Censorship of Real Food on Social Media as possibly offensive or disturbing

Two days ago I posted a photo on Instagram, Facebook and Twitter of fresh chicken that I had bought and had cut up into pieces for dinner. Real food is perfectly normal for a Dietitian to post about, right…but the photo was blurred out by Instagram because it contained what it deemed was “sensitive content” that some would find offensive or disturbing? Calling it what it is, this is censorship of real, whole food.

The photo I posted is above.

The caption under the photo indicated that this shouldn’t look foreign and that real chicken comes with a head, feet and bones (in contrast to chicken we buy in a supermarket that usually comes boneless or pre-cut, in Styrofoam trays, and covered in plastic wrap).

Presumably, someone found this photo offensive and reported it to Instagram.  I was not notified that the photo had been censored and it looks the same from my end so I wouldn’t have known, but several people that follow me told me that my photo was deemed to contain “sensitive content” and was blurred out.

To anyone viewing the post now, it now looks like this:

This photo contains sensitive content which some people may find offensive or disturbing.

A physician who follows me on Instagram posted the following with regard to the censoring;

I cannot believe a photo of food is blurred as “sensitive content”. It is absolutely mind boggling. But it’s totally fine to be constantly inundated with ads for crap that make us feel bad about ourselves, making us buy junk we don’t need.

This physician is right!

There’s a huge difference between real food and the processed food-like substances (“crap”) that we are encouraged to buy and eat (you can read more about telling the difference between these in this previous article).

The two photos that I posted of chicken before and after being cut up has been censored on Instagram because in contains “sensitive content which some people may find offensive or disturbing“.

Do you know what I consider offensive and disturbing?

I find people having to have toes amputated because of uncontrolled diabetes offensive.

I find obese people trying desperately to lose weight, yet finding themselves unable to curb an insatiable craving for processed food that was deliberately created by its producers, disturbing.

I find the fact that many young children in Canada and the US (and likely in many other countries) think of chicken as something that comes boneless, deep fried in batter and packaged in small individual packages with various flavours of sweetened sauce to dip it in, disturbing.

I find pea protein isolate, industrial seed oil, methyl cellulose and a host of other processed ingredients masquerading in the meat counter, offensive.  But please don’t misunderstand…

I have absolutely no problem with vegetarians and vegans having a wide variety of plant-based food available to eat as alternatives to animal-based foods, but it should not be marketed to consumers as “meat”, but ‘better’.

It may be “better” or “ultra” or “beyond” for those who choose a plant-based lifestyle, but an ultra-processed mixture of pea protein isolate, canola oil, refined coconut oil, cellulose from bamboo, methylcellulose, potato starch, maltodextrin, yeast extract, sunflower oil, vegetable glycerin, dried yeast, gum arabic along with seasoning and flavourings is not ‘better’ or preferable to whole, real food with a single ingredient, “beef”.

These are choices…

…and people have the right to choose what they want to eat, without condemnation and judgement.

There is no one-sized-fits-all-diet and individuals who choose to eat meat, fish or poultry should not be vilified or censored for doing so.

To your good health,

Joy

You can follow me on:

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

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

 

 

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Intermittent Fasting Doesn’t Need to be Complicated

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

Here are some of the answer that were posted;

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

Definition of Terms

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

Internal and External Perceptions of Intermittent Fasting

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

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

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

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

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

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

My Answer to the Question

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

My favourite fasting protocol

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

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

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

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

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

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

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

More Info?

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

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

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

To your good health!

Joy

You can follow me on:

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

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

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

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References

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

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

 

Keto Diet Doesn’t Cure Diabetes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Virta Health Data

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

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

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

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

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

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

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

In fact, the ADA said in that report that;

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

* blood sugar

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

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

Final Thoughts…

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

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

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

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

More Info?

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

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

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

To your good health!

Joy

You can follow me on:

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

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

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

References

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

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Focus on Limiting Ultra Processed Food Not Saturated Fat & Sodium

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

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

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

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

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

In my opinion, this conflates two issues. 

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

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

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

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

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

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

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

 

Shifting the Focus off Saturated Fat Based on the Evidence

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

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

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

Focus on Where Change is Needed

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

This makes good sense.

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

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

More Info?

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

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

To your good health!

Joy

You can follow me on:

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

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

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

References

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

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

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

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

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

The “Snapshot”

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

The main points on the Snapshot are;

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

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

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

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

Being mindful can help you:

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

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

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

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

Here is that image by itself;

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

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

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

Fifteen Most Addictive Fast Foods

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

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

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

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

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

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

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

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

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

More Info?

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

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

To your good health!

Joy

You can follow me on:

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

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

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

References

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

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

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

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

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

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

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

Guideline 1 – Real, whole food

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

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

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

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

Yes!

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

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

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

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

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

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

Example of whole, real food (low carb omnivore)

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

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

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

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

Guideline 2 – Limit Processed or Prepared Food

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

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

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

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

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

Guideline 3 – Know How to Prepare and Cook Food

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

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

I agree.

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

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

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

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

Some Final Thoughts…

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

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

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

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

More Info?

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

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

To your good health!

Joy

You can follow me on:

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

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

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

References

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

 

CFG: what’s unlikely to change as new evidence emerges

Note: This article is mainly a Science Made Simple article with some personal comments and rhetorical questions added in, so it is categorized as both an editorial and a Science Made Simple article.

In writing the recent article about low carbohydrate diets eliminate the grains food group, I came across a statement that troubled me.  It was in a Health Canada document titled What are Canada’s Dietary Guidelines? [1] and stated;

“Guidelines 1 and 2 were developed based on convincing findings from scientific reports that included extensive reviews of the literature on the relationship between food and health [1,2]. The reports are listed in Table 1. These convincing findings are supported by a well-established evidence-base and are unlikely to change in the foreseeable future as new evidence emerges.”

Note: Guideline 1 is the recommendation to eat more plant-based foods and limit foods with saturated fat and Guideline 2 is the recommendation to avoid beverages high in sugar and to eat less processed/prepared food] 

from Health Canada’s “What are Canada’s Dietary Guidelines?” (https://food-guide.canada.ca/en/guidelines/what-are-canadas-dietary-guidelines/)

To me, a natural reading of the statement seemed to indicate that the Guidelines are unlikely to change in the foreseeable future as new evidence emerges. That is, the subject of the statement is Guidelines 1 and 2 —which are said to be based on convincing findings supported by well-established evidence base and unlikely to change in the foreseeable future as new evidence emerges.

I thought that it couldn’t say what I understood it to say and asked myself what else it could have meant.

Perhaps Health Canada meant to say that they considered the evidence-base so strong that it was unlikely to change in the foreseeable future, even as new scientific evidence emerges.

I looked up the two references on which Guidelines 1 and 2 were based, namely;

  1. Health Canada. Evidence review for dietary guidance: technical report, 2015. Ottawa: Health Canada; 2016.
  2. Health Canada. Food, Nutrients and Health: Interim Evidence Update 2018. Ottawa: Health Canada; 2019.
Evidence Review for Dietary Guidance (2015) and Interim Evidence Update (2018) [2,3]

In looking at these documents, I found a very similar statement to the one above and which read;

“When developing dietary guidance, Health Canada uses convincing findings that are supported by a well-established evidence base and are unlikely to change in the foreseeable future as new scientific evidence emerges.” [2]

In this context, it is clear that it is the “convincing findings” that are supported by a “well established evidence-base” on which dietary guidance is based that Health Canada believes are unlikely to change in the foreseeable future as new scientific evidence emerges [1].

In support of this understanding, Health Canada says in the earlier report [3], that;

“Health Canada will update Canada’s dietary guidelines, as needed, to ensure the guidance remains consistent with the latest convincing evidence” [3].

Conclusion:

According to Health Canada, the findings are supported by such a well-established evidence-base that they are “unlikely to change in the foreseeable future, even as new evidence emerges”.

[Rhetorical question: is the evidence-base for recommending that Canadians limit saturated fat intake really so strong that it is “unlikely to change in the foreseeable future as new evidence emerges”?

As I elaborate on below, in 2015 the Heart and Stroke Foundation of Canada already questioned the link between saturated fat and cardiovascular disease in their updated position paper (a paper, that I elaborate on below was not included as a reference in the new Canada Food Guide). 

In addition, the 2017 PURE epidemiological study that Health Canada references in their 2018 paper but does not cite (see below) did not find that dietary saturated fat intake was associated with cardiovascular disease. 

Furthermore, a meta-analysis published just last week (months after the release of the new Canada’s Food Guide) of 43 cohort or nested case-control studies that were conducted up until July 1, 2018 did not find that higher saturated fat intake was associated with higher risk of cardiovascular disease (CVD) events.

In my opinion, the presupposition that new evidence is unlikely to change an old, “well established evidence base” assumes that the relationship between blood lipid values (such as LDL) and cardiovascular disease is almost indisputable. Current evidence does not seem to support this.

This brings me to two questions that I have about Canada’s Food Guide’s evidence-base for Guideline 1 (the recommendation to consume plant-based protein more often because it results in lower intake of foods that contain saturated fat).

My questions relate to two references that seem to me to be conspicuous by their absence.  

Guideline 1; consume plant-based protein more often because it results in lower intake of foods that contain saturated fat

Question 1

BACKGROUND: Health Canada’s Interim Evidence Update 2018 [2] lists the 2016 World Health Organization (WHO) reports by Mensink (# 56, below) and Brouer (#57, below) and both of these reports are used as a basis for developing Canada’s Food Guide.

Reference list from Health Canada. Food, Nutrients and Health: Interim Evidence Update 2018. Ottawa: Health Canada; 2019

Reference 58 which is the 2017 Prospective Urban Rural Epidemiology (PURE) study by Souza, RJ, Mente A Maroleanu A et al, is listed in Health Canada’s Interim Evidence Update but is noticeably absent from the table (Annex 3) in the document and is not referenced in Canada’s Food Guide.

The PURE study was largest-ever epidemiological study which recorded dietary intake in 135,000 people in 18 countries over ~ 7.5 years, in low- medium and high income countries and which found that increased saturated fat intake was not associated with increased rates of cardiovascular disease.

Annex 3: Summary of Convincing (strong) Food and Health Relationships and Changes Since 2015, pg 5 (Reference 58 omitted)

QUESTION: Why is the PURE study omitted from the table, but is listed in the References?

Question 2

BACKGROUND: Table 2 of What are Canada’s Dietary Guidelines? [1] titled “convincing findings supporting Guideline 1” lists 5 additional reports in addition to the 2010 FAO/WHO report and the two WHO reports from 2016 and 2017 on which this Guideline was based. One of these five is the American College of Cardiology/American Heart Association report of 2013.

QUESTION: Why was the Canadian Heart and Stroke Foundation position statement titled “Saturated Fat, Heart Disease and Stroke“ released in September 2015 omitted from Table 2 of What are Canada’s Dietary Guidelines? [1] when it it is both; (a) Canadian and (b) several years more recent than the American Heart Association position statement of 2013 which was used in place?

Here is an excerpt from the Canadian Heart and Stroke Foundation position statement titled “Saturated Fat, Heart Disease and Stroke“ released in September 2015. I have highlighted sections of interest in red and put their references directly below, so they can be looked up.

HEALTH EFFECTS OF SATURATED FATS Research over several decades clearly indicates that saturated fats raise low density lipoprotein cholesterol (LDL-cholesterol) in the blood[4,10,11,15]. Research also indicates that elevated LDL-cholesterol is a risk factor for heart disease and stroke, and that lowering LDL-cholesterol decreases cardiovascular morbidity and mortality. However, epidemiological studies provide a mixed picture of the association between saturated fatty acids and cardiovascular disease (heart disease and stroke) [15-22]. Early studies found an association between cardiovascular disease and saturated fat [23,24] while more recent studies have found no such association [18,21]. These mixed findings have been the focus of recent scientific debate, and underscore that the health effects of saturated fats are complex.

Studies investigating the effects of replacing saturated (animal) fats with plant oils and unsaturated spreads (mono- and poly-unsaturated fats) have found that this dietary change results in improved cholesterol levels and reduced risk of cardiovascular disease [5,25,26]. Research further indicates that modifying the type of fat we eat seems to protect us better if we adhere to the changes for at least two years[25].

Dietary recommendations to reduce overall fat intake have also included recommendations to replace saturated fats with carbohydrates. In retrospect, this advice may have played a role in increased calorie consumption and contributed to increased rates of obesity and metabolic syndrome [19].

Studies that have looked at the individual fatty acids (i.e. lauric, stearic, myristic and palmitic acids) have found that individual saturated fatty acids may have different effects on blood cholesterol levels[4,15]. The food source from which the saturated fat is derived may have different effects on cardiovascular risk [20,22]. Additional studies are required to determine whether cardiovascular risks are influenced by the nutrients used to replace saturated fats (i.e. carbohydrates, monounsaturated fatty acids or polyunsaturated fatty acids),[21] the types of saturated fat [26] and/or the foods in which they are consumed.

References

4. Food and Agriculture Organization of the United Nations (FAO). Fats and fatty acids in human nutrition: Report of an expert consultation 2008. Rome, Italy: 2010.

5. Mozaffarian D et al. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PloS Med 2010;23:7(3):e1000252.

6. Ramsden CE et al. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death, evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ 2013;346:e8707.

7. de Oliveira Otto MC, Mozaffarian D, Kromhout D, et al. Dietary intake of saturated fat by food source and incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr 2012;96:397-404.

8. Health Canada. Do Canadian adult meet their nutrient requirements through food intake alone? Health Canada, Ottawa 2012. Retrieved from http://www.hc-sc.gc.ca/fn-an/surveill/ nutrition/commun/art-nutr-adult-eng.php

9. Moubarac JC, Batal M, Bortoletto Marins AP, Claro R, Bertazzi Levy R, et al. Processed and ultra-processed food products: Consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res 2014;75(1):15-21.

10. Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for Americans 2010. http://www. health.gov/dietaryguidelines/2010.asp. Updated 2012.

11. American Heart Association Nutrition Committee. Lichenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006. A scientific statement from the American Heart Association nutrition committee. Circulation 2006;114:82-96.

12. The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). European guidelines on cardiovascular disease prevention in clinical practice (version 2012). European Heart Journal 2012;33:1635-1701.

13. Vannice G, Rasmussen H. Position of the academy of nutrition and dietetics: dietary fatty acids for healthy adults. J Acad Nutr Diet 2014;114(1):136-153.

14. National Cancer Institute. Risk factor monitoring and methods: Table 1. Top food sources of saturated fats among the US population, 2005-2006. NHANES.

15. Micha R, Khatibzadeh S, Shi P, Fahimi S, Lim S, Andrews KG, et al. Global, regional and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys. BMJ 2014;348:e2272.

16. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a metaanalysis of 60 controlled trials. Am J Clin Nutr 2003;77:1146-1155.

17. Mente A, et al. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169(7):659-669.

18. Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. Association of dietary, circulating and supplement fatty acids with coronary risk: A systematic review and meta-analysis. Ann Internal Medicine 2014;160:398-406.

19. Ravnskov U, DiNicolantonio JJ, Harcombe Z, Kummerow FA, Okuyama H, Worm N. The questionable benefits of exchanging saturated fat with polyunsaturated fat. Mayo Clinic Proceedings 2014;89(4):451-53.

20. O’Sullivan TA, et al. Food sources of saturated fat and the association with mortality: a meta-analysis. Am J Public Health 2013;103:e31-42.

21. Sri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nut 2010;91(3):535-546.

22. de Oliveira Otto MC, Nettleton JA, Lemaitre RN, et al. Biomarkers of dairy fatty acids and risk of cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2013;2:e000092.

23. Hu FB, Stampfer MJ, Manson JE, et al. Dietary fats and the risk of coronary heart disease in women. New England Journal of Medicine 1997;337:1491-1499.

24. McGee DL, Reed DM, Yano K, Kagan A, Tillotson J. Ten-year incidence coronary heart disease in the Honolulu Heart Program. Relationship to nutrient intake. Am J Intern Med 2014;160:398- 406.

25. Hooper L, Summerbell CD, Thompson R, Sillis D, Roberts FG, Moore HJ, et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane database of systematic reviews. 2012 issue 5.

26. Jakobsen MU, O’Reilly EJ, Heitmann BL, et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr 2009;89:1425-1432

Final thoughts…

Health Canada has based the new Canada Food Guide on what they consider ‘convincing findings’ that are supported by a ‘well-established evidence-base’; findings that they believe are unlikely to change in the foreseeable future as new evidence emerges. As stated several times in previous articles, for those that are metabolically healthy, the new guide is a huge improvement over the previous one as it focuses on eating real, whole food and avoiding sugar-laden drinks including fruit juice, and processed foods that are high in both fat and carbs.

My main concern, as elaborated on in several previous posts is the effect of a high carbohydrate diet (even if those carbohydrates are unrefined) on the large percentage of Canadians who are metabolically unwell. My other concern is the further limiting of healthy, whole foods such as meat, seafood, cheese and milk because they contain saturated fat, when mixed research findings indicate that the relationship between saturated fat intake and cardiovascular disease is complex. 

Guideline 2 to limit processed foods is fantastic and benefits all Canadians, however in my opinion, recommending that Canadians across the board limit animal based protein foods because the saturated fat they contain may predispose them to cardiovascular disease is not based on robust data. Furthermore, it unnecessarily limits foods that are the best sources of the most bioavailable sources heme-iron (outlined in this article in relation to the plant-based Eat-Lancet Diet) as well limits some of the richest sources of B-vitamins (as outlined in this article).

How does one sort through all this information and make sense of these recommendations in relationship to themselves? As part of my complete assessment, I not only ask about how you usually eat and your food preferences, and weigh and measure you, I also review your most recent lab work to determine whether you fall in the large percentage of Canadians that are no longer metabolically healthy, or  don’t.  From there, we’ll discuss the various options you have for improving your weight and metabolic markers so that you can decide what is the best approach for you.

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

Joy

You can follow me on:

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

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

References

  1. Health Canada, What are Canada’s Dietary Guidelines? https://food-guide.canada.ca/en/guidelines/what-are-canadas-dietary-guidelines/
  2. Health Canada. Food, Nutrients and Health: Interim Evidence Update 2018. Ottawa: Health Canada; 2019.
  3. Health Canada. Evidence review for dietary guidance: technical report, 2015. Ottawa: Health Canada; 2016.
  4. Heart and Stroke Foundation of Canada, Position Statement “Saturated Fat, Heart Disease and Stroke, September 24, 2015, https://www.heartandstroke.ca/-/media/pdf-files/canada/position-statement/saturatedfat-eng-final.ashx

 

But Low Carb Diets Eliminate an Entire Food Group!

Note: This article is classified as an editorial as it reflects some of my own thoughts on these issues and is also classified as a Science Made Simple article, as it is rooted in the science.  By way of references,  I have linked to previous articles I have written (that are referenced) or to the original sources, rather than using footnotes and a reference list. 

One of the common concerns is that a low carbohydrate or ketogenic diet avoids “an entire food group” (i.e. grains) and implies that people will be setting themselves up for decreased nutrient status, or even deficiency if they eat this way, but is that true? Does eliminating this entire food group pose a nutritional risk? That is the subject of this article.

I will begin by discussing food groups, however I will make a small but necessary diversion into the evidence used for recent dietary guidelines that recommend a diet low in saturated fat, as there is a link between the two. As will become clear, it is advisable to include grains in a diet that is low in meat and other animal products.  

Food Groups Come and Go

With the recent re-design of Canada Food Guide, we’ve seen that food groups are not carved in stone.

