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!


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

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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

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

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Note: 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.

 

 

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.


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

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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

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


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

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

 

 

 

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.


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

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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.


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

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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

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.


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

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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.

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% menAverage 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 sugarregular 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.

Have questions?

Why not send me a note using the Contact Me form located on the tab above?

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

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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.

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.

 

What Regulates Body Weight?

Body weight is not under our control as much as we’d like to believe, but is a tightly regulated process that involves a variety hormones with some of the major ones being leptin (a hormone that regulates fat stores by  inhibiting hunger), ghrelin (a hormone that increase hunger when your stomach is empty) and insulin, which plays a very significant role in hunger, eating behavior and fat managementInsulin is one of the major controllers of the body’s “set point”.

What is “set point“?

Think of set point like the thermostat in your house; when the air gets too cold, the thermostat is engaged, and the furnace comes on and when the air gets a little too hot, the thermostat shuts the furnace off. Your body’s set point is maintained by a complex set of hormonal mechanisms that works to maintain your body at its current weight.  If you eat a lot more one day because it’s a special occasion, the next day you won’t feel as hungry as usual, and will eat less. When someone who normally eats a carbohydrate-based diet restricts calories, their body slows its metabolism and lowers the amount of energy (calories) it uses for vital bodily functions in order to ‘save’ the limited calories for use by their brain. In fact, the amount of energy used by your body at rest (called Basal Energy Expenditure) can decrease by as much as 30-50% in order to save those calories!

This saving of calories for essential functions is why when people who are used to eating carbs ‘fast’ or limit the number of calories they eat, they feel cold, tired and find it hard to focus.  This is the body ‘saving’ the few calories for essential body functions, such as for their brain and organs. This doesn’t happen to someone who is fat-adapted, because they use their own fat stores to maintain blood and brain glucose, and for other energy needs.

Equally part of maintaining the body’s set point, when an overweight person takes in too many calories, their body will try to get rid of them by increasing its Basal Energy Expenditure and speeding up breathing rate (respiration), increasing heart rate and generating more body heat.

So, whether we are overweight or underweight, the body will adjust its processes to maintain its ‘set point’.

This is why the so-called calorie in, calorie out model, doesn’t work – because it is not simply a matter of “eating less and moving more“. When people who are carb-dependent restrict their calories, their metabolism slows and so they burn way less calories!

Calories in and calories out are not independent of each other but inter-dependent on each other; when one is lowered (calories in), so is the other (calories out, metabolism).  When one is increased (calories in), so is the other (calories out, respiration, heat generation).

It’s really not as simple as “eating less and moving more” to lose weight, because when we both restrict calories and increase our exercise, our body responds by increasing hungerincreasing craving (especially for foods such as simple carbs that can be broken down quickly for glucose for your blood) and by decreasing the amount of energy it uses. Using the thermostat analogy, our body turns the thermostat down.

Wouldn’t you think that if it were really as simple as “eating less and moving more” that more people would be slim!

Restricting calories doesn’t work for long term weight loss because the body compensates by lowering its energy expenditure. It’s not about how many calories we take in, but about what changes ‘set point’.

It’s mainly about insulin. We have to reduce insulin.

Low-carbohydrate diets and increasing the amount of time between meals (called “intermittent fasting”) are two ways to lower insulin.

Lowering insulin, will in turn will lower blood sugar and when this lifestyle is maintained, over time, it has even shown by researchers to be able to reverse the symptoms of Diabetes. That doesn’t mean people aren’t Diabetic anymore – they are but the symptoms of Diabetes, namely high blood sugar (reflected in high fasting blood glucose and HbA1C) are in remission. Other added benefits include a lowering of blood pressure (which is closely tied to insulin), gradual, sustainable weight loss and a normalizing of triglycerides as well as some cholesterol markers.

When people are ‘fat-adapted‘, they have a ready supply of fuel for their bodies (their own fat stores!), and so their metabolism doesn’t slow down when they eat this way. Their bodies continue to burn calories at the usual rate!

Furthermore, they aren’t cold, tired and hungry because they have excess fat stores to serve as a constant supply of fuel for their brain, blood and muscles. Fat is broken down for ketone bodies which can be used for most body processes, and the essential glucose needed by our blood and brain is easily synthesized by the breaking down of fats. 

Want to know more about how I can help you?

Why not send me a note using the Contact Us form above and I will reply shortly.

To our good health!

Joy

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

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.

A Dietitian’s Journey – before and since

INTRO: “Before” and “after” photos are often the source of encouragement, as I progress on my journey.  This “before and since” photo serves as some Monday-morning motivation.

