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July 17, 2019July 17, 2019

Three Ways to Put Type 2 Diabetes into Remission

According to the scientific literature to date, there are three ways of putting type 2 diabetes into remission, but an article that was widely circulated on social media earlier this week implied that a ketogenic diet ‘cures’ type 2 diabetes.

The article was titled “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.”

The author is entitled to hold the above opinion and to express it, however in my opinion, a ketogenic diet does not “reverse diabetes” — it does not “cure” it. It is one of three scientifically documented ways to put the disease into remission. More on that below.

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.”

I believe 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.

There is no “one-sized-fits-all-diet” that is good for everybody, nor is there a “better” dietary means to achieve remission of type 2 diabetes. As I will elaborate on below, there are 3 ways to put the symptoms of type 2 diabetes into remission, with two of them being dietary, and some might prefer one over the other for a variety of reasons. The one that they want to adopt and ‘stick with’ will be the one that will work best for them.

Virta Health Data

The on-going study from the Virta Health has had over 200 adults ranging in age from 46-62 years of age in the intervention group following a ketogenic diet for the last two years, so far. At the one year mark, participants in the ketogenic diet 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].

The data so far demonstrates that a well-designed keto diet can be a very effective means of 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 by no means 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 state 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, which it is.

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

…but a keto diet is not a ‘cure’ for type 2 diabetes.

At this present time, there is no cure for diabetes. There are, however three documented ways to put type 2 diabetes into remission;

a low calorie energy deficit diet [4,5,6]
bariatric surgery (especially use of the roux en Y procedure) [7,8]
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. So is a calorie restricted diet. The primary difference is in a calorie restricted diet, calories are drastically reduced in order to lose weight and feeling hungry is simply a side-effect that people come to expect. In a low carb or ketogenic diet, calories end up being substantially reduced as an inadvertent result of targeting protein and vegetables and adding sufficient healthy fat that comes along with that protein, or that are added to the vegetables to make them more interesting, while limiting carbohydrates. One isn’t better than the other; it is what is better suited to each individual.

More Info?

If you would like more information on using diet to seek 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
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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.

References

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
Phinney S and the Virta Team, Can a ketogenic diet reverse type 2 diabetes? https://blog.virtahealth.com/ketogenic-diet-reverse-type-2-diabetes/
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.
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
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
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.
Cummings DE, Rubino F (2018) Metabolic surgery for the treatment of type 2 diabetes in obese individuals. Diabetologia 61(2):257—264.
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

July 14, 2019July 15, 2019

Trouble-shooting Ongoing Constipation on a Low Carb Diet

Constipation is one of the most common problems that people face, with between 2 and 28% of the population in Western countries reporting having this [1-3]. In 2007 in the United States, 19.4% of people reported problems with chronic constipation[4] and in Canada between 15% and 27% of people reported having sought health care support for chronic constipation in 2001 [5].

Defining Constipation

The term “constipation” means different things to different people. For some it simply means they don’t pass their stools (feces) often enough, and for others it means that when they do, their stools are hard, difficult to pass, may cause lower abdominal discomfort, or feel like they “still have to go” afterwards (incomplete evacuation).

What is considered a ‘normal range’ in the number of bowel movements per week varies considerably; from anywhere from 3 – 21 times per week, provided the stools are soft and easy to pass, but not loose or unformed.

For some people, having bowel movements 3 times per week may be normal, as long as their stools aren’t hard, dry or compact and there is no abdominal discomfort. For others, 3 times per day (21 times per week) may also be considered fine, provided the stools aren’t unusually loose. There are many factors that can contribute to chronic constipation; including some medications that people take, inadequate fiber or the wrong kind of fiber, insufficient hydration (not drinking enough water, especially when its hotter out, or exercising), high levels of estrogen and progesterone when a woman is pregnant, or disorders such as Irritable Bowel Syndrome (IBS) and diverticulosis.