The once-familiar Meat and Alternatives and Milk and Alternatives food groups were completely eliminated in the newest food guide and replaced by the somewhat all-inclusive “Protein” food group. I qualify this by saying ‘somewhat all-inclusive’ because while the illustrated sample plate of the new guide includes approximately equal amounts of animal-based and plant-based proteins, both milk and cheese are not illustrated on the front, although low fat yogurt is.

Milk and cheese both figured prominently in the past food guides, as did meat, fish and poultry of all kinds, but now inclusion of cheese and higher fat meats are relegated to the inner pages of the new guide where it is explained how to “limit the amount of foods containing saturated fat” by limiting foods such as “higher fat meat”, “cheeses” and “foods containing lots of cheese” (see this article for details). 

Of course, milk, cheese and meat can all still be included in the diet, however the new food guide recommends that these be limited due to their high saturated fat content, which is said to be linked to an increased risk of cardiovascular disease. 

Health Canada writes about how the guidelines were prepared in their report What are Canada’s Dietary Guidelines?”. They state that they considered the “best available evidence” published between 2006 and 2018 to make their recommendations, but as I will outline below, the 2017 PURE study (Prospective Urban Rural Epidemiology) — which was the largest-ever epidemiological study to date and which recorded dietary intake in 135,000 people in 18 countries over ~ 7.5 years, including high-, medium- and low income nations did not seem to be included. This study found that increased saturated fat intake was NOT associated with increased rates of cardiovascular disease. 

Health Canada explains in its report that the Guidelines, including Guideline 1 to eat more plant-based food in order to lower the intake of saturated fat was based on “convincing findings” from scientific reports that included extensive systematic reviews of the literature on the relationship between food and health, and that these reports are listed in Table 1 of the report.

from Health Canada’s “What are Canada’s Dietary Guidelines?”

Best Available Evidence for Saturated Fat Recommendations

Table 1 of Health Canada’s report says that the “best available evidence” for the saturated fat recommendations in the new  food guide were based on the following three systematic reviews;

    1. Food and Agriculture Organization (FAO) of the United Nations 2010 – Fats and fatty acids in human nutrition – report of an expert consultation
    2. World Health Organization (WHO) 2016 – Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and
      regression analysis
    3. World Health Organization (WHO) 2017 – Health effects of saturated and trans-fatty acid intake in children and adolescents: Systematic review and meta-analysis

Based on Table 2 of the report titled “Convincing findings supporting Guideline 1” (the guideline which recommends more plant-based food in order to lower intake of saturated fat) lists the same three systematic reviews as above, plus adds;

  • Dietary Guidelines Advisory Committee 2010: Report of the DGAC on the Dietary Guidelines for Americans
  • Health Canada 2012: Summary of Health Canada’s assessment of a health claim about the replacement of saturated fat with mono- and polyunsaturated fat and blood cholesterol lowering
  • American College of Cardiology/American Heart Association 2013:  Guideline on lifestyle management to reduce cardiovascular risk: a report of the ACC/AHA task force on practice guidelines
  • Dietary Guidelines Advisory Committee 2015: Scientific report of the DGAC: advisory report to the Secretary of Health and Human Services and the Secretary of Agriculture

That is, the new saturated fat guidelines were based on systematic reviews from 2010, 2012, 2013, 2015 as well as the FAO/WHO recommendations from 2010, 2016 and 2017.

It appears that the largest-ever epidemiological study (PURE) that was published in 2017 and which found that saturated fat intake was not associated with cardiovascular disease, or increased rates of death was not included or was deemed for some reason to not be “best available evidence”. What is puzzling is that a key the 2018 Health Canada report titled Interim Evidence Update lists it as a reference, but doesn’t seem to refer to the study anywhere.  More on that in the next article.

Systematic Reviews of Epidemiological Studies

As pointed out at the end of the previous article, epidemiological studies are the study of diseases in populations. These are helpful for researchers to know which areas warrant clinical trials, because epidemiological studies can’t attribute “cause” of disease or death. 

When an epidemiological study finds an “association” between two factors  such as saturated fat and higher blood lipid levels — this does NOT mean that saturated fat ’causes’  heart disease. It only means that higher saturated fat intake is associated with higher blood lipid values. Other studies associate high blood lipid values such as total LDL cholesterol to cardiovascular disease, but this is only helpful when we know which LDL is raised; the atherosclerotic small, dense sub-fraction or the neutral (or possibly protective) large fluffy sub-fraction. To know whether higher saturated fat intake causes cardiovascular disease events requires clinical trials.

There had already been eight meta-analysis and systematic reviews of evidence from randomized control trials (RCT) that had been conducted between 2009-2017 that did not find an association between saturated fat intake and the risk of heart disease that I reviewed in this article — data that was available prior to the redesign of the new food guide. As of this week we also have a new meta-analysis of clinical data from 43 study cohort group studies that was just published on April 6, 2019 which found NO relationship between higher saturated fat intake and higher risk of cardiovascular disease (CVD) events. 

Not Carved in Stone

The recommendations made in the new food guide were based largely on epidemiological evidence and clinical data related to the association between saturated fat and blood lipid levels — sometimes lumping saturated fat and trans fats together. One one would hope that as clinical data from well-designed studies continues to emerge showing no association between saturated fat intake and cardiovascular disease (CVD) — the actual area of concern, that these recommendations will change. 

If food groups are not carved in stone, dietary recommendations ought not to be either. 

Eliminating an Entire Food Group

Now back to the topic of this article…

Is there a valid concern that those eating a low carbohydrate or ketogenic diet who are eliminating a entire food group (i.e. grains) are setting themselves up for decreased nutrient status or deficiency?

To answer that question we need to ask ourselves;

(1) which nutrients are found in grains in significant quantities

and

(2) can those nutrients be found in sufficient quantities in other foods in the diet?

If so, then eliminating grains does not predispose people to risk of decreased or deficient nutrient status.

Main Nutrients in “Healthy Whole Grains”

Yesterday evening, while writing this post,  I stumbled across a recent article title ‘Healthy whole grains’ – really?! that was written by Dr. Zoe Harcombe, a Ph.D. in public health nutrition.  In her article, Dr. Harcombe compiled data from the USDA’s National Nutrient Database for Standard Reference to evaluate the nutrient content in whole grain whole wheat flour, long grain brown rice, whole wheat spaghetti / pasta, oats and whole wheat bread. These foods are representative of what I think most Dietitians would categorize as ‘healthy whole grains’ which are known for being high in B vitamins such as B1 (thiamine), B2 (riboflavin), B3 (niacin) and folate (also called folic acid), as well as minerals such as iron, magnesium and selenium. 

Dr. Harcombe demonstrated that foods such as chicken liver, sardines, eggs and sunflower seeds are much better sources of the B-vitamins than these “healthy whole grains”. As well, I know from having researched the topic that meat and seafood are excellent sources of the most bioavailable form of iron (heme iron which is superior to the non-heme iron found in grains). As discussed in the previous article,  nuts and seeds, dark chocolate and avocados are all rich in magnesium and animal foods such as pork, beef, turkey, chicken, fish, shellfish and eggs are all rich in selenium.

Whole grains are also good sources of  fiber, but so are the wide range of non-starchy vegetables that are eaten on a well-designed ketogenic diet, as well as the starchy vegetables and berries that are eaten on a well designed low- carbohydrate diet. In fact I wrote an article about this a year and a half ago.

In short, there are no nutrients found in grains that are not found in adequate, or even higher quantities in foods eaten as part of a well-designed low carbohydrate or ketogenic diet.

Some Final Thoughts…

As far as I can see, it is only the conviction that there is an established relationship between saturated fat and cardiovascular disease (based on a proxy relationship between saturated fat and blood lipids) and the resulting dietary guidelines based on that relationship that makes the eating of whole grains ‘necessary’. 

The reason?

Current dietary guidelines recommend limiting animal foods so eating more plant-based foods and grains containing B-vitamins, iron, magnesium and selenium is necessary. If, however guidelines could change in the future based on emerging evidence (provided that they continue to be validated by future studies), then eating whole grains would be “optional”, since animal-based foods are equal or superior sources of those nutrients. 

If ‘eating foods with saturated fat causes heart disease’, then limiting them is necessary, and eating whole grains is the next best source of these nutrients.

Personality I am not convinced that the evidence is unequivocal and that it is warranted to limit foods rich in saturated fat. At the same time, I am not persuaded that there is evidence that eating lots of saturated fat to the exclusion of other healthy fats is necessary or preferred. 

Assuming the emerging evidence on the safety of saturated fat continues to hold, I believe including animal foods in the diet precludes the necessity to eat whole grains.

For those that choose to follow a vegetarian diet, the inclusion of some whole grains as good sources of B vitamins, iron, magnesium and selenium is advisable.

 If you would like nutritional support to ensure you are obtaining a wide range of nutrients while following a low carbohydrate diet, I would be glad to help.

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

To your good health!

Joy

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

The Biological Connection Between Sugar and Cancer

I’ve heard that some types of cancer feed on glucose (the sugar in our blood) and I know of a few people that started a ketogenic diet as adjunct therapy to be used along side surgery and chemotherapy in the treatment of glioblastoma (a form of aggressive brain cancer), but just came across an article that explains why limiting sugar intake can lower one’s risk of cancer. In this article, I explain one biological link between cancer and sugar.


A “Master Switch for Cancer”

In the 1980’s, Dr. Lewis Cantley was a Professor at Tufts University School of Medicine in Boston when he identified a previously unknown enzyme known as phosphoinositide-3-kinase, or PI3K which turned out to a type of ‘master switch for cancer’.

PI3K’s normal function is to alert cells to the presence of the hormone insulin; resulting in the cells pumping in glucose to be used as metabolic fuel for the cell. Signals from PI3K are necessary for normal cell growth, survival and reproduction, however when this enzyme is hijacked by cancer cells, it provides tumors with an over-abundant supply of glucose, which results in their rapid proliferation.

The gene that codes for PI3K is now thought to be the most frequently mutated cancer-promoting gene in humans and is believed to be associated with 80% of cancers, including those of the breast, brain and bladder.

In 2012, Dr. Cantley became the Director of the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine, which is the biomedical research unit and medical school of Cornell University, where he is Professor of Cancer Biology. In his work at Weill Cornell, Dr. Cantley has continued to investigate the role of PI3K.

Challenges with some anti-cancer drugs that have been developed that block the PI3K enzyme is that these PI3K-inhibitor drugs are designed to starve the cancer cell of glucose, but also signal the person’s liver that their body is starving for glucose, too.  As a result, the liver would break down glycogen (a storage form of glucose) and send large amounts of glucose into the person’s blood, resulting in their blood sugar spiking and triggering their pancreas to release lots of insulin, as a result. The presence of all of this glucose from the liver and insulin from the pancreas resulted in these patient’s tumors continuing to grow.

Dr. Cantley and his colleagues wondered whether the spike in insulin from the breakdown of glycogen might be countering the effect of the PI3K-inhibiting drugs by reactivating the PI3K pathway in the cancer cells.  Studies first tried giving these patients Diabetes medications to lower their blood sugar and insulin levels, but this didn’t work nearly as well as what they tried next.

The researchers came up with a theory that a ketogenic diet (a diet that is very low in carbohydrate)   could prevent the spikes caused in blood sugar by the  PI3K-inhibiting drugs and might help the drug starve the tumor, while the patient’s blood sugar remained normal because the body would be fueled by breaking down fat and protein for ketones.

They tested the theory using genetically engineered mice that developed pancreatic, bladder, endometrial and breast cancers and treated the mice with a new PI3K inhibitor drug. The study demonstrated that spikes of insulin did indeed reactivate the pathway in tumors, countering the anti-cancer effect of the drug. However, when the researchers put the mice on a ketogenic diet, in addition to the medication, the tumors shrank. The results were published in the journal Nature in July 2018.

Dr. Cantley explains the biological connection between cancer and sugar this way;

“Our pre-clinical research suggests that if somewhere in your body you have one of these PI3K mutations and you eat a lot of rapid-release carbohydrates, every time your insulin goes up, it will drive the growth of a tumor. The evidence really suggests that if you have cancer, the sugar you’re eating may be making it grow faster.”

Some Final Thoughts…

A normal cell function requires the enzyme PI3K that results in the cell pumping in glucose to fuel growth and reproduction and a cancer cell that has a defect in the gene that codes for PI3K may do the same thing. Sugar, in and by itself does not cause cancer, but in those that have a few abnormal cells, sugar can drive the process of tumor development.

According to the World Health Organization, the average American consumes 126 grams of sugar a day, more than people in any other country and the average Canadian eats almost 90 grams (89.1) of sugar per day. Sugar is not required in the diet; in fact, there is no essential need to eat carbohydrate at all, if people eat adequate amounts of healthy fats and protein.

Given that as many as 88% of Americans are already metabolically unhealthy — with likely a smaller percentage of Canadians following suit (due to slightly lower obesity statistics), there is no valid reason for the average American or Canadian to be eating foods with added sugar.* As I’ve written about in many previous articles, high blood sugar and high insulin levels already predispose people to Type 2 Diabetes and obesity and as outlined in this article, are involved in the proliferation of some types of cancer cells.

*(update April 29, 2019): While I say above that there is “no valid reason” for those who may already be metabolically unwell to eat foods with added sugar – in retrospect, this is not well worded.  I think there are lots of valid reasons for people to eat foods with added sugar, but believe that it may be preferable for those who are already metabolically unwell to limited added sugars.

It would seem to me that a prudent approach for metabolically healthy people (12% of Americans, and perhaps an estimated 25% of Canadians) is to stay healthy by avoiding processed foods that are high in refined carbs and sugar, as well as foods high in “natural sugar” such as 100% fruit juice  in order to reduce the risk of becoming metabolically unwell or inadvertently feeding malignant cells that feed on glucose.

For the large majority of those that are already metabolically unhealthy, a well-designed low carbohydrate diet can help you reverse the symptoms of Type 2 Diabetes, putting the disease into remission, as well as achieve and maintain a healthy body weight.  Not inadvertently feeding tumor proliferation seems like a nice ‘side benefit’, too.

If you would like to know more about how I can help you achieve and maintain a healthy body weight or halt the progression of Type 2 Diabetes and other related metabolic disorders, please send me a note using the Contact Me form on this web page.  If you would like to learn more about the services I offer and their costs, please click on the Service tab or have a look in the Shop.

To your good health!

Joy

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Reference

Crawford A, Increasing evidence of a strong connection between sugar and cancer, MedicalXPress, March 20, 2019,  https://medicalxpress.com/news/2019-03-evidence-strong-sugar-cancer.html

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

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

McGill Professor’s Editorial: Known Benefits of Low-Carb “Keto” Diets

This morning, Dr. Joe Schwarcz, Professor of Chemistry from McGill University and popular radio show host released a follow-up to last week’s opinion article and video that was published in the Montreal Gazette on the cardiovascular risks of a keto diet; this one on the known benefits of low-carb keto diets.

Schwarcz begins by fondly reminiscing about going to the circus with his mother when he was about 7 or 8 years old and the memories of the snack that she packed for him of crusty Hungarian bread, slathered with butter and topped with green bell pepper. He said that he’s loved it ever since, but “now we question such snacks. Why? Because of the carbohydrate content of the bread”.

“I’ve been looking into this for quite a while. There is really a plethora of papers and information that floods us about the keto diets; the very low carbohydrate diets”.

To his credit, Dr. Schwarcz acknowledged (possibly as a result of my written response to his article of last week in the Montreal Gazette) that there isn’t just one “keto diet” (singular) but several very low carbohydrate diets (plural) .

Schwarcz reiterates;

“I would have thought that by having all of that fat in the diet that risk levels for certain cardiovascular factors would go up, but really there isn’t really that much alteration in these factors”.

Low-Carb “Keto” Diets and Diabetes

Transitioning from the lack of cardiovascular risks associated with low-carb keto diets, Schwarcz adds;

“When it comes to Diabetes the information is really overwhelming to the benefit of these low carb diets. There are people — Type 2 Diabetes sufferers, who have been able to give up their medication by following a stringent, low carbohydrate diet.”

Schwarcz dismisses anecdotal reports of people’s “brain fog” resolving and possible benefits for cancer, Parkinson’s disease and Alzheimer’s disease as not being scientifically based but is unequivocal about the known benefits;

What we do know is that weight loss can be very significant on a low carbohydrate diet and as I said — surprisingly, without any significant risk factors.”

Schwarcz continues;

“On the other hand, the longest terms studies that I’ve seen which were really properly controlled have only been about six months, and that really isn’t long enough.”

NOTE: In this case, Dr. Schwarcz is referring only to randomized, controlled double blind studies — excluding the data from long term studies of other types.

“We also know from dietary studies that after about a year, it doesn’t much matter what diet you’re on when it comes to weight loss — whether it’s low fat, whether it’s low carb, the results tend to be the same as long as you’re cutting out some calories.”

NOTE: While this may be true, what Schwarcz neglects to mention is that the major difference is that in a calorie-restricted low-fat diet, people are deliberately restricting food intake, often feeling hungry — whereas in a low carbohydrate diet, people naturally feel less hungry due to the satiety (hunger-reducing effect of protein and fat) which results in them eating less. In one case people are purposely restricting calories in the the other case, they don’t feel as hungry so they naturally eat less.

Schwarcz reiterates;

“However, for people who are afflicted with Diabetes, I think there is no question that the very low carb diets are worth trying.”

Towards the end of the video Dr. Schwarcz reflects on his childhood snack of crusty Hungarian bread, slathered with butter and topped with a quarter of a green bell pepper and admits that he looks askew at this snack.

“I admit that I’ve been eating less bread — I haven’t cut it out because I don’t think I need to do that, but I’m eating less.”

Schwarcz adds that for those who are gravitating towards a low carbohydrate diet, they can opt instead to eat bell pepper with a dollop of hummus with tahini (ground sesame seeds) or raw broccoli dipped in a bit of hummus.

“It tastes good! I think it is possible to cut down on the bread!”

Since Dr. Schwarcz is presumably not Diabetic and has all the nostalgia of memories of the circus as a child, he concludes the video by happily biting into a slice of crusty Hungarian bread that’s been slathered with butter and topped with a quarter of a green bell pepper…for nostalgia reasons, of course!

Bon appetit, Dr. Schwarcz!

If you would like to know more about the low carb and ketogenic services I offer, please click on the Services tab, and if you have questions related to those, please feel free to send me a note using the Contact Me form located on the tab above.

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Joy

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

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

Reference

Montreal Gazette, February 15, 2019, Dr. Joe Schwarcz, Known Benefits of Low Carb “Keto” Diets” https://montrealgazette.com/category/opinion

Quebec newspaper: “Keto diets work, but is there a catch?”

This morning, the English language newspaper, the Montreal Gazette published a special article written by Dr. Joe Schwarcz, Professor of chemistry from McGill University titled “The Right Chemistry: Keto diets work, but is there a catch?”, that had an accompanying video.

The article began;

“There is little doubt that cutting way back on carbs results in weight loss. But how does all that fat impact cardiovascular risk factors?”

This is a very good question, however it is incorrectly based on the assumption that a “keto diet” is necessarily very high in fat, especially saturated fat, something which is not necessarily the case.

Dr. Schwarcz stated in the article in the Montreal Gazette that on a “keto diet” there is no bread, pasta, cereal, potatoes, carrots, rice, fruit or beer but that one can;

“gorge on fish, butter, eggs, high-fat cheese, whipped cream, coconut oil and meat to your heart’s delight.”

As mentioned in an earlier article that I wrote titled Misconceptions About the Keto Diet;

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

Some therapeutic ketogenic diets are used in the treatment of epilepsy and seizure disorder and are extremely high in fat. Other types of therapeutic ketogenic diets are used in the treatment of various forms of cancer (those that feed on glucose), such as brain cancer. There are ketogenic diets that are used in the treatment of Polycystic Ovarian Syndrome (PCOS), as well as for weight loss and for increasing insulin sensitivity in those with Type 2 Diabetes and insulin resistance.