Yesterday, after ten days on crutches and a brace due to a torn MCL tendon, I had finally progressed to a cane and just had to get out for a bit.  With a break in the rain, one of my sons and I headed for Indian Arm, an ocean inset nearby. It was mild and humid and I really didn’t want to wear a long sleeve jacket, so I reached for a down-filled vest that I bought a number of years ago that never zipped or snapped up, and headed out.  When we arrived, there was a breeze off the salt water and instinctively, I zipped up the vest and snapped the outer snaps. Only in hindsight did I realize this was the first time I ever did that – and with a little room to spare.

We walked (actually, I hobbled on my cane) along the coast path and down to the pier and took in the fresh air and beautiful view. As we were leaving, I remembered the photo that was taken of me 2 1/2 years ago on the same pier, around the time I first learned about eating low carb high fat (LCHF) and asked my son to snap a photo of me on my phone, so I could compare them. In both photos, I was dressed in comfortable clothes, with no makeup and my hair however it was.

When we returned home, I dug out the old photo and here they are, side by side.  Even with my puffy down-filled vest and knee brace, the difference is noticeable, even though it has only been 6 months that I have been “practicing what I preach” and eating low carb, myself. Since I am very much ‘in progress’ with my weight loss and achieving my health goals, I refer to this as before and since rather than before and after.

Me – summer 2015 (left), me fall 2017 (right)

It will be interesting to take an updated photo this time next year to see the progress.

Encouragement in our health journeys come in many forms; a number on the scale, new lab results, readings on a glucometer, or photos over time.

Today I celebrate this mid-point progress in this Dietitian’s Journey and I encourage you to celebrate yours!

To our good health!

Joy

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

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Note: I am a "sample-set of 1" - meaning that my results may or may not be like any others who follow a similar lifestyle. If you are considering eating "low carb" and are taking medication to control your blood sugar or blood pressure, please discuss it with your doctor, first.

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.

American Diabetes Association Approves Low Carb Diets for Weight Loss

In December 2008, the American Diabetes Association (ADA) issued its Clinical Practice Recommendations which included the option for Diabetics to follow low-carbohydrate diets as a weight-loss option. While this is obviously not ‘news’, it is important to note that the Canadian Diabetes Association – now called Diabetes Canada, does not as yet make the same recommendation.

Why is that?

Is there something inherently different about Diabetics in Canada than Diabetics in the United States?

For the last 9 years the American Diabetes Association has given people the option of following what they call a “moderate carbohydrate diet by (a) omitting some of the carb-containing foods on their standard meal plan or (b) substituting them for much lower carb alternatives. They also (c) provide Americans with the option of following a low carb diet for weight loss.

Let’s take a look at the American dietary recommendations compared with the Canadian ones.

Dietary Recommendations of the American Diabetes Association

On their web page, the American Diabetes Association states that their standard Meal Plans that are “moderate” in carbohydrates provide  ~45% of calories from carbs, but they add;

Your healthcare provider may ask you to limit carbohydrate  more than our meal plan suggests. This means you should cut back on the carbohydrate foods that you eat throughout the day. To keep your calorie intake about the same, substitute sources of lean protein or healthy fats for those higher carbohydrate foods.

Then they give some examples of how people can lower carbohydrate intake by making some adjustments to the posted meal plan, such as;

  • omitting the slice of whole wheat toast at breakfast
  • replacing the whole wheat wrap for a lettuce wrap at lunch
  • skipping the serving of brown rice at dinner and adding another non-starchy vegetable instead.

For the last 9 years (2008), Diabetics in the US have also been given the option by the American Diabetes Association to follow a low carb diet in order to lose weight. The 2008 Summary of Revisions for the Clinical Practice Recommendations was changed to include the following;

The “Medical Nutrition Therapy” section has been revised; updates to this section include the following revised recommendations for weight loss:

For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short-term (up to 1 year).

For patients on low-carbohydrate diets, monitor lipid profiles, renal function and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed.

What the last sentence means is that doctors should monitor the  cholesterol and triglyceride levels of their patients on low-carb diets and adjust the dosage of the medication prescribed to control blood sugar levels. 

As has been the experience of physicians that prescribe a low carb high fat diet to their patients, as blood sugar levels drop – they need to reduce their patient’s medications dosages and in time, these medications are often discontinued entirely.

What are the dietary recommendations given to Diabetics in Canada?

Dietary Recommendations of Diabetes Canada

Diabetes Canada basic meal planning information advises people to;

“Choose starchy foods such as whole grain breads and cereals, rice, noodles, or potatoes at every meal. Starchy foods are broken down into glucose, which your body needs for energy.”

The sample meal plan for small appetites on the Diabetes Canada website recommends that people consume 193 g of carbohydrates per day which is approximately 13 servings* of carb-containing food per day (based on the Diabetic exchanges, where 1 serving is 15 g of carbohydrate).