The Causes of Chronic Constipation

People often think (or are told) that if they are constipated, they just need to eat more fiber, but in some cases increasing fiber from certain sources such as grains may make the problem worse. For example, some people are wheat sensitive, but not gluten-intolerant (i.e. not Celiac). That is, they are sensitive to wheat only, but not rye or barley (which also contain gluten). Others have something called non-celiac gluten sensitivity which resolves when gluten is eliminated from the diet, yet don’t test positive for Celiac disease. These people feel better when they avoid grain-based carbs, and may opt instead for eating nutritiously-dense starchy vegetables, such as winter squash or yam, for instance. Since a low-carb diet is non-grain-based, people who experience chronic constipation due to wheat intolerance or non-celiac gluten sensitivity will start to feel considerably better eating this way. The problem may be that for those with non-celiac gluten sensitivity, other sources of gluten, such as those found in malt vinegar or low carb beer may continue to cause them symptoms.

Many people who try a “low-carb” or “keto” diet on their own often complain of being constipated and this may be for a number of other reasons. They may be taking a medication that causes constipation as a side-effect, they may not don’t drink enough water, or it may be the result of something else.

Inadequate Hydration

I would estimate that ~80% of the people that I assess in my office have observable signs that they are aren’t drinking enough water, so this is something I would recommend most people to consider as a possible contributor to chronic constipation.

The idea that everybody needs to drink “8 glass of water per day” is a fallacy; everyone’s need for water is different. A good rule of thumb to know if you are dehydrated is just to look in the mirror. If your lips are dry and wrinkled, then you probably should aim to increase your water intake. When your lips are plump and without deep lines, you’ve probably had sufficient amount. Water is best, as coffee and tea act as a mild diuretic. They won’t dehydrate you, but you will pass the water contained in them more rapidly.

If you don’t really like plain water, a Sodastream® that enables you to make carbonated water at home may be the answer. My clients know that there is always a bottle of it on my desk, as that is how I make sure to drink enough water. A twist of lime or lemon makes a nice treat too!

What about Getting Enough Fiber?

In Canada, dietary recommendations for dietary fiber intake varies with age and gender. Men under the age of 50 years are recommended to take in 38 gm / day of dietary fiber, and men over 50 years to take in 30 gm / day. Women under 50 years old are recommended to take in 25 gm of fiber per day and over 50 years, 21 gm per day [6].

In the US, fiber intake recommendations from the Institute of Medicine range from 19 grams to 38 grams per day, depending on gender and age [7].

While people generally think of “healthy whole grains” as good sources of fiber, many are not. For example, medium grain brown rice only has 3.4 g of fiber per 100 g, whereas wild rice (which is actually a grass and not a grain) has 6.2 g of fiber per 100 g [8]. Many vegetables and fruit such as avocado and berries are excellent sources. More on that below.

Two Kinds of Fiber — soluble and insoluble

There are two kinds of fiber; insoluble and soluble.

Insoluble fiber is what most people think about when they think of ”roughage” needed to form stool and prevent constipation. It helps form the bulk of the stool. Insoluble fiber is naturally present in the outside of grains, such as whole grain wheat and the outside of oats and is also found in fruit, legumes (or pulses) such as dried beans, lentils, or peas, some vegetables, and in nuts and seeds. Many of these are eaten on a low carb diet and can provide the recommended amount of fiber (more on that below).

Soluble fiber forms a gel’ in the intestine and binds with fatty acids. It slows stomach emptying and helps to make people feel fuller for longer, as well as slow the rate that blood sugar rises, after eating. Soluble fiber absorbs water in the gut, and helps to form a pliable stool. Soluble fiber is found on the inside of certain grains, such as oats, chia seeds or psyillium, as well as the inside of certain kinds of fruit such as apple and pear.

For those eating a low carb diet, getting enough fiber is not that difficult. Here are a few examples of the fiber content of foods that can be eaten;