Even among those using a nutritional ketogenic diet for weight loss and to increase insulin sensitivity, there is no one “keto diet”.

There are ketogenic diets with a higher percentage of fat than protein, with a higher percentage of protein than fat and mixed approaches which may have different ratios of protein to fat – depending on whether the individual is in a weight loss phase or a weight maintenance phase.

There are as many permutations and combinations as there are people following a keto diet for these reasons.

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

Assuming that the specific type of “keto diet” that Dr. Schwarcz is referring to is one where one;

(1) avoids bread, pasta, cereal, potatoes, carrots, rice, fruit* or beer

and

(2) indulges in foods high in fat, such as fish, butter, eggs, high-fat cheese, whipped cream, coconut oil and meat,

it is a very appropriate question to ask as to what effect does this type of keto diet have on cardiovascular risk factors.

Note: Most keto diets used for weight loss allow fruit as berries, such as raspberries, strawberries, blueberries, blackberries as well as those fruit that we often think of as vegetables, including tomato, avocado, cucumbers, lemon and lime.  Dr. Schwarcz raised a concern in the video that not eating fruit limits one’s access to the important antioxidants in fruit, which for the most part is incorrect.

The article states that;

“There is little doubt that cutting way back on carbs results in weight loss. The question is, why?

The body’s main source of energy is glucose, generally supplied by starches and sugars [i.e. carbs] in the diet. If consumption of these carbohydrates is drastically reduced, below about 50 grams a day, energy has to be derived from an alternate source. At first, the 65 or so grams of glucose the body needs per day are produced from amino acids, sourced from proteins. But this process itself has a high energy requirement, and furthermore, the body is not keen on using up proteins that are needed to maintain muscle integrity. Fortunately, there is a backup system that can swing into action.

The liver begins to convert fats into “ketone bodies,” namely beta-hydroxybutyrate, acetoacetate and acetone. These are then shuttled into the mitochondria, the cells’ little energy factories, where they are used as fuel. At this point the body is said to be in “ketosis,” with excess ketones being excreted in the urine.”

Great explanation!

The article raises a few excellent points;

The article states that the “usual argument” for the more efficient weight loss associated with extremely low carb diets as compared to low fat diets is that (1) low carb diets produce a metabolic advantage because a lot of calories are needed to convert proteins to glucose.  The article adds that not everyone agrees with this premise and states that others suggest that (2) ketone bodies have either a direct appetite suppressant effect or that they (3) alter levels of the respective appetite stimulating and inhibiting hormones, ghrelin and leptin. Lastly, the article states that some argue that (4) ketogenic diets lead to a lower calorie intake which the article’s author believes is “due to the greater satiety effect of protein”.

“No long-term studies of keto diets”

Correctly the article states that;

“There are numerous studies published over the last 20 years that have compared low-fat diets to low-carb diets with the overall conclusion that the low-carb diets are more effective in terms of weight loss, at least in the short term.

…but incorrectly adds;

“Unfortunately, there are no long-term studies of keto diets.”

While there have been 3 long-term clinical trials (2 years) published over the past 10 years involving low carb diets, unfortunately as documented in my earlier article, none of these involved research groups that actually ate a low carbohydrate diet. There is, however the recent two-year data from the Virta Health’s study that was published this past December 2018 which demonstrated the long term safety of a ketogenic diet and that participants on average;

(1) lost 12.4 kg (28 pounds) in two years; most of which was achieved in the first year maintained with only a slight increase of 2.3 kg (5 pounds) in the second year.

In addition to the weight loss, participants in the Virta Health study;

(2) significantly lowered medication use for Type 2 Diabetes (read more here)

(3) lowered glycated hemoglobin (HbA1C) by a full percentage point at two years (7.7% to 6.7%)

(4) lowered fasting blood glucose from 9.1 mmol/L (164 mg/dl) at the start of the study to 7.4 mmol/l (134 mg/dl ) at two years.

High Fat Keto Diet and Cardiovascular Risk Factors

The article concludes with the initial question as to how a diet “high in fat, such as fish, butter, eggs, high-fat cheese, whipped cream, coconut oil and meat” impacts markers of cardiovascular risk.

“As one would expect, LDL, the “bad cholesterol,” does go up, although the increase is mostly in the “large particle” sub fraction that is deemed to be less risky.

Triglycerides, a significant risk factor, actually decrease on a very-low-carbohydrate diet, as does the body’s own production of cholesterol.

Levels of HDL, the “good cholesterol,” increase.

That is, over the short term, markers of cardiovascular risk doesn’t change to any degree.

What about over the long term?

Unfortunately, the article concludes with;

“the problem is that there are no studies of people who have followed a keto diet long enough to note whatever effect such a diet may have on heart disease.”

…but as mentioned above, we do have the two-year data from the Virta Health’s study that was published this past December 2018 and which demonstrates that;

(1)  LDL cholesterol of the intervention group at the start of the study averaged 2.68 mmol/L (103.5 mg/dl) and at two years was slightly higher as expected, to 2.96 mmol/L (114.5 mg/dl), however this level after 2 years was almost identical to what it was at 1 year; 2.95 mmol/L(114 mg/dl). That is, LDL (mostly the large particle sub-fraction) increased as expected the first year but didn’t continue to rise.

(2) At baseline, HDL cholesterol (“good cholesterol”) of the intervention group averaged 1.11 mmol/L (41.8 mg/dl) and after two years was stable at the same level it had risen to at 1 year, namely 1.28 mmol/L (49.5 mg/dl).

(3) At baseline, triglycerides of the intervention group averaged 2.23 mmol/L (197.2 mg/dl) and at two years was down to 1.73 mmol/L (153.3 mg/dl ), only up slightly for the one year average of 1.68 mmol/L (148.9 mg/dl).

Final Thoughts…

While Dr. Schwarcz seemed to be unaware of the publication of the two-year Virta Health study data in December 2018 that demonstrates both long-term safety and efficacy of a ketogenic diet for weight loss and improvement in metabolic health (including markers of cardiovascular risk), the Montreal Gazette article and accompanying video does indicate that a very high fat ketogenic diet does not adversely impact markers of cardiovascular risk.

If you would like to know more about the low carb and ketogenic services I offer, please click on the Services tab, and if you have questions related to those, please feel free to send me a note using the Contact Me form located on the tab above.

To your good health!

Joy

UPDATE (February 15, 2019): a review of Dr. Schwarcz’ follow up to this article is located here.

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

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

Reference

  1. Dr. Joe Schwarcz, “The Right Chemistry: Keto diets work, but is there a catch?” Montreal Gazette, February 8, 2019, https://montrealgazette.com/opinion/columnists/the-right-chemistry-keto-diets-work-but-is-there-a-catch

 

Reflections on Being a Nutritional Centrist

INTRODUCTION: In a recent article titled Carbohydrates are not Evil I referred to myself as a “nutritional centrist” and in this post I’ll elaborate on what I mean by this. This post is more of an editorial than a standard ‘Science Made Simple’ article. References can be found in the previous articles by using the search feature.


Much of the discussion about nutrition these days on social media seems to take an “all-or-nothing” stance.

As in politics, there are those that tend towards a “left-wing” (liberal) position and others who tend towards a “right-wing” (conservative) position; some who are libertarian (let people decide for themselves) and others who are very authoritarian (dictate what they believe is best).

When it comes to nutrition, I am a centrist.

Defining Nutrition Centrism

In this article, I am using the term “centrism” to include a very wide range of nutritional positions apart from any at extreme ends of the spectrum. I believe that a wide range of nutritional centrists positions are supported by current, evidence-based science.

Veganism and Carnivory – two ends of the spectrum

In the food world there are vegans on one hand and carnivores on the other.  One eats only plant-based food with nothing coming from animals (no eggs, milk or cheese) and the other eats only animal flesh food (no fruit, vegetables or dairy). These can be looked at as the nutritional equivalents to ” left wing” and “right wing” political positions. While I respect people’s individual right to choose veganism or carnivory as a lifestyle, for health reasons, or on the basis of ethical or religious beliefs, in my understanding there are significant nutritional challenges to both ends of the spectrum.

Nutritional centrists – vegetarians, pescatarians and omnivores

Somewhere between veganism and carnivory are vegetarians
(who eat mostly plant-based foods but will also eat eggs, milk and cheese because no animal is killed or harmed in the making of these) and those who are omnivores (that will eat food from a wide variety of plant and animal sources). Somewhere in the middle of these two are pescatarians who are like vegetarians but who will also eat fish (perhaps because they are not mammals, and sometimes only when they are wild species i.e. not man raised).

From my perspective, people who chose any of these lifestyles fall somewhere in the “nutritional centrist” position. I find it easy to support people following any of these lifestyle or ethical choices because it is possible to design a diet that ensures adequate nutritional intake of a wide range of macro- and micro-nutrients from the foods they choose to eat.

Whole-food-plant-based

Those who follow a “whole-food plant-based diet” can be either vegan or vegetarian so in my understanding, whole-food plant-based vegetarians fall somewhere in the “nutritional centrist” position, whereas whole-food plant-based  vegans are vegans with an approach that falls at one end of the spectrum.

Low Carb High Fat and Ketogenic diets – a centrist approach

As I’ve mentioned in numerous previous articles, there are several different types of “low carb” and “ketogenic” diets.

For example, if a client comes to me with a dietary prescription from a physician for a specific type of ketogenic diet to support a specific medical or metabolic condition that is a very different scenario than someone who wants me to help them with “quick weight loss” using a “keto diet”.

As a “nutritional centrist” my approach to supporting people in following a low carbohydrate lifestyle for weight loss is to start at a moderately-low level of carbohydrates (130 g carbohydrate per day) and lower the amount of carbohydrate as needed to achieve clinical outcomes. If individuals are insulin sensitive, this level of carbohydrate intake often works very well, especially at first when people were formerly eating ~300+ g of carbohydrate per day. For those who are insulin resistant or have Type 2 Diabetes, I start at a moderately-low level of carbohydrate intake and with self-monitoring of blood sugar and follow-up and oversight from their doctor with respect to any medications taken, will gradually lower carbohydrate intake as needed to achieve the desired clinical outcome(s).

It is not a “one-sized-fits-all” approach. As documented in several previous articles, people’s glycemic (blood sugar) response to carbohydrate varies significantly, even among those who are insulin sensitive and also in those with Type 2 Diabetes, so determining individual blood sugar response to carbohydrate is the best way to determine which types and amounts of carbohydrate people respond best to. I don’t believe it is appropriate or necessary for everyone to follow a “keto diet”.

Nutritional Centrism with respect to added fat

Amongst those that teach and support a “low carb” lifestyle, there are those that promote lots of added fat from a wide variety of sources.  These are people that believe in adding coconut oil and butter to beverages, butter to top meat and vegetables and using whipping cream copiously. From the beginning this is not an approach I have taken. In light of the recent scientific evidence (such as the large-scale PURE epidemiological study and others), I do not believe that moderate saturated fat intake is harmful to cardiovascular health. At the same time, I see no reason that if added fat is helpful in a particular person’s diet, that fats such as cold-expressed olive and avocado oil as well as nut and seed oils such as macadamia, walnut and almond oil aren’t suitable options.

I don’t see the need for extremes with regards to added fat. I encourage people for whom the recommendation is appropriate to add enough good quality healthy fat to make the vegetables or salad taste interesting enough that they will want to eat a fair amount of them and enjoy them. After all, eating isn’t only about getting enough nutrients, but enjoying the foods that are eaten.

Fat that comes with protein

Unless there is a medical or metabolic condition involved which precludes it, I encourage people to eat the fat that comes naturally with their protein source if they enjoy doing so.

I encourage folks to trim excess external fat off a fatty cut of steak, but if they enjoy chewing on the bone on a rib steak to ‘go for it’. The yolk in an egg or the fat in cheese is not harmful when eaten in moderate amounts so unless there are strong risk factors, I don’t believe people need to avoid or limit these foods.

While the new Canada Food guide recommends limiting foods with saturated fat based on the fact that dietary saturated fat raises total-LDL cholesterol, as I’ve documented in several previous articles I don’t believe when considering all the recent evidence that there is compelling reason to advise all people to limit foods containing cheese or to select plant-based foods over foods that contain saturated fat.

As mentioned in a few recent articles, Canada Food Guide is directed towards a healthy population in order to help them stay metabolically well and I believe that the whole-food approach of the new Guide which avoids refined grains, fruit juice and processed foods is a good evidence-based approach to accomplishing this, and one I support in my practice.

My concern as covered recently is that as many as 88% of Americans are already metabolically unwell (with presumably a slightly lower percentage in Canada due to our slightly lower obesity statistics) so in those that already have indications of insulin resistance (which is a large percentage of my client base), I do recommend a whole-foods approach but with a lower percentage of carbohydrate intake.  In my understanding, this is a “nutritional centrist” approach which is supported by the American Diabetes Association and the European Association for the Study of Diabetes who both support the use of a low carbohydrate diet as Medical Nutrition Therapy in the management of Type 2 Diabetes and for weight loss.

Supporting lifestyle choices

Veganism, like carnivory is a lifestyle choice that is sometimes made for religious or ethical reasons and sometimes for health reasons.  Regardless of the reason for the choice, these are lifestyles that need to be respected and supported by healthcare professionals who are qualified to do so.

As a “nutritional centrist” I can help healthy individuals follow the new Canada Food Guide and provide meals for their family along those lines if they so choose, as well as to support those who are already metabolically unhealthy using everything from a Mediterranean diet, a whole-food plant-based approach or a low carbohydrate or ketogenic diet. There is no “one-sized-fits-all” diet for any of these approaches and each should be tailored to individual needs.

No Conspiracy Theories

Conspiracy theories abound in many areas from religion to politics and there are plenty in the nutrition arena, as well. As a “nutritional centrist“, I don’t believe that “big-pharma” and “big-food” are behind everything, but at the same time I am also not naive enough to think that industries and special interests groups don’t attempt to influence the marketplace or government funding or policies by the types of research they fund, or by other means. I give scientists and researchers the benefit of the doubt that their intentions are in the interest of good science and the public interest, even though on occasion it is found out otherwise.

No Conspiracy Theories

My writing about topics such the funding of the Harvard studies by the sugar industry does not mean that I believe the scientists involved deliberately wrote biased reports. The articles were written to document the fact that researchers were funded by the sugar industry to write articles about why saturated fat was the underlying issue with respect to cardiovascular disease. Likewise, the recently translated French language newspaper report that shed light on why the government (e.g. Agriculture Canada or a political party’s leadership) may have been motivated to encourage the highlighting of legumes does not mean anything inappropriate occurred.  In my understanding, conspiracy theories are not compatible with a “nutritional centrist” position.

I would encourage my readers to give scientists and researchers the benefit of the doubt when it comes to their intentions; unless there is very credible and verifiable reasons to believe otherwise.

Libertarian versus Authoritarian Approach – a centrist approach

libertarian approach to dietary choice supports each person’s individual’s right to choose the most suitable dietary approach for themselves whereas an authoritarian approach essentially tells a person what is best for them.

As a “nutritional centrist“, I am frequently in the scientific literature, reading and reviewing the latest studies and evaluating these in light of what is already known about nutrition. My motivation in writing articles that put these studies into “plain English” is that so ordinary people can evaluate these in light of what they know and choose what they feel is best for them. From my perspective, the current available quality research on the subject is the “authority” but by no means should this be used in an authoritarian way to tell a person what is best for them. My position as a “nutritional centrist” is that people should be presented with the range of available evidenced-based options and the supporting science behind those options, but in accordance with a libertarian approach, the choice is theirs to make.

I hope that as a result of reading this article, you have a fuller understanding of what I believe and why and that I support a range of evidence-based dietary approaches including those who want to follow the Canada Food Guide, a Mediterranean approach, a whole-food vegetarian plant-based approach or a low carbohydrate approach and that include moderate amounts of healthy fats of all types. There certainly isn’t a “one-sized-fits-all” dietary approach suitable for everyone so from my perspective, the issue is which one may be best suited to help you achieve your health and nutrition goals, within your personal food preferences.

If you would like to know more about the services I offer, please click on the Services tab and if you have questions related to those, please feel free to send me a note using the Contact Me form located on the tab above.

To your good health!

Joy

Feedback and question from Dr. Andrew Samis, MD, PhD – shared with prior permission

UPDATE: February 1, 2019 13:20

Dr. Andrew Samis, MD, PhD, a surgeon and critical care specialist from Kingston, Ontario asked a very interesting question on Twitter, in response to this article;

Could the same eating strategy be healthy for one person, and make a second metabolically unhealthy?”

This was my response;

Yes, I believe there is ample evidence that the same eating strategy could be healthy for one person and make a second person metabolically unhealthy. Monitoring metabolic markers enables us to catch this early and make adjustments, as necessary.

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

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

 

 

Quebec newspaper:”no coincidence” dried beans so prominent in new Canada Food Guide

DISCLAIMER: (February 1, 2019) The views expressed in the translated editorial are solely the opinions of the Journal de Montréal and its editors.

Today, the French language populist newspaper Le Journal de Montreal published an article that states that it is “no coincidence” that Health Canada featured dried beans so prominently in the new Canada Food Guide; ‘certainly they are good for health’, but there is also an ‘obvious economic benefit and benefit to local agricultural interests'[1].

The pea arguments

[translation] “This is not well known, but Canada is the major supplier of legumes (pulses) on the planet.  Between 35% and 40% of world production comes from here, essentially from the prairie  provinces. Quebec is participating by growing dry beans.”

Economic and Local Interest

The article states that in addition to the health benefits there are two reasons why legumes (pulses) feature so prominently in the new Canada Food Guide;

I – Economic interests – the first “because”

The Journal de Montreal article states that one of the additional reasons  legumes (pulses) were highlighted in the new Canada Food Guide was because Agriculture Canada had forecast a 20% decrease in production of legumes during 2019[1]. The reason for this decrease production is outlined below.

II – benefit to local agriculture – the second “because”

The article also states that growing legumes benefits local agricultural interests[1] because;

“legumes contain bacteria that allow them to transfer nitrogen from the air to the ground and this nitrogen is needed for growth of vegetables.”

This means that by growing legumes one season, the soil becomes enriched with nitrogen which helps the growing of other food crops the following growing season.

BACKGROUND TO THE FIRST “because”

Last March, the CBC reported that India, a top importer of Canadian chickpeas and lentils imposed a huge tariff on legumes which resulted in Canadian producers facing duties of 33% on lentils and 50% on desi chickpeas. The type that Canada produces are kabuli chickpeas, which have a slightly lower tariff of 40% [2]. These tariffs resulted in a decreased demand for Canadian legumes (pulses), as well as a price decline.

CBC also reported [3] that India’s imposed tariffs on pulses has sent “a huge ripple effect through the whole industry” as dried beans are a 1.1 billion dollar industry in Saskatchewan alone and India is it’s biggest customer[3].

“Farmers are calling on Prime Minister Justin Trudeau for help to make sure that business continues and to consider the importance of agriculture in Canada”[3].

New Canada Food Guide – free of influence?

The article in Le Journal de Montreal raises the question as to how much of the prominent inclusion of legumes (pulses) in the new Canada Food Guide has to do with their reported health benefits and how much may have been driven by industry or lobby groups influence on various levels of government due to decreased demand and resulting falling production.