Diabetic Sample Meal Plan (for small appetites) from Diabetes Canada

The Diabetic Sample Meal Plan for larger appetites is the same as above, but also includes an afternoon snack with a medium apple or small banana (+ 25 g carbohydrates), plus a medium pear at supper (+29 g carbohydrates) and another glass of milk with the above evening snack (+12 g carbohydrates), amounting to 259 g of carbohydrates per day, which is almost 17 servings* of carb containing foods.

Diabetics in Canada are advised to eat 45 – 60 g of carbs at each of 3 meals, plus 15 – 30 grams of carbs at each of 1-2 snacks

This is a lot of carbohydrate for someone whose body isn’t handling carbohydrates well.

The Diabetes Canada webpage, under Healthy Living Resources, there is a section titled Diet and Nutrition.  Under this are the organizations recommendations concerning Carbohydrates. They encourage carbohydrate counting which “focuses on foods that contain carbohydrate as these raise your blood glucose (sugar) the most.

They encourage Canadian Diabetics to “follow these steps to count carbohydrates and help manage your blood glucose levels“.

What are those steps?

  • Step 1: Make healthy food choices
  • Step 2: Focus on carbohydrate
  • Step 3: Set carbohydrate goals
  • Step 4: Determine carbohydrate content
  • Step 5: Monitor effect on blood glucose level

Diabetes Canada recommends that Diabetics eat ~ 1/2 of their calories as carbohydrate while at the same time advising people that “foods that contain carbohydrate … raise your blood glucose (sugar) the most”. 

So, when Diabetics eat the large percentage of their diet as carbs and their blood sugar is raised, what should they do?

Well, the Diabetes Canada webpage goes onto explain under Step 5 that they should “monitor the effect (of carbohydrates) on blood glucose level and

Work with your healthcare team to correct blood glucose levels  that are too high or too low.

I had to read this several times to make sure I wasn’t misreading it.

Diabetics in Canada are being told;

  1. carbs raise their blood sugar the most
  2. that they are to take in ~1/2 of their calories as carbs
  3. when their blood sugars get too high, they need to have their medication adjusted to handle the load.

Could this be why Diabetes is said to be “a chronic, progressive disease”?

Change in the American Diabetes Association Postion

In 2007, a year before the revised recommendations came out approving either a low-carb diet or a low calorie restricted diet, the American Diabetes Association recommendations stated that ‘low carb diets were not recommended for the treatment of overweight or obesity—even in the short term, because their long-term effects were unknown and they did not seem to provide better maintenance of weight loss than low-fat diets over the long term’.

However, in a press release with the release of the 2008 recommendations the American Diabetes Association reversed its position saying;

“there is now evidence that the most important determinant of weight loss is not the composition of the diet, but whether the person can stick with it, and that some individuals are more likely to adhere to a low carbohydrate diet while others may find a low fat calorie-restricted diet easier to follow.”

Furthermore, in the same press release, the American Diabetes Association President of Health Care & Education at the time, Registered Dietitian Ann Albright, PhD, RD, said;

“We’re not endorsing either of these weight-loss plans over any other method of losing weight.”

Albright added that it was ‘more important that people with Diabetes choose a weight-loss plan that works for them and that their healthcare team supports their efforts and monitors their health accordingly‘.

Canadian Recommendations

The Canadian Clinical Practice Guidelines recommends that people with Diabetes receive nutrition counselling from a Registered Dietitian. They recommend that those who are overweight or obese reduce caloric intake to achieve and maintain a healthier body weight and state that it is consistency in carbohydrate intake and in spacing and eating regular meals that may help control blood glucose levels and weight.

From the 2017 Guidelines:

People with diabetes should receive nutrition counselling by a registered dietitian.

Reduced caloric intake to achieve and maintain a healthier body weight should be a treatment goal for people with diabetes who are overweight or obese.

The macronutrient distribution is flexible within recommended ranges and will depend on individual treatment goals and preferences.

Replacing high glycemic index carbohydrates with low glycemic index carbohydrates in mixed meals has a clinically significant benefit for glycemic control in people with type 1 and type 2 diabetes.

Intensive lifestyle interventions in people with type 2 diabetes can produce improvements in weight management, fitness, glycemic control and cardiovascular risk factors.

A variety of dietary patterns and specific foods have been shown to be of benefit in people with type 2 diabetes.

Consistency in carbohydrate intake and in spacing and regularity in meal consumption may help control blood glucose and weight.

Final Thoughts…

Why are Diabetics in the US recommended to lose weight by following  either a low-carb diet or a low calorie restricted diet, yet Diabetics in Canada are recommended to eat 13-17 servings of carb-containing foods per day, with 45 – 60 g of carbs at each of 3 meals, plus 15 – 30 grams of carbs at each of 1-2 snacks? That’s a good question.

