitoring is still necessary, with (a) daily fasting blood sugar and (b) at bedtime and a few times per week (c) just before a meal, and (d) 2 hrs after a meal. This is to be sure that blood sugar levels do not drop too low.

For those whose clinical condition requires use of a very low carbohydrate diet / use of nutritional ketosis, monitoring of ketone levels using urine sticks at first and then blood levels of β-hydroxybutyrate occurs is highly recommended to make sure that steady levels are maintained.

Note: It is not recommended for people with any health or medical conditions to seek to achieve the levels of nutritional ketosis described in the above study, with levels of β-hydroxybutyrate between 0.5 and 3.0 mmol·L−1 without regular medical supervision.

Some final thoughts…

As demonstrated by this intervention study, it is entirely possible for the symptoms of Type 2 Diabetes to go into remission by following a low-carbohydrate lifestyle. After 6 months, >75% of people had HbA1c that was no longer in the Diabetic range (6.5%). This does not mean, however that their Diabetes was “cured”. If those people revert back to eating a high carb intake, they will experience the return of high blood sugar, blood pressure and abnormal lipid profile.

For those wanting to manage and aim to achieve remission of Type 2 Diabetes symptoms, I recommend that people first speak with their doctor about following a low carbohydrate diet with the support of an Registered Dietitian who is experienced using a wide range of low carb diets.

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References

1. Gordon ES, Goldberg M, Chosy GJ. A New Concept in the Treatment of Obesity, JAMA. 1963;186(1):50–60. doi:10.1001/jama.1963.63710010013014

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

3. McKenzie AL, Hallberg SJ, Creighton BC, Volk BM, Link TM, Abner MK, Glon RM, McCarter JP, Volek JS, Phinney SD
A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes, JMIR Diabetes 2017;2(1):e5
URL: http://diabetes.jmir.org/2017/1/e5
DOI: 10.2196/diabetes.6981

4. Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ. Lifestyle Weight-Loss Intervention Outcomes in Overweight and Obese Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Journal of the Academy of Nutrition and Dietetics. 2015;115(9). doi:10.1016/

5. Boden G, Sargrad K, Homko C, Mozzoli M, Stein PT. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. 2005;142(6): 403-411.

6. Bistrian BR, Blackburn GL, Flatt JP, Sizer J, Scrimshaw NS, Sherman M. Nitrogen metabolism and insulin requirements in obese diabetic adults on a protein-sparing modified fast. 1976;25(6):494-504.

Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

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