Figure 2 Adapted Framework for Developing Dietary Guidance – Evidence Review Cycle Model for Canadian Dietary Guidance, from Colapinto et al 2016

UPDATE:(February 3, 2019): While it is evident from the CBC report[3] above that the pulse industry was exerting pressure on various levels of the Federal government to address decreased demand for its product, decreased legume production would have been factored into the design of the new Canada Food Guide as both (1) the role of legumes and plant-based dietary patterns on health and (2) food availability of legumes in light of decreased production would have necessarily been evaluated i.e. two of the four of the direct influences involved Dietary Guidance design. [see “Evidence Review for Dietary Guidance: Summary of results and implications for Canada’s Food Guide, 2015” – available here) which on page 2 refers to the longer document “Colapinto CK, Ellis A, Faloon-Drew K, Lowell H Developing an evidence review cycle model for Canadian dietary guidance. Journal of Nutrition Education and Behavior. 2016;48:77-83)” that has Figure 2, below. This figure indicates that Food Availability of the Food Supply is one of the four direct influences in the development of Dietary Guidance. While decreased legume production (i.e. food availability) would have been factored into the decision for Canadians to include more legumes in their diet for health benefits on the new Canada Food Guide, I can find no evidence that legume’s benefit to agriculture was ever evaluated. Some thoughts… I think it is important to know what is said in the populist press about important issues such as this because a large segment of the population relies on such sources, as well as the internet for their news. Often times such stories are based on truth but leave what isn’t said up to the audience (readers or listeners). Knowing the facts behind the story enables us to tease out conjecture from fact.

If you would like to learn more about what I do and how I can help, please have a look at the Services tab to learn more about the hourly consultations and packages that I offer. If you have questions about my services, please send me a note using the Contact Me form located on the tab above and I will reply as soon as I can.To your good health!

Joy

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

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

References

  1. Le Journal de Montreal – 29 January 2019 0600 https://www.journaldemontreal.com/2019/01/29/des-arguments-de-pois?
  2. CBC News – Pulse industry worries about precedent as India slaps 60% tariff on chickpeas – March 02, 2018 3:50 PM CT  https://www.cbc.ca/news/canada/saskatchewan/india-chickpea-tariff-pulse-industry-1.4559947
  3. CBC News – Prairie farmers want Canada’s trade dispute with India ‘straightened out’ – February 25, 2018 4:00 AM CT

 

Carbohydrates are Not Evil

Much of the discussion about nutrition these days on social media seems to take an “all-or-nothing” stance on carbohydrates.  On one hand there are those who promote a plant-based diet that necessarily comes with a large amount of carbohydrate as grains, legumes (pulses) such as beans and lentils as well as carbohydrate-containing vegetables and fruit, and on the other hand there are those who eschew anything with the remotest amount of carbohydrate.

In politics, there are left-leaning ‘liberals’ and right-leaning ‘conservatives’, as well as those that hold a moderate position called “centrists”.

I am a centrist when it comes to my position regarding carbohydrates. In this article, I will elaborate on the following;

  1. Carbs are not evil or single-handedly responsible for the obesity epidemic or metabolic diseases. If that were the case, then the traditional diets of much of Asia and West Africa would have resulted in obesity and diabetes and they did not. It is the degree of processing of the carbohydrate-based foods that impacts the blood glucose and blood insulin response of carbohydrate-containing foods.
  2. Carbohydrate-based foods combined with fat in the same food ‘hijack’ the reward center of our brains (striatum), resulting in over-consumption.
  3. Carbohydrates are not essential macronutrients.

Part 1 – Degree of Processing

Processing carbohydrate even in simple ways such as cooking or grinding means that more of the carbohydrate is available to the body to be digested. As pointed out in an earlier article which I will refer to throughout this section, when grains are cooked they become much more digestible – meaning that more of the nutrients in the grain is available to be absorbed. In the case of potatoes, there is double or triple the amount of energy (calories) available to the body when they are cooked versus when they are raw.

Mechanical processing, such pounding, grinding or pureeing are also forms of food processing which have an effect on how many nutrients are available to be digested. The nutrients available to the body when food is eaten raw and whole versus raw and pounded is significant.

Glucose Response – based on the amount of food processing

Mechanical processing of a food doesn’t change the amount of carbohydrate that is in it. That is, when 60 g of whole apple are compared with 60 g of pureed apple or 60 g of juiced apple, there are the same amount of carbohydrates in each and the Glycemic Index of these are similar, however when these foods are eaten the blood glucose response 90 minutes later is significantly different. As outlined in the earlier article, in healthy individuals, blood glucose level goes very high with the juiced apple and in response to the release of insulin, blood glucose then goes very low, below baseline. The response that we see with the juiced apple in healthy individuals is typical of what is seen with other forms of ultra-processed carbohydrates.

This is why it is preferable for metabolically healthy people to eat carbohydrate-based foods as whole, unprocessed foods with a minimum of disruption to the cell structure.

Insulin Response with Mechanical Processing

When healthy individuals eat grain-based meals, the plasma insulin response is inversely related to the particle size of the grain.  That is whole, unprocessed grain releases less insulin than the same amount of cracked grain, which is still less than the same amount of course flour. The highest amount of insulin is released in response to eating the same amount of fine flour.

This increased insulin response of eating grains that are highly processed can drive chronic hyperinsulinemia (chronically high levels of insulin) that eventually results in insulin resistance; the beginning of the metabolic disease process.

It is for this reason that for metabolically healthy individuals, eating whole, unrefined grains is recommended.

Effect or Lack of Effect of Fiber

It is the lack of disruption to the cell structure of the grain that limits the insulin response and not the fiber content that makes the difference.

As mentioned in the earlier article (link above), studies have been done with bread where the fiber was added back in (such as in so-called “whole wheat bread” which is essentially white bread with added bran) and the insulin response was the same as with white bread, so it is not the amount of fiber in the grain that makes the difference, but the lack of disruption to the grain structure itself. I find it helpful to think of it in terms of ‘the fiber that counts is that which is part of the whole, undisrupted grain’.  (Note: it is for this reason that I only factor “net carbs” for food whose fiber is in this undisrupted form. For all other products where fiber is added, I don’t deduct the fiber).

The disruption of the structure of the grain also has an adverse effect on GIP response (an incretin hormone released from the K-cells high up in the intestine that triggers the release of insulin). Bread made with flour (as opposed to whole, intact grains) results in a much larger and earlier plasma GIP response, which in turn results in a higher and earlier insulin response, than bread made with whole kernel grains, such as artisanal rye or wheat breads.

In metabolically healthy individuals, the eating of whole, intact minimally processed carbohydrate-containing food is preferable, as opposed to eating processed carbohydrate-containing foods (be it grains or fruit) with significant disruption to the cell structure.

Part II – Carbohydrate and Fat Combined

In nature, there are very few foods in the human diet that contain a combination of both carbohydrate and fat in substantial quantities. Human breast milk is one of those few natural foods, along with some nuts and seeds. When humans began drinking the milk of other mammals such as goats, sheep and cows, milk became one of those foods.

Also as outlined in a previous article foods with both fat and carbs together result in much more dopamine being released from the reward-center of our brain, called the striatum. Dopamine is the same neurotransmitter that is released during sex and that is involved in the addictive “runner’s high” familiar to athletes so this is a very powerful neurotransmitter.

It is believed that there are separate areas of the brain that evaluate carb-based foods and fat-based foods but when carbs and fat appear in the same food together, this results in what the researchers called a “supra-additive effect“. That is, both areas of the brain get activated at the same time, resulting in much more dopamine being released from the striatum and a much bigger feeling of “reward” being produced. This combination of carbs and fat in the same food is why we find foods such as French fries, donuts and potato chips irresistible and this powerful reward-system is why we’ll  choose French fries over baked potato and why we have no difficulty wolfing back a few donuts, even when we’ve just eaten a meal.

This “supra-additive effect” on the pleasure center of our brain along with the fact that more insulin is released when both carbs and fat are eaten together helps explain the roots of the current obesity epidemic and the metabolic diseases such as Type 2 Diabetes that go along with it. The high rates of obesity seen more recently in places like China (as covered in this article) are due to the adoption of Western eating habits (refined, processed foods) that are notoriously high in both carbohydrates and fat.

When foods that are rich sources of carbohydrate are eaten it is best that foods that are also rich sources of fat are not eaten at the same time in order to avoid this supra-additive effect.

I do not believe that carbohydrate-based foods in and by themselves in metabolically healthy individuals are the underlying cause of obesity and metabolic disease. I believe that it is the (1) consumption of carbohydrate-based foods that have undergone some kind of food processing (grinding, milling, pureeing, etc) that has disrupted their cell structure and (2) the consumption of foods that combine both carbohydrate and fat in the same food that have driven both.

Part III – Carbohydrates are Not Essential Macronutrients

With all the arguing about eating more carbs or less carbs, it needs to be emphasized that carbohydrates are not essential nutrients. Yes, the body needs a certain amount of glucose for the brain, but the body can make this glucose from protein and fat through a process called gluconeogenesis.

This is not simply my opinion, but is stated by the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) on page 275;

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

That is, there is no essential need for dietary carbohydrate provided there are adequate amounts of protein and fat provided in the diet.

The Recommended Dietary Allowance (RDA) for carbohydrate is set at 130 g / carbohydrate per day based on the average minimum amount of glucose utilized by the brain— however the body can manufacture this glucose from protein or fat. A well-designed low carbohydrate diet provides sufficient amounts of fat and  protein such that the body can manufacture the glucose it needs.

Carbohydrate – to eat or not to eat

For Healthy Individuals

For those who are healthy and metabolically flexible, consumption of whole, unprocessed carbohydrate-containing foods such as whole grains, tubers, starchy vegetables such as peas, squash and corn and whole fruit are of no concern. Due to the ‘supra-additive’ effect of fats with carbohydrate, I recommend that when eating carbohydrate-based foods, to avoid foods that are a rich source of fat.

For Metabolically Unhealthy Individuals

As mentioned in the two previous articles related to the new Canada Food Guide (here and here), 88% of Americans are already metabolically unwell, with presumably a large percentage of Canadians as well.

That is, only 12% have metabolic health defined as;

  1. Waist Circumference: < 102 cm (40 inches) for men and 88 cm (34.5 inches) in women
  2. Systolic Blood Pressure: < 120 mmHG
  3. Diastolic Blood Pressure: < 80 mmHG
  4. Glucose: < 5.5 mmol/L (100 mg/dL)
  5. HbA1c: < 5.7%
  6. Triglycerides: < 1.7 mmol/l (< 150 mg/dL)
  7. HDL cholesterol: ≥ 1.00 mmol/L (≥40 mg/dL) in men and ≥ 1.30 mmol/L (50 mg/dl) in women

For the large majority who are metabolically unhealthy, knowing which carbohydrate-based food raise one’s blood glucose levels is important. Even if lab tests show one’s fasting blood glucose is still normal, blood glucose levels after eating carbohydrate may be quite abnormal, and even more significantly insulin levels may be as well. You can read more about that here. As mentioned previously in this article, these high insulin levels are what drives metabolic disease by driving insulin resistance.

Eating a low carbohydrate diet can be very helpful to lower blood glucose response and lower chronically high levels of insulin. Which carbohydrates can be tolerated and in what quantities varies considerably between people, but is easy to determine and I help people do this.

For those that already have Type 2 Diabetes, reducing carbohydrate intake for a considerable length of time will enable them to reduce their overall blood glucose and insulin response, which will help them reverse the symptoms of Diabetes as well as other metabolic diseases that often go along with it, such as high blood pressure and high triglycerides. In time, some carbohydrates may be able to be eaten again however the amount and type will vary between individuals.

Final Thoughts…

Carbohydrates aren’t “evil”.  In and by themselves, they don’t result in obesity or metabolic disease. It is the amount of food processing that carbohydrate-containing foods have undergone that results in cell-wall disruption that will determine how much of a glucose- or insulin-response they will cause. In metabolically healthy people, eating minimally processed whole grains, starchy vegetables and fruit without a source of fat is fine.

For those who are metabolically unhealthy, especially those who have a measurably abnormal glucose- or insulin-response, the amount of carbohydrate that can be tolerated is individual and will need to be determined.

For those who have Type 2 Diabetes and follow a low carbohydrate diet to reduce the symptoms of high blood sugar or metabolic diseases that often go along with it, eating the amount of tolerated carbohydrates as minimally processed ones, without a source of fat is also best.

There is no “one size fits all” diet that is suitable for everyone.

For metabolically healthy individuals, following the new Canada Food Guide and selecting carbohydrate sources using the above principles can provide people with a healthy diet. For those that are already metabolically unhealthy, I can help design a Meal Plan that will meet your energy and nutrient needs and that provides the amount of carbohydrate that you can tolerate. If you would like more information, please send me a note using the Contact Me form, above and I’ll be happy to reply soon.

To your good health!

Joy

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

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

New Canada Food Guide – carbohydrate estimate of the sample plate

There has been some discussion on Twitter that the macronutrient estimated in the previous article of an average ~325-350 g of carbohydrate per day based on a 2000 kcal per day diet for the new Canada Food Guide was “too high”, so in the interest of determining whether it was accurate, I’ve evaluated the carbohydrate content of the illustrated plate.

Actual Number, Standard Cup Measure and Scale of Reference

Since no portion sizes are provided with the new guide, both scale of reference or when available, the actual number of items was used.

The actual number of chickpeas, kidney beans, nuts and seeds were used and determine in terms of the portions of a standard cup measure.

For items such as vegetables and fruit, actual portions were measured using a standard set of stainless steel measuring cups.

For any remaining quantities, since a quarter of an egg is featured on the illustration of a healthy plate and a large sized egg is the standard on which nutrient analysis is based and this is of a known size, I used the 1/4 of a large egg as the scale of reference for other items,when the actual number was not available.

Carbohydrate Content of the Protein Group

The protein group contributed~37 g of carbohydrate to the sample plate.

Carbohydrate content of the protein group on the sample plate

Carbohydrate Content of the Whole Grains Group

The whole grains group contributed more than~58 g of carbohydrate to the sample plate.

Carbohydrate content of the whole grains group on the sample plate

Carbohydrate Content of the Vegetable and Fruit Group

The vegetable and fruit group contributed more than~53 g of carbohydrate to the sample plate.

Carbohydrate content of the vegetable and fruit group on the sample plate

The sample plate used as an illustration for the new Canada Food Guide has close to 150 g  of carbohydrate on it— and this is for only one meal. The carbohydrate content of lunch and dinner (the two generally mixed meals of the day) already totals as much as 300 g of carbohydrate — and there’s still breakfast to add! Whether it’s a couple of whole grain toast (30 g carbs), 2 tbsp unsweetened nut butter (6 g carbs) or some whole grain cereal (30 g carbs) and 1/2 cup of low fat unsweetened yogurt (6 gm carbs), there’s another 42 g of carbs (plus the carbs for the milk or nut or soy milk to pour on the cereal); bringing the average for the three meals alone to 337+ g of carbs which is exactly what it was estimated as in the previous article — as between 325 – 350 g carbohydrate per day.

And this is just for 3  MEALS.

What about snacks?

Yes, snacks are mentioned  TWICE on the first page under the link for “eating habits” in the section on “how to make a meal plan and stick to it”;

Recommendations for meals and snacks

Assuming a person eats a “healthy whole grain” muffin without any dried fruit in it for coffee break in the morning (~50 g of carbs) and a single piece of fruit like an apple or orange mid-afternoon (15 g of carbs), these add another 65 g of carbohydrate to this day, bringing the average total to over 400 g of carbohydrate for one day.

UPDATE (January 26, 2019) Given the sample plate is there to demonstrate proportions, not portions — looking at the grain group alone, the proportion of grain is 1/4 of the dietary intake. Based on a 2000 kcal/day diet, that’s 500 calories per day / ~125 g of carbohydrate from the grain group alone. Add in the carbohydrate from the largely plant-based protein group, that’s another ~100 g carbohydrate per day, on average. Since half the plate should be vegetables and fruit and both starchy vegetables such as squash, yam, potato, peas and corn contain 15 g of carbohydrate per half cup, as does the same amount as fruit, it is reasonable to assume that on average, half of the vegetable servings will be comprised of a mixture of starchy vegetables — along with the fruit servings and the other quarter of the plate of non-starchy vegetables. That is, 1/4 of the vegetable and fruit side of the plate will be carbohydrate-containing, adding another ~125 g of carbohydrate per day to the diet. Of course, there will be days where people will eat lower carbohydrate grains like quinoa and lower carbohydrate plant-based protein such as tofu, but equally there will be days where vegetable servings are starchy ones such as peas and corn along with plant-based proteins that are higher in carbohydrate, such as legumes like kidney beans. So, the numbers above are averages.  Whether one uses the portions on sample plate as a basis for estimating the carbohydrate content or uses the proportion of the diet that is carbohydrate, the results fall in the same range of an average of 325 – 350 g carbohydrate per day, based on only 3 meals (without snacks).

Real Life Meals

Despite there being no “portion sizes” in the new Canada Food Guide, some insist that a “serving of pasta is 1/2 cup” because that is what is illustrated on the sample plate. Okay, let’s go with that for the sake of argument.

If a person ate twice that amount of pasta (instead of also eating some wild rice or rice or bread, for example), this is what the size of that portion would look like (of course it would be “whole grain”):

1 cup of cooked pasta – size of a tennis ball

I’ve been in private practice a long time and in my experience only children and women who are portion restricting eat pasta in amount the size of a tennis ball.  More than 90% of my clients report eating servings of pasta that are significantly larger than that. In fact, the usual ‘smaller-sized’ servings are about a cup and a half when eaten along with salad or a cooked vegetable (bigger if eaten alone). What does a cup and a half of pasta look like? It looks like this;

1 1/2 cups of whole grain pasta

…and this amount of pasta without sauce has 45 g of carbohydrate in it — which is still less than the 53 g of carbs illustrated in the Canada Food Guide sample plate.

Naturally, no one is expected to eat exactly like the “sample meal”, but whether one eats their “whole grains” as all brown rice, wild rice, Bulgar wheat or something else, 1/4 of the plate all have the same amount of carbohydrate per 1/2 cup serving as pasta.

Add to the pasta the vegetables and fruits above on the sample plate (or corresponding assortment of a mix of starchy, non-starchy vegetables and fruit) and that adds up to 100 g of carbohydrate …and we still haven’t added any protein into the meal, yet.

Add another 37 g of carbohydrate for an assortment of legumes, nuts and seeds as well as a bit of meat and “low fat” cheese for the pasta sauce (because after all, we are encouraged to eat animal protein “less often”) and that totals more than 135 g of carbs for just this one “real life” meal. Eat a meal like the one in the sample illustrations, it adds up to 150 g of carbs!

The question I’ve been asked is if it is “healthy whole grain”, then what’s the concern?

For metabolically healthy adults, none. For metabolically healthy adults, the new Canada Food Guide is a huge improvement from it’s predecessor! It eliminates refined carbs, sugary drinks including fruit juice and encourages eating whole foods, cooked at home as much as possible.

The problem is, most adults are not metabolically healthy.

Majority of Adults Metabolically Unhealthy

As mentioned in the previous article research indicates that as many as 88% of Americans[1] are already metabolically unwell, with presumably a large percentage of Canadians as well. That is, only 12% of the adult population would be considered metabolically healthy [1]”.