Avocado — Surprisingly, avocado which is an excellent source of vegetable fat, is also high in fiber, having more than 10 gm fiber per cup (250 ml). Avocado grown in Florida which are the bright green, smooth-skinned variety have more insoluble fiber than California avocado, which are the smaller, darker green, dimpled variety.
Berries — Berries such as blackberries and raspberries are an excellent source of antioxidants, but also have 8 gm fiber per cup (250 ml).
Coconut — Fresh coconut meat has 6 gm of net carbs per 100 grams of coconut, but also packs a whopping 9 gms of fiber and is a very rich source of fat (33 gms per 100 gm coconut). It can be purchased peeled, grated and sold frozen in many ethnic stores or in the ethnic section of regular grocery stores.
Artichoke — Artichoke is a low-carbohydrate vegetable that is delicious boiled and it’s leaves dipped in seasoned butter. Surprisingly, one medium artichoke has over 10 gm of fiber.
Okra — Okra, or lady fingers’ is a staple vegetable in the South Asian diet and is commonly eaten in the Southern US. Just one cup of okra contains more than 8 gm of fiber.
Brussels Sprouts — These low-carb cruciferous vegetables are not just for Thanksgiving and Christmas dinner. Split and grilled on the BBQ with garlic, they are a sweet, nutty addition to any meal, packing almost 8 gm of fiber per cup.
Turnip — Turnip, the small white vegetable with a hint of purple is not to be confused with the pale beige, larger rutabaga. Turnip contains almost 10 gm of fiber per cup. It is delicious pickled with salt and one beet and is commonly eaten with Middle Eastern food.

Irritable Bowel Syndrome (IBS) and Diverticulosis

Unfortunately, in addition to the fact that 20-30% of people in the US and Canada experience chronic constipation, approximately 10-15% of the population have Irritable Bowel Syndrome (IBS) [9].

IBS is a functional disorder of the gastrointestinal (GI) tract â — which means there is no structural or biological abnormality that can be measured on routine diagnostic tests. These people often experience chronic constipation, sometimes alternating with bouts of diarrhea, as often experience abdominal pain and bloating, as well. You can read more about IBS here. As mentioned in the linked article, many people with IBS feel considerably better when they adopt a low-carb diet because they are no longer eating many of the foods that underlie their symptoms such as grains, milk and fruit, other than berries. Unfortunately, even after adopting a low carb diet about 15- 20% of those diagnosed with IBS still have residual symptoms. I have years of experiencing working with those with IBS and offer a package as well as a one-hour teaching session that can help.

Another common problem is diverticulosis, which an estimated 50% of those over 50 years of age have. Diverticulosis is where your colon (large intestine) has small ”pockets” in it called diverticula, which can cause a number of symptoms including chronic constipation. Like those with IBS, many people with diverticulosis feel much better when they adopt a low-carb diet because they are no longer eating foods such as wheat, dairy products with lactose or high fructose fruit that used to contribute to their symptoms. The problem is that many of the low carb vegetables that are low in carbs and may be rich in fiber also may be contributing to their symptoms. So many of my clients have recently been diagnosed with diverticulosis, that I have recently added a one-hour teaching session that can be added to the end of a Complete Assessment Package, or taken as a stand-alone session to help.

Final Thoughts

In trouble-shooting constipation, I recommend that people ensure they are adequately hydrated, and that they remember to drink extra water when it’s hot out or when they’ve been ill.

Eating wide variety of low-carb veggies, including those listed above that are known to be high in fiber is also good. For those on a moderate low-carb diet (not a ketogenic diet), small amounts of yam or winter squash are other ways to get added nutrients and fiber.

Berries are a wonderful source of nutrients and anti-oxidants, can be enjoyed by those on a low-carb diet and are a wonderful source of fiber! Strawberries have 3g of fiber per cup and blackberries and raspberries have a whopping 8 g of fiber per cup, with blueberries paling in comparison with a mere 2.4 g of fiber (and are higher in carbs, too).

Of course, exercise as simple as a daily walk can often help people move their bowels and many people swear by their morning cup of coffee!

For those doing all of the things above and still experiencing chronic constipation, it may be time to rule out other possible causes such as Celiac disease, or non-celiac gluten sensitivity, IBS, or diverticulosis.

I can help.

More Info?

