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.

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.

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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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.

“Because of falling production”

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.

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

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

 

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.