Metabolic Health is defined as [1];

  1. Waist Circumference: < 102 cm (40 inches) for men and 88 cm (34.5 inches) in women
  2. Systolic Blood Pressure: < 120 mmHG
  3. Diastolic Blood Pressure: < 80 mmHG
  4. Glucose: < 5.5 mmol/L (100 mg/dL)
  5. HbA1c: < 5.7%
  6. Triglycerides: < 1.7 mmol/l (< 150 mg/dL)
  7. HDL cholesterol: ≥ 1.00 mmol/L (≥40 mg/dL) in men and ≥ 1.30 mmol/L (50 mg/dl) in women

Given the slightly lower rates of obesity in Canada (1 in 4) as in the United States (1 in 3), presumably there is a slightly lower percentage of Canadians who are metabolically unhealthy. For the sake of argument, let’s assume that there are TWICE as many metabolically healthy adults in Canada, which would mean that only slightly over 75% of adults are metabolically unhealthy.  Since Canada’s Food Guide is intended for a healthy population in order to reduce the risk of overweight and obesity as well as chronic diseases manifest as the markers above, that means that the new Canada Food Guide — as beautiful as it is, is only appropriate for ~1/4 of the adult population.

For the other 75% of adults that are presumably metabolically unwell, a diet that provides 342 g of carbohydrate per day for meals alone (based on a 2000 kcal per day diet) and as much as 400 g of carbohydrate per day with 2 “healthy” snacks is not going to address the large percentage of adults who are already demonstrating symptoms of being carbohydrate intolerant.

Carbohydrate Intolerance

As outlined in detail in a previous article, based on a large-scale 2016 study that looked at the blood glucose response and circulating insulin responses from 7800 adults during a 5-hour Oral Glucose Tolerance Test, 53% had normal glucose tolerance at 2 hours but of these people, 75% had  abnormal blood sugar results between 30 minutes and 60 minutes  demonstrating that they were already hyperinsulinemic, although it went undetected on standard assessors that only look at glucose and insulin responses at baseline (fasting) and at 2 hours.

These people are already exhibiting symptoms of not tolerating a normal carbohydrate load of 100 g.

How does it make sense to encourage adults that already have abnormal glucose response to eat 150 g of carbohydrate per meal when these people already have an impaired first-phase insulin response? How will eating “whole grains” and the “added fiber from plant-based proteins” improve their first-phase insulin response (which likely results from dysfunction in the release of the incretin hormone GIP (Glucose-dependent Insulinotropic Polypeptide) from the K-cells?

For these people, continuing to eat a diet high in carbohydrate, irrespective of the amount of fiber or the glycemic load will not restore their insulin response, and in time is likely to make it worse. This is my concern.

Canada Food Guide is for a healthy population to avoid the risk of chronic disease and based on these statistics most adults are not metabolically healthy.

Final Thoughts…

For the ~1/4 of adults that are metabolically healthy, I think the new Canada Food Guide is beautiful and focuses on real, whole food, preparing food at home, avoiding refined grains and avoiding high sugar beverages such as fruit juice (formerly seen as “healthy”).

For the high percentage of adults that are already metabolically unwell and who already demonstrate abnormal glucose responses, I don’t see that advising them to eat a diet that is between 325-350 g of carbohydrate per day (meals without snacks) helps them to avoid the progression to Type 2 Diabetes.

If you are part of the majority of Canadians that are already struggling with overweight and/or being metabolically unwell and would like to know more about how I may be able to help you achieve a healthy body weight and restore metabolic markers then please send me a note using the Contact Me form, on the tab above.

To your good health!

Joy

You can follow me at:

         https://twitter.com/lchfRD

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https://www.instagram.com/lchf_rd

References

  1. Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metabolic Syndrome and Related Disorders Vol 20, No. 20, pg 1-7, DOI: 10.1089/met.2018.0105
  2. Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.

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

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

There’s Something About Real Life Personal Stories

NOTE: This article is an editorial but is cross-posted under Science Made Simple to make it easy to find.

Critics of the use of a low carbohydrate diet for weight loss and for putting the symptoms of Type 2 Diabetes into remission will often say that there are no randomized control trials (RCTs) showing that this diet is safe and effectiveness over the long-term, but what they often don’t realize is that there were no randomized controlled studies demonstrating safety and efficacy underlying the recommendation that people consume 45-65% of their daily calories as carbohydrate, while limiting their fat intake. What we do have in both Canada and the US since 1977 (when the Dietary Guidelines in both countries changed) is 40+ years of epidemiological data showing a massive increase in the incidence and prevalence of obesity and Type 2 Diabetes that shows no sign of letting up, and a millions of people that are fed-up of feeling “sick and tired”. Is it simply that people stopped “moving” as much or could it be the diet?

Recently, the therapeutic use of a low carbohydrate diet as a dietary option for reducing blood sugar, use of blood-sugar lowering medications and for weight loss has been recognized by the American Diabetes Association  (ADA) in the release their 2019 Standards of Medical Care in Diabetes (you can read more about that here. In addition, in October 2018 the ADA and the European Association for the Study of Diabetes (EASD) released a joint position paper that classifies a low carbohydrate diet as Medical Nutrition Therapy for the treatment of Type 2 Diabetes in adults (more about that here). This means that physicians and healthcare professionals in Europe and the United States can recommend a low carbohydrate diet as one of the treatment options for their patients.  This moves a low carbohydrate diet from the realm of popular lifestyle choice to Medical Nutrition Therapy for the purpose of disease management.

You can get a one-page downloadable summary (with references) of both the American Diabetes Association (ADA) 2019 Standards of Medical Care in Diabetes and the ADA and the European Association for the Study of Diabetes (EASD) joint position paper here.

As covered in previous articles, there are ample studies showing that a well-designed low carbohydrate diet is both safe and effective for putting Type 2 Diabetes into remission and for weight loss.

In fact, there was a list compiled by Dr. Sarah Hallberg at the end of January 2018 of studies that involved a low carbohydrate diet which spanned  18 years, 76 publications involving 6,786 subjects, including 32 studies of 6 months or longer and 6 studies of 2 years or longer. Now, it is a year later and there are numerous other studies including very recent two-year data from the Virta Health study which demonstrates that a low carbohydrate diet is not only safe, but effective long term.

But there’s something about real-life, personal (n=1) accounts of ordinary people losing weight and putting their Type 2 Diabetes and other metabolic conditions into remission that people find very compelling.

Diet Doctor, a well-known website dedicated to a low-carb high fat / “keto” approach has a whole section of “success stories”, and a very popular ketogenic Facebook page from Nigeria which promotes a “keto” diet (mostly self-defined) does as well.

What about when the “ordinary people” that lose weight and put their own metabolic disorders into remission also happen to be healthcare professionals? It seems many find this particularly compelling because we know the full range of dietary options and have chosen the method we have after careful consideration.

As many of you know, I was recently the featured guest on the Low Carb MD Podcast which was hosted by Dr. Tro Kalajian and Dr. Brian Lenzkes. As outlined on the article at the link above, both of these doctors struggled with obesity their whole lives and both have lost weight and found improved metabolic health, and are now helping their patients to do the same.

Then there’s me, a Registered Dietitian in private practice who’s lost almost 50 pounds and put my Type 2 Diabetes of 10 years into remission.

The three of us are just ‘two Docs and a Dietitian’ who were sick of being sick, but there are many more healthcare practitioners just like us that have done similarly, including some of the more than 1500 that are part of the Canadian Clinicians for Therapeutic Nutrition (CCTN) Facebook group and members of CCTN.

We are ordinary people who as clinicians are knowledgeable about the therapeutic benefits of following a low carbohydrate diet and who have implemented it in our own lives. Our stories are not scientific case studies, nor are they part of a randomized controlled trials or research of any kind.  Our single subject (n=1) anecdotal stories and those of hundreds of thousands of ordinary people from all walks of life are powerful because they stand in sharp contrast to the large percentage of the population that are overweight or obese just like we were, but who keep eating the same way and getting sicker.

We offer people choices.

The choice of turning things around.

The option of getting healthy.

The ability to achieve a healthy body weight and in the process be able to have our doctors reduce or eliminate medications for metabolic diseases.

If you’re tired of being “sick and tired” then I’d encourage you to listen to the podcast above or to have a look through some of the “Science Made Simple” articles on this web page under the Food for Thought tab. There you can learn about the different types of “low carb” and “keto” diets and get a feel for what eating this way is like.

If you would like medical support in the US, be sure to check out Dr. Kalajian and Dr. Lenzkes, other physicians such as Dr. Eric Westman and Dr. Ted Naiman, as well as the Virta Health Clinic, as well as many others who are knowledgeable and experienced to provide you with support in this area. If you are in Canada and are looking for a therapeutic nutrition practitioner, you can search the list on the CCTN website (link above) and if you’d like to know how I can help (either in-person or from where you are via Distance Consultation) then feel free to send me a note using the Contact Me form above and I’ll reply as soon as possible.

To your good health!

Joy

You can follow me at:

       https://twitter.com/lchfRD

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

          https://plus.google.com/+JoyYKiddieMScRD

https://www.instagram.com/lchf_rd

 

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

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

Silver Bullet for Addressing Carb Cravings

I was asked an interesting question recently which was “have you found the silver bullet for reducing carb craving“? This was an interesting way to phrase something I have been asked in many different ways the last few years.

Some people have been told that it really doesn’t matter what or how much they eat as long as they only eat “real” food. Others have heard that they need to eat plenty of fat each day, and that this will work to keep them full and reduce cravings. Some have read that what they need to do is eat mostly protein with some fat or only eat during a very small ‘eating window’.

So what is the answer?

There really isn’t a ‘silver bullet’ as much as there is the need for a well-designed low carbohydrate diet that is specific to each person’s physiological needs.

Every person has different nutrient needs based on their age, stage of life, gender and activity level. As well, each individual has different degrees of insulin resistance and hyperinsulinemia and each person’s blood sugar responds differently to a carbohydrate load (called glycemic response). Much of these depends on their specific family history, their medical history and the type of foods they normally eat. [You can read more about all three of these here.]

There isn’t a “once-size-fits-all low carb diet”.  Based on all of the above factors, some people will do better with a higher ratio of protein to fat, whereas others need plenty of natural, healthy fats and average amount of protein. The amount and type of carbohydrate each person can tolerate will also be different. Since everyone’s needs are different, in designing a Meal Plan for someone, I start by conducting a complete nutritional assessment (personal medical history, family medical history, review of recent lab tests, dietary and lifestyle review, etc.) so that the Meal Plan that I design is tailored to their individual needs.

If there was a ‘silver bullet’ to eliminate carb cravings it would be to understand what causes them. Carb cravings are driven by several different hormones that the body produces in response to the way each person eats, as well as how much and how well they sleep, how they manage stress (or don’t), as well as any conditions or diseases that they have and any medications that they take.  All of these affect the various hormones that impact cravings for carbohydrate-based food. When I design people’s Meal Plans, I take all of these into account.

A well-designed low carbohydrate diet designed specifically for each person and taking into account the various factors that are driving their specific carbohydrate cravings is the most effective means to addressing them.

A person’s Meal Plan is not carved in stone. If a person has a fair amount of weight to lose, their Meal Plan will change once they’ve lost a significant amount of weight or if they’ve hit a plateau where they haven’t lost either weight or inches in a while.  Achieving optimal body weight is a dynamic process not a static one — as people’s needs change, so should their diet.  It’s not that a person’s Meal Plan needs to be re-designed, as much as ‘tweaked’ or ‘adjusted’ to keep them moving towards achieving their goals. This is where follow-up can be helpful.

If you have questions as to how I can help you achieve your health and nutrition goals — either by taking service in-person in my office or via Distance Consultation please send me a note using the Contact Me form above and I will be happy to reply as soon as I am able.

To your good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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

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

 

When Fat Became the Villain

Those who are younger than 40 years old probably grew up hearing that saturated fat is “bad” and polyunsaturated fat is “good”, but where did we get this idea and is it true?

The process of what I call the “vilification of fat” began when researcher Ancel Keys presented a graph at a talk at Mount Sinai Hospital in New York in January 1953 and later published it in a research paper titled Atherosclerosis: a problem in newer public health [1]. It was said to show the relationship between ‘fat calories as a percentage of total fat” and the number of ‘deaths from degenerative heart disease per 100,000 people’ for men between the ages of 45-49 and 55-59. The linear relationship of these data points from the Six Country Study (Japan, Italy, England & Wales, Australia, Canada and the USA) suggested that there was a strong relationship between the amount of fat calories as a percentage of dietary intake and deaths from degenerative heart disease for men aged 55-59. At the time of publication of the Six Country Study, Keys said that it was possible to only get complete data from those 6 countries [1] at the time. He concluded;

“Whether or not cholesterol etc. are involved, it must be concluded that dietary fat somehow is associated with cardiac diseases mortality, at least in middle age [1].

In Key’s mind, the total amount of dietary fat was “somehow associated” with cardiac death in middle aged men, but he expressed doubt whether or not cholesterol was involved.

In 1957, Yerushalamy and Hilleboe [2] published data from 22 countries which showed there was no linear relationship between ‘fat calories as a percentage of total fat” and the number of ‘deaths from degenerative heart disease per 100,000 people’.

Keys went onto conduct what became known as the Seven Country Study which collected data on almost 13,000 men aged 40-59 from the USA, Finland, the Netherlands, Yugoslavia, Greece and Japan. Findings were only published in 1970 in the journal Circulation in several papers from separate countries [3]. Keys no longer believed that total fat was associated with heart disease but that saturated fat was the villain. Keys concluded that the average consumption of animal foods (with the exception of fish) was positively associated with 25-year heart disease death rates and that the average intake of saturated fat was strongly related to 10 and 25-year coronary heart disease death rates.

What solidified this association was that the 1970 publication on the Seven Country Study contained Keys’ 1953 graph from the Six Country Study (above) [4]. Even though it indicated a linear relationship between total fat intake and degenerative heart disease it became tied in the minds of many that this graph “proved” that saturated fat was linked to heart disease—even though that is not what the graph shows at all.  It isn’t even about saturated fat. Keys also neglected to mention Yerushalamy and Hilleboe’s data from 22 countries showed no relationship between total fat consumption and heart disease.

The Diet Heart Hypothesis

The diet-heart hypothesis originated with Ancel Keys and is the belief that eating foods high in saturated fat contributes to heart disease. Keys believed that replacing fat from meat, butter and eggs with newly-created polyunsaturated vegetable oils such as soybean oil would reduce heart disease and deaths by lowering blood cholesterol levels.

The Sugar Industry Funding of Research Vilifying Fat

In the mid-1960’s, the Sugar Research Foundation (predecessor of the Sugar Association) wanted to offset research that had been published and that suggested that sugar was a more important a cause of heart disease and stroke from atherosclerosis than dietary fat. The Sugar Research Foundation invited Dr. Fredrick Stare and the late Dr. D. Mark Hegsted of Harvard’s School of Public Health Nutrition Department to join its scientific advisory board and then approved $6,500 in funds ($50,000 in 2016 dollars) to support a review article that would respond to the research showing the danger of sucrose [5]. Letters exchanged between the parties came to light a November 2016 article published by Kearns et al [6] which said that the Sugar Research Foundation had tasked the Harvard researchers with preparing “a review article of the several papers which find some special metabolic peril in sucrose and, in particular, fructose [7]”.

The Sugar Industry paying researchers to blame dietary fat and vindicate sugar for heart disease seems a little like the tobacco industry having secretly funded articles demonstrating that something other than smoking was responsible for lung cancer.

In August 1967 the New England Journal of Medicine published the first review article written by Drs. Stare, Hegsted and McGandy titled “Dietary fats, carbohydrates and atherosclerotic vascular disease” which stated;

Since diets low in fat and high in sugar are rarely taken, we conclude that the practical significance of differences in dietary carbohydrate is minimal in comparison to those related to dietary fat and cholesterol”.

The report concluded;

the major evidence today suggests only one avenue by which diet may affect the development and progression of atherosclerosis. This is by influencing the levels of serum lipids [fats], especially serum cholesterol.”

The Harvard researchers went on to say;

there can be no doubt that levels of serum cholesterol can be substantially modified by manipulation of the fat and cholesterol of the diet” and that “on the basis of epidemiological, experimental and clinical evidence, that a lowering of the proportion of dietary saturated fatty acids, increasing the proportion of polyunsaturated acids and reducing the level of dietary cholesterol are the dietary changes most likely to be of benefit.

At no point did Stare, Hegsted and McGandy disclose that they were paid by the Sugar Research Foundation for the two-part review.

A commentary in the Journal of Accountability in Research [8] summarized the significance of those articles as follows;

“Researchers were paid handsomely to critique studies that found sucrose [sugar] makes an inordinate contribution to fat metabolism and heart disease leaving only the theory that dietary fat and cholesterol was the primary contributor.”

The same Dr. Hegsted that was funded by the Sugar Industry to write the above articles vindicating sugar and vilifying dietary fat went on to work on editing the 1977 US Dietary Guidelines [9], which entrenched the vilification of fat into the US Food Pyramid for the next 40+ years. The rest, they say, is history.

The same year (1977), Canada’s Food Guide recommended that Canadians limit fat to <30% of daily calories with no more than 1/3 from saturated fat but did not specify an upper limit for dietary cholesterol. This was based on the belief that total dietary fat and saturated fat were responsible blood levels of LDL cholesterol levels and total serum cholesterol [10]. Cholesterol in general (total cholesterol) and LDL cholesterol was assumed to be tied to heart disease, so the focus was on lowering the proxy measurements of LDL cholesterol and total cholesterol.

Recommendations for the continued restriction of dietary fat continued in both the US and Canada in the 2015 revision of the Dietary Guidelines based on the enduring belief that lowering saturated fat in the diet would lower blood cholesterol levels and reduce heart disease.

The question is does it?

A 2018 study published in the journal Nutrients looked at health and nutrition data from 158 countries from 1993-2011 and found that total fat and animal fat consumption were least associated with the risk of cardiovascular disease and that high carbohydrate consumption,  particularly as cereals and wheat was most associated with the risk of cardiovascular disease [11]. Significantly, both of these relationships held up regardless of a nation’s average national income.

These findings support those of the 2017 PURE (Prospective Urban and Rural Epidemiological) study, the largest-ever epidemiological study which recorded dietary intake of 135,000 people in 18 countries over an average of 7 1/2 years, including high-, medium- and low-income nations. The PURE study found an association between raised cholesterol and lower  cardiovascular risk and that “higher carbohydrate intake was associated with higher risk of total mortality”. It also reported that “total fat and individual types of fat were related to lower total mortality (death)” [12].

A recent study published in the American Journal of Clinical Nutrition reports that long-term consumption of the saturated fat found in full-fat dairy products is not associated with an increased risk of cardiovascular disease (atherosclerosis, coronary artery disease, etc.) or other causes of death, and may actually be protective against heart attack and stroke [13].

This recent large-scale epidemiological data provides strong evidence that eating a diet containing saturated fat is not associated with heart disease. While eating saturated fat raises blood levels of LDL cholesterol, we now know that there is more than one type of LDL cholesterol and only the small, dense LDL cholesterol is linked to atherosclerosis. The large, fluffy LDL is protective [14].

We now know that fat was made out to be the villain in scientific reviews paid for by the sugar industry and this combined with Ancel Key’s Diet-Heart Hypothesis ended up being the impetus for the creation of an entire food industry designed to extract fat from industrial seed oils, such as soybean oil and rapeseed (Canola). These industrial seed oils are the so-called “healthy polyunsaturated fats” that we are encouraged to eat instead of so-called “dangerous” saturated fat, yet these industrial seed oils are only able to be produced using solvent-based chemical extraction under very high temperature. Should we be confident in industrial fats brought to us by the same industry that brought us “trans fats”? With a lack of evidence that natural fats such as butter or cream are dangerous, perhaps eating a bit of real animal fat and plenty of natural plant-based monounsaturated fats such as olive oil is the better way to go?