Many physicians report that Diabetics following LCHF diets have their medications reduced and in many cases discontinued entirely. As a Dietitian this seems preferable as a first approach, than recommending that Diabetics eat half of their calories as carbs, which would necessitate having their medication adjusted upwards when their blood sugars get too high, and having people’s Diabetes continue to worsen in time.

Why should Canadians with Diabetes not be provided with choice?

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

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/


Copyright ©2017 BetterByDesign Nutrition Ltd.  

All illustrations and text content contained on this web page are the intellectual property of 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.


References

American Diabetes Association, Adjusting the Meal Plan, http://www.diabetes.org/mfa-recipes/2017-07-adjusting-the-meal-plan.html

Dairman T., Diabetes Self-Management, ADA’s New Guidelines OK Low-Carb Diets for Weight Loss, 2008 Jan 7,  www.diabetesselfmanagement.com/blog/adas-new-guidelines-ok-low-carb-diets-for-weight-loss/

Dworatzek PD, Arcudi K, Gougeon R, Husein N, Sievenpiper JL, Williams SL. Nutrition Therapy, Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, http://guidelines.diabetes.ca/browse/chapter11

New York Style Chocolate Cheesecake – less carbs than a slice of 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.

Some people think of Dietitians as the healthcare professional that is going to take all the fun out of life. We’re going to advise you to eat carrots, when everyone else is eating cheesecake. That is not how I practice. Even when I taught a higher carb style of eating, I always believed there were “everyday foods” and “sometimes foods” and never believed in forbidding any food (unless serious food allergies were involved). For me it’s always been about how much and how often we eat something.

If you’ve been following my blogs for a while, you know that I don’t believe in eating unlimited amounts of any type of foods or restricting any food groups. Yes, I recommend people eat carbs in vegetables, nuts and seeds, certain dairy and some fruit and legumes, if tolerated. Protein is adequate, but not in excess.  I encourage eating a wide range of healthy fat, including that found in the protein sources, as well as monounsaturated fats such as olive oil and avocado oil, as well as using coconut oil to raise the smoke point of those, when heating them to higher temperatures.

But what about sweets? Where do they fit in?

I do think there are times where celebrating a special occasion warrants making something special that contains carbs, fat and protein beyond what we usually eat.  I am not the Grinch of holidays or celebrations!

I encourage people to plan for eating the treats by knowing the  macronutrient content in it (amount of protein, fat and carbs in grams) and subtracting that from their Meal Plan ahead of time.  This rarely necessitates people eating more than they usually do because the foods themselves, if well planned, can take the place of a meal. If it means that someone eats “Pumpkin Pie without the Pie” (crust-less low carb pumpkin custard) instead of supper, so be it!  The net carbs from the pumpkin itself minus the fiber aren’t that high, and the eggs and cream inside the custard filling serve as the protein source for the meal, and the rest is fat.  So? What’s wrong with that?

Tonight is one of those occasions that a special treat was warranted. One of my sons has been wanting New York style cheesecake since he began eating low carb high healthy fat with me, 7 months ago and today I baked him one!  It is creamy and rich with all the mouth-feel one expects from New York Cheesecake from the cream cheese, egg and egg yolks.  It has real Swiss dark chocolate and homemade vanilla extract, made from real vanilla beans soaked in Russian vodka. It has a little hint of sweet, because after all, it is for a special occasion!  Should he choose to (or rather if he were even able to) he could eat the entire 8 1/2″ cheese cake and not exceed his daily 100 g of carbs!  I can assure you, he will try! And who could blame him?

Low Carb New York Style Cheesecake

Ingredients

  • Five 250 g (8 oz) pkgs cream cheese, room temperature
  • 1/2 cup of berry sugar (extra fine castor sugar)
  • 1/4 tsp salt
  • 1/2 tsp real vanilla
  • 5 lg eggs plus two egg yolks, room temperature
  • 100 gm (3.5 oz.) 85% cocoa Swiss dark chocolate, melted in a double boiler

Instructions

Preheat the oven to 500 F.

Prepare an 8 1/2 ” spring-form pan by lining with parchment paper and spraying well with an oil spray.

 

In the bowl of a stand mixer using the flat paddle or by hand, beat the cream cheese until very well blended and add the eggs one at a time, continuing to blend.  Add the egg yolks, then the salt, berry sugar (castor sugar) and real vanilla.

Remove the bowl from the stand mixer and fold in the melted, cooled chocolate.

 

Bake at 500 F for 12 minutes, then lower the heat to 200 F and make for another 45 minutes.

Turn off the heat of the oven and open the door, but leave the cheesecake inside for 30 minutes until partially cooled.

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

Enjoy!


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

  • Carbohydrates: 12.6 g*
  • Protein: 17 g
  • Fat: 46 g

* a slice of bread has 15 g of carbs


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


you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/