For more than forty years, generations of Americans and Canadians have avoided eggs, full fat cheese and creamery butter – and done so because they have believed that saturated fat raising LDL cholesterol predisposed them to heart disease. We know much more than we did in the 1970s when the first Dietary Guidelines were created in the US (under the watchful editorial oversight of one of the researchers that had been paid by the sugar industry to vilify fat).  We now know that eating foods with saturated fat will raise LDL-cholesterol, but not all LDL-cholesterol is “bad”[14]. Before we knew this high total LDL-cholesterol (LDL-C) was seen as a good proxy (indirect substitute) measurement for heart disease risk, but no longer.

It has been known since the early 1990s that a high TG:HDL ratio is very good estimator of coronary heart disease risk [15].

The measurement of the LDL-cholesterol particle number (LDL-P) which measures the actual number of LDL particles is a much stronger predictor of cardiovascular events than LDL-C [16] because the more particles there are, the more small, dense LDL there are.

The ratio of apolipoprotein B (apoB): apolipoprotein A (apoA) is another good estimator of cardiovascular risk. Lipoproteins are particles that transport cholesterol and triglycerides (TG) in the blood stream and are made up of apolipoproteins, phospholipids, triglycerides and cholesterol. Apolipoprotein B is an important component of many of the lipoprotein particles associated with atherosclerosis, such as chylomicrons, VLDL, IDL, LDL – with most found in LDL. Since each lipoprotein particle contains one apoB molecule, measuring apoB enables the determination of the number of lipoprotein particles that contribute to atherosclerosis and for this reason that ApoB is considered a much better predictor of cardiovascular disease risk than LDL-C [17].

In light of the recently published epidemiological evidence and much stronger proxy measurement of cardiovascular risk we must update our thinking that fat in general, or saturated fat in particular is the “villain”. It’s not.

Perhaps you could use some help as to which fats you should eat more of and in what amounts, or on deciding on what ratio of protein to fat in your diet will best help you reach your health and weight goals? I can help.

I provide services via Distance Consultation (Skype, long distance telephone) as well as in-person in my Coquitlam office.

If you have questions on my services, please send me a note using the Contact Me form located on the tab above, and I will reply as soon as I’m able.

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/

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

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

References

  1. Keys, A., Atherosclerosis: a problem in newer public health. J Mt Sinai Hosp N Y, 1953. 20(2): p. 118-39.
  2. Yerushalamy, J. and Hilleboe HE, Fat in the diet and mortality from heart disease; a methodologic note. N Y State J Med, 1957. 57(14): p. 2343-54.
  3. Coronary heart disease in seven countries. Summary. Circulation, 1970. 41(4 Suppl): p. I186-95.
  4. Harcombe, Z., An examination of the randomised controlled trial and epidemiological evidence for the introduction of dietary fat recommendations in 1977 and 1983:  A systematic review and meta-analysis. 2015, University of the West of Scotland.
  5. Husten, L., How Sweet: Sugar Industry Made Fat the Villain. 2016.
  6. Kearns, C.E., L.A. Schmidt, and S.A. Glantz, Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med, 2016. 176(11): p. 1680-1685.
  7. McGandy, R.B., D.M. Hegsted, and F.J. Stare, Dietary fats, carbohydrates and atherosclerotic vascular disease. N Engl J Med, 1967. 277(4): p. 186-92 contd.
  8. Krimsky, S., Sugar Industry Science and Heart Disease. Account Res, 2017. 24(2): p. 124-125.
  9. Hegsted D.M. Introduction to the Dietary Goals for the United States. p. 17 of 130.
  10. McDonald, B.E., The Canadian experience: why Canada decided against an upper limit for cholesterol. J Am Coll Nutr, 2004. 23(6 Suppl): p. 616S-620S.
  11. Grasgruber, P., et al., Global Correlates of Cardiovascular Risk: A Comparison of 158 Countries. Nutrients, 2018. 10(4).
  12. Dehghan, M., et al., Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet, 2017. 390(10107): p. 2050-2062.
  13. de Oliveira Otto, M.C., et al., Serial measures of circulating biomarkers of dairy fat and total and cause-specific mortality in older adults: the Cardiovascular Health Study. Am J Clin Nutr, 2018.
  14. Lamarche, B., I. Lemieux, and J.P. Després, The small, dense LDL phenotype and the risk of coronary heart disease: epidemiology, patho-physiology and therapeutic aspects. Diabetes Metab, 1999. 25(3): p. 199-211.
  15. Manninen, V., et al., Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment. Circulation, 1992. 85(1): p. 37-45.
  16. Cromwell, W.C., et al., LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study – Implications for LDL Management. J Clin Lipidol, 2007. 1(6): p. 583-92.
  17. Lamarche, B., et al., Apolipoprotein A-I and B levels and the risk of ischemic heart disease during a five-year follow-up of men in the Québec cardiovascular study. Circulation, 1996. 94(3): p. 273-8.

 

 

Evolving Theory of Obesity – a combination of refined carbs and industrial seed oils

Three years ago, my theory about the roots of the current obesity and Diabetes epidemic was simple. I believed that it was largely a matter of us eating too many carbs while having reduced the amount of healthy fat we ate. I now think it is a little more subtle than that, and that it is specifically the combination of a diet too high in refined carbs while high in industrial seed oils (such as soybean and canola oil) that underlies the issue.

When I first started reading and writing about the current obesity and Diabetes epidemic, my thoughts were summarized in two articles written in May and June of 2015. In the first article, I documented how in 1970-72 only 6% of men and 11.7% of women were considered obese (Body Mass Index > 30) in Canada, but by 2013 obesity in men had tripled to 20.1% in men and to  17.4% in women. In the second article, I explained how the changes in the obesity rates coincided with the changes in the Dietary Recommendations that began in 1977 and continued in 1982, 1992 and 2005 and which encouraged people to eat considerably more carbs and a lot less fat coincided with the increased obesity rates, and that the increasing rates of Type 2 Diabetes (9.4% in 2014 in Canada) was just a natural outworking of the higher obesity rates.

The problem was, I really didn’t know of any specific mechanisms that related one to the other.

Now I know of several.

This article summarizes my current theory of obesity, as it relates to previous articles and a brand new study published last week.

Correlation is not Causation

There’s an expression in science is that “correlation is not causation”.

That is, the fact that a dramatic increase in obesity rates correlates (or coincides) with the changes in the Dietary Recommendations doesn’t mean that the Dietary Recommendations ’caused’ the obesity epidemic or the Diabetes epidemic.

One can hypothesize that there is a relationship between these two things, but without some understanding of the mechanism and more data, we don’t know what this relationship might be.

From the reading I have been doing the last number of years, I have some ideas of some of what may be involved.

Evolution of the Theory

A presentation at a conference at the beginning of March (documented in  two previous articles) got me thinking that the picture was bigger than just “too many carbs” and a “decrease in the satiety effect of saturated fat” from full fat milk, cheese and butter. I was challenged by the fact that in the late 1960s and early 1970s, people in the US and Canada were generally slim, despite eating carbohydrates at just about every meal;

“They ate cereal or toast for breakfast and just about every household had a toaster. Lunch was often sandwiches, as there were no microwaves to heat food up in. Potatoes were a mainstay at dinner, sometimes pasta – yet the majority of young adults and adults were slim. Of course there were always some people that were overweight. Most elementary school classes had one ‘chubby’ kid, but when one looks around the classes of today or on public transit or in stores and supermarkets, most people are considerably heavier than people in the 1950’s and 1960’s”

(from A New Hypothesis for Obesity Part 1)

The question was raised ‘what resulted in overweight and obesity all of a sudden exploding in the 1970’s and just keep rising?’

What changed?

We knew that (based on US data) people began eating ~240 calories a day more as carbohydrate but what was causing them to do this? Was it just because the Dietary Recommendations were encouraging us to eat more carbohydrate or was there something else going on?

Not More Fat but the Type of Fat

While people were eating more carbohydrate, neither people in Canada nor the US were eating more fat, but the type of fat we’ve been eating since the 1970s has changed substantially. This tweaked my interest.

We’d reduced our intake of saturated fat (because the “Diet-Heart Hypothesis” had told us they were the “cause of cardiovascular disease”) and we dutifully ate more and more of ‘polyunsaturated fats’ / vegetable oils  which as I wrote about previously are more appropriately called “industrial seed oils”.  These oils, including soybean, corn oil and canola oil contain high amounts of linoleic acid which is at the very top of the omega 6 (n-6) pathway and these fats which elongate to arachidonic acid are pro-inflammatory products in nature.

There is nothing inherently ‘bad’ about linoleic acid which is found naturally in nuts and seed oils, including walnut, macadamia and sesame oil, but it is the sheer amount of these industrial seed oils which suddenly became excessive in our diet, which I think may be a significant factor.  These fats are in our bread, pastries, salad dressing, margarine and even our peanut butter.  Canned fish is packed in it, our mayonnaise is made from it and everything we eat that is fried from a restaurant is bathed in these industrial seed oils. On top of that, many of us use it our own homes to cook with.

So many of the foods we now eat are prepared with soybean or canola oil and as a result, we consume a much greater amount of linoleic acid than our body ever evolved to handle.

As outline in previous articles, these oils are much more unstable than the saturated fats they were created to replace. What I mean by ‘unstable’ is that they are more easily oxidized – that is, when industrial seed oils are heated in the making of commercial foods using them or in cooking, they react with oxygen in the air to form toxic substances including  aldehydes  and lipid peroxides.  When these oils are heated, they produce oxidized metabolites which have been also been implicated in the development of a variety of conditions, including non-alcoholic fatty liver disease (NAFLD), cardiovascular disease and cancer and it has been proposed that inflammation is involved in the development of Type 2 Diabetes and metabolic syndrome, as well.

Also as written about previously, cardiolipin  is an important component of the inner membrane of the mitochondria (the so-called “powerhouse of the cell”) and the fats that make up cardiolepin change, depending on the types of fats in the diet. That is, the fatty acid composition of cardiolepin is altered by us eating a diet high in linoleic acid, such as soybean and canola oil. This past week a study about cardiolepin was published that added a very interesting piece to my evolving theory of the obesity and Type 2 Diabetes epidemic.

In this new study, researchers at the University of Copenhagen found that when large amounts of cardiolipin are produced in ‘brown fat’ cell mitochondria, there is much stronger calorie-burning. Conversely, when there are low amounts of cardiolepin in brown fat, there is much less calorie-burning. Low amounts of cardiolepin and less calorie-burning in brown fat was reported to be associated with obesity and Type 2 Diabetes [1].

Note: “Brown fat” is a specialized type of fat that burns fat, rather than stores it and cardiolepin acts like a kind of on-off switch for the activity in our brown fat.

This study got me thinking that since it is known that the fatty acid composition of cardiolepin changes according to the fatty acid composition of the diet (covered in previous blogs), what effect has the massive increase in linoleic acid intake in the diet in both Canada and the US had on the function of the cardiolipin?

Could it be that a shift in the types of fats that make up cardiolepin in brown fat stemming from a very high linoleic acid intake from industrial seed oils has had a similar effect as an absolute decrease in cardiolepin – and that this is somehow related to the increase in obesity and Type 2 Diabetes?

Type of Fats and Refined Carbohydrates

My theory of obesity has evolved and will likely continue to evolve. I don’t think that increased carbohydrate consumption based on changes in the Dietary Recommendations in the late 1970s / early 1980s in and by itself resulted in the obesity epidemic and huge increase in Type 2 Diabetes we see now.

I currently believe that the introduction of these manufactured industrial seed oils (soybean, canola, corn) that were created in the 1970s and meant to replace saturated fat in the diet (presumably to protect people from heart disease!) may be part of the initiation of the disease process.

As documented in earlier articles, we know that these fats are easily oxidized, have a direct impact on increasing inflammation and triggering the disease generation process in several health conditions and on acting on the endo-cannibinoid receptors in the body, in much the same way as cannabis (marijuana).  Could it be that these created oils that are very high in the average Western diet actually lead people to consuming more and more carbohydrate-based foods; foods that often comes liberally bathed in more industrial seed oils?

The mechanism of how the above might work was presented in an earlier article and had to do with how energy is generated in the electron transport chain of the mitochondria being different for saturated fats and unsaturated fats.

There are several possible mechanisms that may link consumption of these novel fats to obesity and development of Type 2 Diabetes (oxidation, inflammation, food cravings) and now based on this new study, the possibility of an increase in linoleic acid content in cardiolepin and it’s effect on fat burning.

It will take years more research before we have a fuller picture, so what do we do in the meantime?

Sensible Recommendations based on the Current Knowledge

For someone who is metabolically healthy (i.e. does not have Type 2 Diabetes or Insulin Resistance, hypertension or high cholesterol), it would seem that a whole-foods approach combined with avoiding omega – 6 industrial seed oils such as soybean, canola and corn oil combined with being mindful of the amount and type of carbohydrate in the diet may be sufficient to avoid developing these chronic diseases. Such a scenario would not be unlike the diet of the average American or Canadian in the 1950s and 60s. Not that that diet was that healthy, when compared with a classic Mediterranean diet, Japanese or Okinawan-style diet, or a whole food low-carbohydrate diet. These, it would seem offer a much healthier alternative.

For those who are already are insulin resistant or been diagnosed with Type 2 Diabetes, avoiding industrial seed oils would prudent and eating naturally-obtained vegetable fats such as olive oil or avocado oil instead. Since it does not seem that studies clearly support that saturated fat causes heart disease and not simply increase in surrogate markers of heart disease such as higher LDL (which LDL subfraction?), it would seem that using modest quantities of real butter is preferable to eating margarine made from industrial seed oils. It would also seem that at least initially, eating a diet where the amount and type of carbohydrate is kept to a quantity that does not trigger large amounts of insulin release or spike blood glucose makes good sense. As I wrote about recently, with the availability of Continuous Glucose Monitoring (CGM), this approach can be tailored to each individual person’s response to specific foods. We are no longer reliant on Glycemic Index or Glycemic Load, which are derived from healthy people’s response to foods, not those with Type 2 Diabetes. A suitable diet could be expressed as a variety of different lifestyles (just as for the healthy individual) including a Mediterranean diet, Okinawan-style diet, or whole food low-carbohydrate diet – with carbohydrate levels tailored on an individual basis, based on glycemic response and insulin levels.

Whether a person is healthy or metabolically unwell, based on the studies I have read and some of the mechanisms that have come to light, I can see no benefit in people eating either industrial seed oils or refined, processed carbohydrates. There is every reason to believe that both of these may have been part of the underlying cause of the current obesity and Type 2 Diabetes epidemic.

Unrefined Carbohydrates and Healthy Fats

If someone is metabolically healthy, I recommend eating minimally processed carbohydrates as they reduce the ‘incretin effect’ of hormones such as GIP, GLP-1 and GLP-2 that are released in the intestine and trigger the release of insulin from the pancreas beta-cells. Eating minimally processed carbs would result in less triggering of the release of insulin, thus reducing the likelihood of developing either insulin resistance or Type 2 Diabetes.

If someone is already insulin resistant or has Type 2 Diabetes, it seems from recent studies that minimizing carbohydrate initially, along with weight loss and some forms of activity may be at least as good if not more beneficial than a low-fat calorie-restricted diet. Certainly, many people find they are a lot less hungry eating a low carbohydrate whole foods diet and are easily able to stick with it long term (a year or two in studies), allowing for a period of improving insulin sensitivity and lower overall blood sugar levels. It certainly has been demonstrated to be safe and effective in periods up to two years.

For both those that are metabolically healthy or insulin resistant or have Type 2 Diabetes, avoiding industrial seed oils makes good sense, for all the reasons outlined above.

What about your specific situation?

Do you have questions about the type and amount of carbohydrates that are most suitable for you based on your health and family history? What about which fats are are the best choices given your lifestyle?

I can help.

Please feel free to send me a note using the “Contact Me” form located on the tab above to find out how I can support your needs and I will reply as soon as possible. Remember, I provide both in-person services and am experienced providing services via Distance Consultation (telephone or Skype).

To your good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

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Reference

Sustarsic EG, Ma T, Lynes MD et al, Cardiolipin Synthesis in Brown and Beige Fat Mitochondria Is Essential for Systemic Energy Homeostasis,
Cell Metabolism (2018), https://doi.org/10.1016/j.cmet.2018.05.003

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

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

 

 

 

 

 

Diabetes Canada 2018 Clinical Practice Guidelines – option of a low carb diet


Diabetes Canada has released their long-awaited 2018 Clinical Practice Guidelines [1] which affirms that nutrition therapy is an integral part of people’s self-management of their Diabetes, as well as part of the treatment for the disease.  One of the main goals of nutrition therapy is to maintain or improve the quality of life and nutritional and physical health of those with the disease, while preventing the need to treat both sudden (acute) and long term complications. Effective nutrition therapy can improve blood sugar control, including reducing three-month average blood glucose (i.e. HbA1C, glycated hemoglobin) by 1.0% to 2.0%.

Diabetes Canada 2018 Clinical Practice Guidelines

The new Guidelines mention that since Canada has wide ethnic and cultural diversity, with each group having their distinct foods, preparation methods, and dietary patterns and lifestyles. Effective nutritional therapy needs to take these cultural variations into account and needs to be individualized;  specific to the individual, their age, the duration they’ve had type 2 diabetes, their goals, personal values and preferences, along with their individual need, lifestyle and economic situation. They recognize that nutrition therapy for those with Diabetes is not “one-size-fits-all”.

“Nutrition therapy should be individualized, regularly evaluated, reinforced in an intensive manner and should incorporate self-management education. A registered dietitian (RD) should be involved in the delivery of care wherever possible.”

The Nutrition Therapy Guidelines recommend that those with Diabetes follow the recommendations of Eating Well with Canada’s Food Guide;

“The starting point of nutrition therapy is to follow the healthy
diet recommended for the general population based on Eating Well With Canada’s Food Guide.”

They recommend that those with Diabetes continue to eat 45% to 65% of their daily calories as carbohydrate, 10% to 35% of their daily calories as protein and only 20% to 35% of their daily calories as fat, yet at the same time say that “the ideal macronutrient distribution for the management of diabetes can be individualized”;

“The ideal macronutrient distribution for the management of diabetes can be individualized. Based on evidence for chronic disease prevention and adequacy of essential nutrients, the DRIs (Dietary Reference Intakes) recommend acceptable macronutrient distribution ranges (AMDRs) for macronutrients as a percentage of total energy. These include 45% to 65% energy for CHO, 10% to 35% energy for protein and 20% to 35% energy for fat.”

They recommend that those with Diabetes continue to follow the same macronutrient distribution (percent of carbs, protein and fat) as the general population because it

“may help a person attain and maintain a healthy body weight while ensuring an adequate intake of carbohydrate (CHO), fibre, fat, protein, vitamins and minerals.”

What is encouraging is that they also have said that there is evidence to support a number of other macronutrient-, food- and dietary pattern-based approaches and advise against any rigid adherence to any one approach;

“There is evidence to support a number of other macronutrient-, food- and dietary pattern-based approaches. As evidence is limited for the rigid adherence to any single dietary approach, nutrition therapy and meal planning should be individualized.”

These Guidelines leave it open to individuals to choose other dietary approaches and outline a number of those approaches in the body of the text and in a summary table (Table 1). Figure 1 and Figures 2 and Table 1 in the Clinical Practice Guidelines (below) present an algorithm that summarizes the approach to nutrition therapy for diabetes which includes;

“allowing for the individualization of therapy in an evidence-based framework”.

Figure 1 – Clinical Assessment – Diabetes Canada 2018 Clinical Practice Guidelines

Figure 2 – Stage Targeted Nutrition Flowchart – Diabetes Canada 2018 Clinical Practice Guidelines

Table 1:

Table 1: Properties of Dietary Intervention – Diabetes Canada 2018 Clinical Practice Guidelines

The new Diabetes Canada guidelines recognize that the ideal macronutrient distribution (the ratio of carbs, protein and fat) may vary and depend on, amongst other things, the individual’s values and preferences;

“The ideal macronutrient distribution for the management of diabetes may vary, depending on the quality of the various macronutrients, the goals of the dietary treatment regimen and the individual’s values and preferences.”

That is, they recognize that a person’s individual preference for the amount and type of protein (animal-based, plant-based, both), fat (from animal or plant based sources), as well as the amount and type of carbohydrate in their diet factors into their personal decision for how they choose to manage their diabetes.

The Clinical Practice Guidelines for Nutrition Therapy mentions that based on the 3 systematic and meta-analysis of controlled trials of carbohydrate restricted diets that they looked at (mean carbohydrate intake from 4% to 45% of total daily energy) that consistent improvements in HbA1C, lipids and blood pressure weren’t shown.

“As for weight loss, low-carbohydrate diets for people with type 2 diabetes have not shown significant advantages for weight loss over the short term. There also do not appear to be any longer-term advantages.”

So while they do not believe based on the few studies that they examined that there is any advantage to someone following a low carbohydrate diet, there are no clear disadvantages. It comes down to individual preference.

The Guidelines also highlight that there may be a benefit of substituting monounsaturated fat (MUFAs) such as is found in olive oil for carbohydrate (something I regularly do when I design Meal Plans) and that systematic review and meta-analysis of randomized controlled trials found that monounsaturated fat substituted calorie for calorie for carbohydrate did not reduce HbA1C, but did improve fasting blood glucose, body weight, systolic BP, triglycerides and HDL (so-called “good cholesterol”) in people with type 2 diabetes over an average follow up of 19 weeks.

Another finding they reported is that replacement of refined high glycemic index carbohydrates with monounsaturated fat (up to 14.5% total energy) or nuts (up to 5% total energy) has been shown to improve HbA1C and lipids in people with type 2 diabetes over a 3 month period.

Together, these findings provide support to those who prefer to replace high glycemic carbs in their diet (such as white bread, pasta and rice) with monounsaturated fat sources such as olives, avocado as well as some nuts.

The new Clinical Practice Guidelines outline several popular weight-loss diets highlighting that there are a “range of macronutrient profiles are available to people with diabetes”;

“Numerous popular weight-loss diets providing a range of macronutrient profiles are available to people with diabetes. Several of these diets, including the Atkins™, Zone™, Ornish™, Weight Watchers™ and Protein Power Lifeplan™ diets, have been subjected to investigation in longer-term, randomized controlled trials in participants with overweight or obesity that included some people with diabetes, although no available trials have been conducted exclusively in people with diabetes.

They say that a systematic review and meta-analysis of four trials of the Atkins™ diet and 1 trial of the Protein Power Lifeplan™ diet showed that these diets were no more effective than conventional energy-restricted, low-fat diets in inducing weight loss, or with improvements in triglycerides and HDL for up to one year and have been reported to increase total cholesterol and LDL. As mentioned in an earlier article, without differentiating between particle size of LDL (small, dense versus large, fluffy), LDL and total cholesterol going up has not real meaning.

The Guidelines also mentioned that “The Dietary Intervention Randomized Controlled Trial (DIRECT) showed that the Atkins™ diet produced weight loss and improvements in the lipid profile compared with a calorie-restricted, low-fat conventional diet; however, its effects were not different from that of a calorie-restricted Mediterranean-style diet at two years.”

They add that “another trial comparing the Atkins™, Ornish™, Weight Watchers™ and Zone™ diets showed similar weight loss and improvements in the LDL:HDL ratio without effects on fasting blood sugar at one year in participants with overweight or obesity, of whom 28% had diabetes.

So again, it comes down to a matter of choice as to whether someone would prefer to do a calorie-restricted weight loss diet or a well-designed low carb one.

At the end of the paper, the authors make their final recommendations, some of which include that;

“People with diabetes should receive nutrition counselling by a registered dietitian to lower A1C levels and to reduce hospitalization rates”.

“Individuals with diabetes should be encouraged to follow Eating Well with Canada’s Food Guide in order to meet their nutritional needs.”

“In people with overweight or obesity with diabetes, a nutritionally balanced, calorie-reduced diet should be followed to achieve and maintain a lower, healthier body weight”.

“An intensive healthy behaviour intervention program, combining dietary modification and increased physical activity, may be used to achieve weight loss, improve glycemic control and reduce CV risk.”

“In adults with diabetes, the macronutrient distribution as a percentage of total energy can range from 45% to 60% carbohydrate, 15% to 20% protein and 20% to 35% fat to allow for individualization of nutrition therapy based on preferences and treatment goals.”

“People with type 2 diabetes should maintain regularity in timing and spacing of meals to optimize glycemic control.”

“To reduce the risk of cardiovascular disease, adults with diabetes should avoid trans fatty acids and consume less than 9% of total daily energy from saturated fatty acids, replacing these fatty acids with polyunsaturated fatty acids, particularly mixed n-3 / n-6 sources, monounsaturated fatty acids from plant sources, whole grains or low glycemic index carbohydrates”

“Adults with diabetes should select carbohydrate food sources with a low-GI to help optimize glycemic control to improve LDL and to decrease cardiovacular risk.”

“The following dietary patterns may be considered in people with type 2 diabetes, incorporating patient preferences, including:

(a) Mediterranean-style dietary pattern to reduce major cardiovascular events and improve glycemic control.

(b) Vegan or vegetarian dietary pattern to improve glycemic control and reduce myocardial infarction risk.

(c) DASH dietary pattern to improve glycemic control and reduce major cardiovascular events.

(d) Dietary patterns emphasizing dietary pulses (e.g. beans, peas, chickpeas, lentils) to improve glycemic control, systolic BP and body weight.

(e) Dietary patterns emphasizing fruit and vegetables to improve glycemic control and reduce CV mortality.

(f) Dietary patterns emphasizing nuts to improve glycemic control and LDL cholesterol.

Funding sources for the three authors of the Nutrition Therapy guidelines were as follows; Dr. John L. Sievenpiper, MD, PhD; Canadian Institutes of Health Research (CIHR), Calorie Control Council, INC International Nut and Dried Fruit Council Foundation, The Tate and Lyle Nutritional Research Fund at the University of Toronto, The Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), PSI Graham Farquharson Knowledge Translation Fellowship, Diabetes Canada Clinician Scientist Award, Banting & Best Diabetes Centre Sun Life Financial New Investigator Award, and CIHR INMD/CNS New Investigator Partnership Prize; grants and non-financial support from American Society for Nutrition (ASN), and Diabetes Canada; personal fees from mdBriefCase, Dairy Farmers of Canada, Canadian Society for Endocrinology and Metabolism (CSEM), GI Foundation, Pulse Canada, and Perkins Coie LLP; personal fees and non-financial support from Alberta Milk, PepsiCo, FoodMinds LLC, Memac Ogilvy & Mather LLC, Sprim Brasil, European Fruit Juice Association, The Ginger Network LLC, International Sweeteners Association, Nestlé Nutrition Institute, Mott’s LLP, Canadian Nutrition Society (CNS), Winston & Strawn LLP, Tate & Lyle, White Wave Foods, and Rippe Lifestyle, outside the submitted work; membership in the International Carbohydrate Quality Consortium (ICQC) and on the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the study of Diabetes (EASD), Canadian S74 J.L. Sievenpiper et al. / Can J Diabetes 42 (2018) S64–S79 Cardiovascular Society (CCS), and Canadian Obesity Network; appointments as an Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation; unpaid scientific advisor for the Food, Nutrition, and Safety Program (FNSP) and the Technical Committee on Carbohydrates of the International Life Science Institute (ILSI) North America; and spousal relationship with an employee of Unilever Canada. Dr. Chan reports grants from Danone Institute, Canadian Foundation for Dietetic Research, Alberta Livestock and Meat Agency, Dairy Farmers of Canada, Alberta Pulse Growers, and Western Canada Grain Growers. Dr. Catherine B Chan has a patent No. 14/833,355 pending to the United States. Dr. Catherine Freeze, MEd, RD reports personal fees from Dietitians of Canada and Government of Prince Edward Island.

Some Final Thoughts…

Much of the same wording  regarding supporting individual preference was previously embodied in the 2013 Clinical Practice Guidelines of the Canadian Diabetes Association. While not “recommended”, there was previously the same option for individuals to choose to follow a low carb lifestyle, based on personal preference.

As a Dietitian, I keep reading and reviewing the literature in order to provide the most current, evidence-based low carbohydrate diet to support those that choose to follow a low carb lifestyle — or who’s doctors recommend that they do, and in this way allow for the individualization of nutrition therapy in an evidence-based framework.

Do you have questions as to how I can help support your preference to follow a low carb lifestyle? Please send me a note using the “Contact Me” form on this web page and I’ll reply as soon as possible.

To our good health,

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

 

References

  1. Sievenpiper JL, Chan CB, Dwortatzek PD, Freeze C et al, Nutrition Therapy – 2018 Clinical Practice Guidelines, Canadian Journal of Diabetes 42 (2018) S64–S79 http://guidelines.diabetes.ca/docs/CPG-2018-full-EN.pdf

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

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

Time Frame of an Epidemic

It occurred to me that the time frame for an epidemic to occur is absolutely critical in determining public response. If rates of a disease went from 1 in 10 people to 1 in 3 people in only 10 years, there would be public outcry for scientists to determine the cause and to find a cure quickly. If the disease caused debilitating metabolic effects such as very high blood pressure that resulted in heart attacks or strokes and people of all ages were getting this disease, with many dying – the outcry would be even more urgent.

But what if rates of the same disease went from 1 in 10 people to 1 in 3 people over a period of 40 or 50 years? The current generation would have no recollection of what it was like ‘before’ because things had always been this way since they were kids.  The older generation would remember what it was like ‘before’ and concluding that for whatever reason, that is the way it is now. Doctors and scientists of the older generation that might be able to apply their knowledge and skill to find the cause and a cure would be at the end of their working lives.

The disease is obesity.

Debilitating metabolic side effects of obesity include very high blood pressure that can lead to heart attacks and strokes and Type 2 Diabetes which can result in blindness, amputations and organ failure.

Once a rare disease, obesity has now reached epidemic proportions and the metabolic side effects are not just for the old, but are rampant among youth and young adults.

This disease epidemic has taken place over 50 years but few are noticing because it has fallen between the cracks of time.

Obesity Rates Then and Now

Photographs and videos of what people looked like fifty years ago are widely available, and a simple Google search will provide an abundance of them. Movies, documentaries and TV shows from the mid-1960s also provide a glimpse of what the average American and average Canadian looked like then.

In the 1960s only 10.7% of the US population and 10.2% of the Canadian population were obese; that’s approximately 1 in 10 people.

Below is a US sorority photo of a Sigma Iota Chi chapter from West Virginia from 1967. Look how slim most of the women are compared to today’s young adults.

SIX 1967.png
Sigma Iota Chi Sorority – West Virginia – 1967 (https://sororityhistories.wordpress.com/tag/sigma-iota-chi/)

West Virginia now has one of the highest adult obesity rate in the US.

Related image
1967 Kappa Alpha Fraternity Party Photograph – Cornell University

To the left is another photo from a 1967 Fraternity party at Cornell University. For the most part, the young men and their girlfriends are slim and lean – certainly much slimmer than university students today.

Below is what the average city-dwelling Canadian looked like in 1967, riding the subway in Toronto. Young adults, middle aged adults and older people were very slim compared to today’s standards – especially when compared to what the average public transit rider looks like today.

toronto subway rush hour

Most recent international data from 2015 found that 38.2% of the US population and 25.8% of the Canadian population are obese; that’s more than 1 in 3 people in the US and more than 1 in 4 people in Canada [1].

People in both countries are now some of the most obese in the world;

OECD Health Statistics 2017, June 2017

When one compares what university students looked above to what they look like now in a current photo of Fraternities and Sororities below, the difference in average body weight of the students from 50 years ago to today is quite apparent – despite the fact that university students come from families where the average family income is significantly higher than the national average.

Given this, their higher body weights cannot be dismissed due to low income, socioeconomic status or lack of education. So what is going on?

University of Nevada’s Fraternity and Sorority Community

What changed in the last 50 years that contributed to this obesity epidemic?

As written about in a previous article, in 1967 (fifty years ago) the sugar industry paid three Harvard researchers (Stare, Hegsted and McGandy) very handsomely to critique studies that vindicated sugar as contributing to abnormal fat metabolism and heart disease, and who instead laid the blame on dietary fat, and in particular  saturated fat and dietary cholesterol [2,3].

They concluded;

“Since diets low in fat and high in sugar are rarely taken, we conclude that the practical significance of differences in dietary carbohydrate is minimal in comparison to those related to dietary fat and cholesterol…the major evidence today suggests only one avenue by which diet may affect the development and progression of atherosclerosis. This is by influencing the levels of serum lipids [fats], especially serum cholesterol.” [4]

These researchers who were sponsored by the sugar industry concluded that there was “major evidence” which  suggested that there was only ONE avenue for diet to contribute to hardening of the arteries and the development of heart disease – and that was dietary fat and cholesterol…yet only a year later in 1968, the Diet-Heart Review Panel of the National Heart Institute recommended that a major study be conducted to determine whether changes in dietary fat intake prevented heart disease – because such a study had not yet been done [5].

No major study had yet been done to find out whether changing the types of fat we ate prevented heart disease, yet these researchers were SO certain that there was “only one avenue” for diet to contribute to hardening of the arteries and the development of heart disease. How much was their certainly impacted by their sponsors?

Their influence didn’t end there.

Only ten years later, one of the three Harvard researchers (Hegsted) was directly involved with developing and editing the 1977 US Dietary Guidelines [6] which recommended a decrease in saturated fat and cholesterol  consumption, and an increase in dietary carbohydrate. While Canadian Dietary Guidelines are distinct from the US ones, much of the research on which they are based is the same.

Comparing the US to Canadian dietary recommendations with respect to the consumption of fat in general, as well as the consumption of saturated fat in particular, one finds the recommendations mirror each other.

We are told to limit saturated fat ostensibly because of its negative impact on blood cholesterol and heart disease. We are told to increase consumption of vegetable oils, and to substitute polyunsaturated fats for saturated fat in cooking and baking and to eat 45-65% of our daily calories as carbohydrate.

It is increasingly my conviction that the simultaneous (1) marketing of polyunsaturated vegetable oil – more accurately called industrially-created seed oils, such as soybean oil and canola oil, along with (2) changes in the Dietary Recommendations in both Canada and the US for people to (a) limit calories from fat and especially to (b) limit saturated fat, combined with the recommendations for people to (c) eat 45-65% of calories as carbohydrate created the “perfect storm” that when viewed together,  explains the obesity epidemic we now have and the associated increase in metabolic health problems that we now see 50 years later.

I will be writing more in the days ahead on what is thought to be the role of these industrially-created seed oils in the process of obesity and inflammation that underlies many metabolic conditions, including Type 2 Diabetes.

Why isn’t the public alarmed by this massive increase in obesity?

I believe it’s because it took place over such a long period of time that those old enough to remember what things were like before have either died or are approaching retirement age and have left its solution to the next generation, and those young enough to do something about it have never known it any other way.

I think that looking at the magnitude of the epidemic without the time frame is helpful.

What if only 10 years ago, only 1 in 10 people were obese and now 1 in 3 people were obese? Would there not be a public outcry for scientists to determine what caused this and to research to find a cure quickly?

Obesity underlies debilitating metabolic effects such as very high blood pressure that can lead to heart attacks and strokes and people of all ages are getting this disease – including children and teenagers. Obesity underlies the huge increase in Type 2 Diabetes and when poorly managed can result in blindness, limb amputation and organ failure. People of all ages are dying from these metabolic effects of these disease, which at present are mainly being managed through medication and advising people to “eat less and move more”.

Is that the best we can do to curb this epidemic?

As covered in previous articles, there are peer-reviewed published studies – some a year or two long, that demonstrate that these metabolic effects can be put into remission by eating a diet with less carbohydrates yet government-funded research into use of this is not a priority.

Why?

What role does the sugar industry and the corn-producers (that manufacturer high fructose corn syrup found in much of our packaged food) play?

What role do the grain boards (that market wheat and other grains for baked goods) play?

What about the soybean and canola growers – multi-billion dollar a year  industries in both countries that grows the soybeans and canola seed that are processed into fats sold to consumers for cooking and baking?

These industries and their respective lobby groups play an influential role in the economies of both Canada and the United States and in that way (and others) influence what types of research should be funded.

There is an epidemic going on and people are living with terrible metabolic consequences of them or dying from them.

Before the Dietary Guidelines are updated in both countries, the governments of Canada and the US must approve external, independent scientific review of the evidence-base for the existing dietary recommendation as well as examine the evidence-base for use of a well- designed low carbohydrate diet in reducing obesity and managing the debilitating metabolic effects.

The length of time since the obesity epidemic began does not make this any less urgent.

Do you have questions about how I can help you in tackling obesity and lowering or putting metabolic side effects into remission?

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

To our good health,

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/


References

  1. OECD Health Statistics 2017, June 2017, http://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf
  2. Kearns C, Schmidt LA, Glantz SA, et al. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016 Nov 01; 176(11):1680-1685.
  3. Husten, L, How Sweet: Sugar Industry Made Fat the Villain, Cardio|Brief, 2016 Sept 13.
  4. McGandy, RB, Hegsted DM, Stare,FJ. Dietary fats, carbohydrates and atherosclerotic vascular disease. New England Journal of Medicine. 1967 Aug 03;  277(5):242–47
  5. The National Diet-Heart Study Final Report.” Circulation, 1968; 37(3 suppl): I1-I26. Report of the Diet-Heart Review Panel of the National Heart Institute. Mass Field Trials and the Diet-Heart Question: Their Significance, Timeliness, Feasibility and Applicability. Dallas, Tex: American Heart Association; 1969, AHA Monograph no. 28.
  6. Introduction to the Dietary Goals for the United States – by Dr D.M. Hegsted. Professor of Nutrition, Harvard School of Public Health, Boston, MASS., page 17 of 130, https://naldc.nal.usda.gov/naldc/download.xhtml?id=1759572&content=PDF

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

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

 

Vilification of Saturated Fat – Bad Fat Enduring Beliefs Part 1

This is Part 1 in a new series titled Bad Fat Enduring Beliefs and this article looks at how and when saturated fat was vilified and why sugar was          vindicated as the cause of heart disease.

The Diet-Heart Hypothesis

The diet-heart hypothesis is the belief that eating foods high in saturated fat contributed to heart disease was first proposed in the 1950s by a scientist named Ancel Keys who believed that by replacing saturated fat from meat, butter and eggs with newly-created industrial polyunsaturated vegetable oil (such as soybean oil) that heart disease and the deaths allegedly associated with it would be reduced by lowering blood cholesterol levels.

In 1952, Keys suggested that Americans should reduce their fat consumption by 1/3 and in 1953, Keys published a study where he said that he had demonstrated that there was an association between dietary fat as a percentage of daily calories and death from degenerative heart disease [1].

Four years later, in 1957, Yerushalamy et al published a paper with data from 22 countries[2] which showed a weak relationship between dietary fat and death by coronary heart disease – a much weaker relationship than was suggested by Keys’s in 1953. Nevertheless, in 1989 Keys and colleagues published their Seven Countries Study[3] which maintained there was an associative relationship between increased dietary saturated fat and Coronary Heart Disease – basically ignoring the data presented in Yerushalamy’s 1957 study, and which failed to study countries where Yerushalamy found no relationship between dietary fat and heart disease, such as in France. The paper maintained that the average consumption of animal foods (with the exception of fish) was positively associated with 25-year Coronary Heart Disease death rates and the average intake of saturated fat was strongly related to 10 and 25-year Coronary Heart Disease death rates. Keys and colleagues knew of the Yerushalamy’s data from 1957 and seemingly dismissed it.

Keys et al – Epidemiological studies related to coronary heart disease: characteristics of men aged 40–59 in seven countries [1]


Yerushalmy J, Hilleboe HE. Fat in the diet and mortality from heart disease. A methodologic note [2]
The paper has been widely criticized for selecting data only from the 7 countries that best fit their Diet Heart Hypothesis.

The Sugar Industry Funding of Research Vilifying Fat

In August of 1967, Stare, Hegsted and McGandy – the 3 Harvard researchers paid by the sugar industry published their review in the New England Journal of Medicine, titled “Dietary fats, carbohydrates and atherosclerotic vascular disease”[3] which vindicated sugar as a contributor of heart disease and laid the blame on dietary fat and in particular, saturated fat and dietary cholesterol (previous article on that topic here).

Stare, Hegsted and McGandy concluded that there was “only one avenue” by which diet contributed to the development and progression of “hardening of the arteries” (atherosclerosis) and resulting heart disease and that was due to how much dietary cholesterol people ate and its effect on blood lipids;

“Since diets low in fat and high in sugar are rarely taken, we conclude that the practical significance of differences in dietary carbohydrate is minimal in comparison to those related to dietary fat and cholesterol…the major evidence today suggests only one avenue by which diet may affect the development and progression of atherosclerosis. This is by influencing the levels of serum lipids [fats], especially serum cholesterol.” [4]

These researchers concluded that there was major evidence available at the time which suggested that there was only ONE avenue for diet to contribute to hardening of the arteries and the development of heart disease – yet a year later in 1968 the report of the Diet-Heart Review Panel of the National Heart Institute made the recommendation that a major study be conducted to determine whether changes in dietary fat intake prevented heart disease because such a study had not yet been done [5];

“the committee strongly recommended to the National Heart Institute that a major definitive study of the effect of diet on the primary prevention of myocardial infarction be planned and put into operation as soon as possible. ”

This is an important point; prior to a major study having ever been conducted to determine whether changes in dietary cholesterol impacts heart disease, 3 Harvard researchers paid by the sugar industry concluded that there was “only one avenue” by which diet contributed to the development and progression of atherosclerosis (i.e. “hardening of the arteries”) and heart disease and that was due to how much dietary cholesterol people ate and its effect on blood lipids.

Researcher Paid by the Sugar Industry Helps Develop the 1977 US Dietary Guidelines

Only ten years after the sugar industry paid Stare, Hegsted and McGandy to write their reviews, the same Dr. Hegsted was directly involved with  developing and editing the 1977 US Dietary Guidelines [6] which recommended an increase in dietary  carbohydrate and a decrease in saturated fat and cholesterol in the diet.

Historic changes in the Dietary Recommendation in Canada have largely been based on changes to the Dietary Recommendations in the US, and as a result both stemmed from a belief that eating saturated fat increases total cholesterol and therefore increases the risk of heart disease.

The problem is this belief is just that, a belief.

There have been many studies that have disproved this including a  randomized, controlled dietary intervention trial from 2008 which compared a low calorie, low in fat with a low carbohydrate, high fat diet of the same number of calories. This study found that overall heart health is significantly improved when carbohydrate is restricted, rather than fat [7,8].

Not all LDL cholesterol is “bad” cholesterol.

Small, dense LDL (“Pattern B”)  causes more “hardening of the arteries” than the large, fluffy LDL particles (“Pattern A”)[9].

It has been reported that when dietary fat is replaced by carbohydrate, the percentage of the small, dense LDL particles  (the ones that cause hardening of the arteries) is increased, increasing risk for heart disease.  Furthermore,  the low carb diet increased HDL (so-called “good” cholesterol), which are protective against heart disease and HDL and small, dense LDL were made worse on the low fat diet. Quite opposite to the “Diet-Heart Hypothesis, this study demonstrated improvements in the risk of heart disease for those eating a low carbohydrate, high fat diet compared to those eating a low fat, low calorie diet – which is not all that surprising given that it had been reported previously that a diet high in saturated fat actually lowers small, dense LDL (the type of LDL that causes hardening of the arteries) and raises the large fluffy LDL; actually improving risk factors for heart disease [15].

There are also other randomized controlled trials from 2004-2008 which demonstrate that a low carb diet improves blood cholesterol test results more than a low fat diet [10,11,12,13,14] – yet despite this, the belief that eating saturated fat increases blood cholesterol, persists.

Both the American and Canadian governments are in the process of revising their Dietary Guidelines and what is clear is that what is needed is an external, independent scientific review of the current evidence-base for the enduring false belief that dietary fat, especially saturated fat contributes to heart disease.

Have questions about how I can help you follow a low carb lifestyle?

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

To our good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

References

  1. KEYS, A., Prediction and possible prevention of coronary disease. Am J Public Health Nations Health, 1953. 43(11): p. 1399-1407.
  2. Yerushalmy J, Hilleboe HE. Fat in the diet and mortality from heart disease. A methodologic note. NY State J Med 1957;57:2343–54
  3. Kromhout D, Keys A, Aravanis C, Buzina R et al, Food consumption patterns in the 1960s in seven countries. Am J Clin Nutr. 1989 May; 49(5):889-94.
  4. McGandy, RB, Hegsted DM, Stare,FJ. Dietary fats, carbohydrates and atherosclerotic vascular disease. New England Journal of Medicine. 1967 Aug 03;  277(5):242–47
  5. The National Diet-Heart Study Final Report.” Circulation, 1968; 37(3 suppl): I1-I26. Report of the Diet-Heart Review Panel of the National Heart Institute. Mass Field Trials and the Diet-Heart Question: Their Significance, Timeliness, Feasibility and Applicability. Dallas, Tex: American Heart Association; 1969, AHA Monograph no. 28.
  6. Introduction to the Dietary Goals for the United States – by Dr D.M. Hegsted. Professor of Nutrition, Harvard School of Public Health, Boston, MASS., page 17 of 130, https://naldc.nal.usda.gov/naldc/download.xhtml?id=1759572&content=PDF
  7. Volek JS, Fernandez ML, Feinman RD, et al. Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res 2008;47:307–18
  8. Forsythe CE, Phinney SD, Fernandez ML, et al. Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids 2008;43:65–77
  9. Tribble DL, Holl LG, Wood PD, et al. Variations in oxidative susceptibility among six low density lipoprotein subfractions of differing density and particle size. Atherosclerosis 1992;93:189–99
  10. Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003;348:2082–90.
  11. Stern L, Iqbal N, Seshadri P, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 2004;140:778–85
  12. Gardner C, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women. JAMA 2007;297:969–77
  13. Yancy WS Jr., Olsen MK, Guyton JR, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med 2004;140:769–77
  14. Shai I, Schwarzfuchs D, Henkin Y, et al. Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008;359:229–41
  15. Dreon DM, Fernstrom HA, Campos H, et al. Change in dietary saturated fat intake is correlated with change in mass of large low-density-lipoprotein particles in men. Am J Clin Nutr 1998;67:828–36

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

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

 

The Marketing of Vegetable Fats to an Unsuspecting Public

Yesterday, in preparing to begin a new series of articles on the relationship between polyunsaturated vegetable fats to obesity, I came across an old, yellowed sheet titled “Comparison of Dietary Fats” that I was given as an undergrad Dietetic student at McGill, in 1989.

(reverse side) Comparison of Dietary Fats – “Provided as a Professional Service by Proctor & Gamble”, 1989 – full size photo, below

It was designed to help us teach consumers how to choose the “healthiest” dietary fats.

As indicated at the bottom of both sides of the handout (see full size photos, below), it was “provided as a Professional Service by Proctor and Gamble“.

Why would Proctor and Gamble, a soap company provide future Dietitians with a teaching handout on choosing healthy oils for cooking? A bit of understanding about how soap is made, will help.

At the time, the making of soap required a mixture of animal fats and lye, however William Procter and James Gamble (brothers-in-law living in Cincinnati in the late 1800s and who formed Proctor and Gamble) needed to find an inexpensive replacement for animal fat for the creation of individually wrapped bars of soap.

The source of soap fat they turned to was a waste-product of the cotton industry – cottonseed oil. It was literally the garbage leftover when cotton was produced and is cloudy, red and bitter to the taste, and toxic to most animals.

They needed to make cottonseed oil solid in order to make bar soap and utilized a newly patented technology to produce a creamy, pearly white substance out of cottonseed oil. This fat resembled lard (the most popular natural animal fat baking and frying fat at the time), so with a little more tweaking, this hydrogenated cottonseed oil was then sold in 1911 by Procter & Gamble to home cooks as Crisco® shortening.

All that was needed now was for Proctor and Gamble to market this industrially-produced seed oil fat, and market it they did. They hired America’s first full-service advertising agency, the J. Walter Thompson Agency that employed graphic artists and professional writers.

“Samples of Crisco were mailed to grocers, restaurants, nutritionists, and home economists. Eight alternative marketing strategies were tested in different cities and their impacts calculated and compared.

Doughnuts were fried in Crisco and handed out in the streets.

Women who purchased the new industrial fat got a free cookbook of Crisco recipes. It opened with the line, “The culinary world is revising its entire cookbook on account of the advent of Crisco, a new and altogether different cooking fat.” [1]

From the very beginning, Proctor and Gamble marketed their industrially-created solid fat (Crisco®) to “nutritionists” and “home economists” – the forerunners to Dietitians.

When Procter & Gamble introduced Puritan Oil® in 1976, a liquid cooking oil made of sunflower oil which became 100% canola oil by 1988, it was natural for them to market their newly created oil to Dietitians.

Proctor & Gamble now had a lucrative business manufacturing industrial seed oils as dietary fats and they wanted to make sure that we, as Dietitians encouraged people to use their “healthy” fats.

I’ve scanned in both sides of the handout (it’s old and yellowed, having been kept in the back of my “new” 1988 Canada’s Food Guide book for almost 30 years). As can be seen, in first place on the front side of the handout is canola oil identified by the trade name “Puritan Oil®”, a registered trademark of Proctor and Gamble.

(front side) Comparison of Dietary Fats – “Provided as a Professional Service by Proctor & Gamble”, 1989

On the reverse side, is what consumers should know about these oils, including that canola oil is “better than all other types of vegetable oil“.

(reverse side) Comparison of Dietary Fats – “Provided as a Professional Service by Proctor & Gamble”, 1989

I’ve highlighted some of the wording that makes Proctor & Gamble’s bias apparent;

(reverse side) Comparison of Dietary Fats – “Provided as a Professional Service by Proctor & Gamble”, 1989 – red text mine

Some Final Thoughts…

From the very beginning, industrially-produced seed  fats and oils have been marketed to nutritionists, home economists and Dietitians by the companies that created them, in some cases as a “Professional Service”.

As will become clear in the next article we, as Dietitians were tasked by the Dietary Guidelines in both Canada and the US with promoting “polyunsaturated vegetable oils” to the public as ‘healthful alternatives’ to presumably unhealthy saturated animal fats. The manufacturers were there to ‘assist’ as a ‘Professional Service’.

Looking back on the role of fat manufacturers and the sugar industry (outlined in the preceding article) on which foods were recommended and promoted, it makes me question what I was taught and who affected what I was taught. Given that it was known at the time the sugar industry funded the researchers that implicated saturated fat as the alleged cause of heart disease, I wonder what we don’t know about which industry funded which research.  After all, the knowledge about the sugar industry having funded the researchers that implicated saturated fat only ‘came out’ in November 2016 when it had occurred decades earlier.

NOTE: It is increasingly my conviction that the simultaneous (1) marketing of polyunsaturated vegetable oil (soybean oil, canola oil) along with (2) changes in the Dietary Recommendations for people to (a) eat no more than 20- 30% of calories from fat and to (b) limit saturated fat to no more than 10% of calories, combined with the recommendations for people to (c) eat 45-65% of calories as carbohydrate was the “perfect storm” that may well explain the current obesity crisis and associated  increase in metabolic health problems that we now see 40 years later.

In subsequent articles I’ll elaborate on why I believe this is the case.

To our good health,

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

References

  1. Ramsey, D*., Graham T., The Atlantic. How Vegetable Oils Replaced Animal Fats in the American Diet, April 26 2012 (www.theatlantic.com/health/archive/2012/04/how-vegetable-oils-replaced-animal-fats-in-the-american-diet/256155/)

*Dr. Drew Ramsey, MD is an assistant clinical professor of psychiatry at Columbia University.


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

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

 

 

 

Sugar Industry Paid Researchers that Blamed Saturated Fat as Cause of Heart Disease

A year ago, I found out from a fellow Dietitian that a recently published article in the Journal of the American Medical Association revealed that the sugar industry had secretly funded a group of renowned Harvard researchers to write an influential series of articles which downplayed, discredited or outright ignored research known at the time, and which demonstrated that sugar was a contributor to heart disease.

I read the article and was stunned at its significance.

As I am in the midst of a new series of articles on the role of saturated fat and polyunsaturated fat in health and disease, I felt it’s important that people understand the sugar’s industry involvement in potentially skewing of the scientific evidence at the very time that the original 1977 low-fat high carb Dietary Guidelines were being formulated and so I researched further and wrote this article.

Two of the prominent Harvard researchers that were paid by the sugar industry and who wrote articles dismissing that sugar was a significant contributor to heart disease and implicating saturated fat as the cause were the late Dr. Fredrick Stare, chair of Harvard’s School of Public Health Nutrition Department and the late Dr. D. Mark Hegsted, a professor in the same department [2].

POST PUBLICATION NOTE (March 12 2018): Dr. Hegsted, one of the 3 Harvard researchers paid by the sugar industry to write these review articles was directly involved in developing and editing the 1977 US Dietary Guidelines [6].

A commentary in the Journal of Accountability in Research [4] summarized the significance of those articles as follows;

“Researchers were paid handsomely to critique studies that found sucrose [sugar] makes an inordinate contribution to fat metabolism and heart disease leaving only the theory that  dietary fat and cholesterol was the primary contributor.”

In the mid-1960’s, the Sugar Research Foundation (which is the predecessor to the Sugar Association) wanted to counter research that had been published at the time which suggested that sugar was a more important cause of atherosclerosis than dietary fat. The Sugar Research Foundation invited Dr. Stare of Harvard’s School of Public Health Nutrition Department to join its scientific advisory board and then approved $6,500 in funds ($50,000 in 2016 dollars) to support a review article that would respond to the research showing the danger of sucrose[2].  Letters exchanged between the parties were brought to light in the November 2016 article published by Kearns et al [1] maintained that the Sugar Research Foundation tasked the researchers with preparing “a review article of the several papers which find some special metabolic peril in sucrose [sugar] and, in particular, fructose [3].”

This would seem akin to the tobacco industry having secretly funded articles demonstrating that something other than smoking was responsible for lung cancer.

In August 1967 the New England Journal of Medicine published the first review article written by Drs. Stare, Hegsted and McGandy titled “Dietary fats, carbohydrates and atherosclerotic vascular disease”[3] which stated;

“Since diets low in fat and high in sugar are rarely taken, we conclude that the practical significance of differences in dietary carbohydrate is minimal in comparison to those related to dietary fat and cholesterol”

The report concluded;

“the major evidence today suggests only one avenue by which diet may affect the development and progression of atherosclerosis. This is by influencing the levels of serum lipids [fats], especially serum cholesterol.”

The Harvard researchers went on to say;

“there can be no doubt that levels of serum cholesterol can be substantially modified by manipulation of the fat and cholesterol of the diet.”

The Harvard researchers concluded;

“on the basis of epidemiological, experimental and clinical evidence, that a lowering of the proportion of dietary saturated fatty acids, increasing the proportion of polyunsaturated acids and reducing the level of dietary cholesterol are the dietary changes most likely to be of benefit.”

Stare, Hegsted and McGandy did not disclose that they were paid by the Sugar Research Foundation for the two-part review [4].

In response to Kearns et al article in the Journal of the American Medical Association in November 2016 [1], the Sugar Association responded [5] by stating that it;

“should have exercised greater transparency in all of its research activities, however, when the studies in question were published funding disclosures and transparency standards were not the norm they are today.” [5]

Some final thoughts…

The reviews written by these influential Harvard School of Public Health Nutrition Department researchers and paid for by the sugar industry have the appearance of being a deliberate manipulation of the perception of the scientific evidence known at the time. 

Whether deliberate or inadvertent, the fact that such sponsorship occurred at the very period in time when the Dietary Guidelines were under revision to emphasize that saturated fat intake must be reduced and carbohydrate consumption must be increased cannot be understated — a move which certainly benefited the sugar industry.

POST PUBLICATION NOTE (March 12 2018): Discovered after publication of this article, one of the three Harvard researchers funded by the sugar industry, Dr. D.M Hegsted was one of the scientists that worked on the 1977 US Dietary Guidelines[6].

How has this turned out for us?

For the last 40 years, Americans and Canadians have diligently eaten more carbohydrate (including foods containing sucrose and fructose) and more polyunsaturated fats (especially soybean and canola oil) just as the Harvard researchers paid for by the sugar industry recommended — and to what end?

Obesity rates have gone from ~10% in the 1950’s and 60’s in both countries to 26.7% in Canada (2015) and ~34% in the US (2017) and Diabetes and high blood pressure (hypertension) rates have risen exponentially.

What’s going on?

Could it be that the shift to a diet abundant in omega-6 polyunsaturated fat (such as soyabean oil) and which supplies 45-65% of daily calories as carbohydrate created the ‘perfect storm‘ which inadvertently fueled the obesity and health epidemic we now see?

This will be the subject of future articles.

Have questions?

I provide both in-person and Distance Consultation services (via telephone or Skype) can help you learn a better and easier way to eat, while you achieve and maintain a healthy body weight long term.

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

To our good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

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

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

References

  1. Kearns C, Schmidt LA, Glantz SA, et al. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016 Nov 01; 176(11):1680-1685.
  2. Husten, L, How Sweet: Sugar Industry Made Fat the Villain, Cardio|Brief, 2016 Sept 13.
  3. McGandy, RB, Hegsted DM, Stare,FJ. Dietary fats, carbohydrates and atherosclerotic vascular disease. New England Journal of Medicine. 1967 Aug 03;  277(5):242–47
  4. Krimsky, S. Sugar Industry Science and Heart Disease, Accountability in Research. 2017 Oct 07; 24:2, 124-125.
  5. Sugar Association, The Sugar Association Statement on Kearns JAMA Study, 2016 Sep 12
  6. Introduction to the Dietary Goals for the United States – by Dr D.M. Hegsted. Professor of Nutrition, Harvard School of Public Health, Boston, MASS., page 17 of 130, https://naldc.nal.usda.gov/naldc/download.xhtml?id=1759572&content=PDF

What is Ideal Protein®?

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

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

Pharmacy-based

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

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

Restricted Foods

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

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

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

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

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

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

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

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

Ideal Protein® “Meals”

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

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

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

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

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

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

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

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

Additional Instructions

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

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

Restricted Calories

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

Low Carb

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

High Protein

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

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

Costs

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

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

Each additional month is another ~$400.

Ideal Protein® – the company

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

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

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

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


A few thoughts…

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

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

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

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

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

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

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

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

It restricts calories.

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

It restricts which non-starchy vegetables can be consumed.

It allows no fruit.

It allows no nuts or seeds.

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

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

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

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

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

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

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

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

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

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

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

To your good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

 

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

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

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