If you would like more information about how I can help in this regard, you can find the various services I offer related to Food Sensitivities / Food Allergies, Celiac Disease, IBS and Diverticulosis under the Services tab, and 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/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd

References

Higgins PDR, Johanson JF, Epidemiology of constipation in North America: a systematic review, The American Journal of Gastroenterology 99(4); 750—759, 2004.
Corazziari E, Definition and epidemiology of functional gastrointestinal disorders, Best Practice and Research: Clinical Gastroenterology, 18 (4); 613—631, 2004.
Harris LA, Prevalence and ramifications of chronic constipation, Managed Care Interface, 18 (8); 23—30, 2005.
Johanson JF, Kralstein J, Chronic constipation: a survey of the patient perspective, Alimentary Pharmacology and Therapeutics, 25(5); 599—608, 2007.
Pare P, Ferrazzi S, Thompson WG et al, An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking, The American Journal of Gastroenterology, 96(11); 3130—3137, 2001.
Health Canada, Fiber, https://www.canada.ca/en/health-canada/ services/ nutrients/fibre.html
Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes: Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, DC: National Academies Press; 2005
Source: US Department of Agriculture, Agricultural Research Service. 2014. USDA National Nutrient Database for Standard Reference, Release 27. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndl.
Foundation for Gastrointestinal Disorders (IFFGD), https://www.aboutibs.org/facts-about-ibs/statistics.html

July 12, 2019April 23, 2021

What is IBS and Why Do Symptoms Improve on a Low Carb Diet?

Quite a few physicians that I know that recommend a low-carb diet to their patients have mentioned to me that those who had previously been diagnosed with Irritable Bowel Syndrome (IBS) and who suffered for years reported significant improvements within a short time of adopting the dietary changes and have asked me why. That is the topic of this article.

Prior to expanding my Dietetic practice to include this low carb division a little over 4 years ago, my main focus was on helping people who were dealing with food allergies and food sensitivities; including Celiac disease, Mast Cell activation disorder (MCAD) / histamine intolerance, fructose intolerance and Irritable Bowel Syndrome For many of my clients, it was the gastrointestinal (GI) symptoms that caused them to seek out my help in the first place.

What is IBS?

I have often thought of Irritable Bowel Syndrome (IBS) as the diagnosis that people receive when all the other possible options have been ruled out. For the most part, by the time people are told that they have IBS, they already know for sure that they don’t have Celiac disease or inflammatory Bowel Disease (IBD) such as Ulcerative Colitis or Crohn’s, and they don’t have diverticulosis â —as each of those diagnoses are confirmed after a colonoscopy and/or a biopsy, and are often supported with underlying blood test results.

What makes IBS different is that it is a functional GI disorder â — which means there is no structural or biological abnormality that can be measured on routine diagnostic tests.

Of course a person experiencing a bout of diarrhea or constipation, or abdominal pain does not mean that person has a GI disorder or disease. Those symptoms could be the result of a virus, bacteria, food-borne illness (“food poisoning”) or food sensitivities. Once these have been ruled out, if the symptoms recur over and over again over time, then investigation as to what else it could be is often begun.

How is IBS Diagnosed?

While many of the symptoms of IBS and Celiac disease can be quite similar, including diarrhea and abdominal pain and bloating, there are very specific indicators that a person may have Celiac disease that clinicians such as myself notice as evidence to request further testing. The first stage in ruling out Celiac disease is an ordinary blood test looking for an antibody to gluten. If that comes back positive, then the person is referred to a Gastroenterologist for an endoscopy. If the blood test is negative, the next step may be for the person to be scheduled for a colonoscopy.

A colonoscopy which is where the inside of the large intestine (colon) is examined using a flexible probe about 1/2″ in diameter that’s fitted with a light and telescopic camera at one end and endoscopy is where a fine, flexible probe fitted with a light and telescopic camera is inserted via the mouth to view the esophagus, stomach and the upper part of the small intestine.

Celiac disease will be ruled out or confirmed using endoscopy, as the upper small intestine is where the damage to the villi (little hair-like projections on the wall that increase the surface area in order to help absorb nutrients from food) will be visible, or not.

A colonoscopy enables the Gastroenterologist to see what the lining of walls of the colon look like and to look for physiological signs of diverticulosis (little bulges or “pouches” in the colon) or signs of inflammation and damage consistent with Inflammatory Bowel Disease (IBD), such as Ulcerative Colitis or Crohn’s and to rule out colon cancer.

If the endoscopy and colonscopy come back normal, the person is often told that their symptoms of diarrhea or constipation (or both alternating), flatulence (“gas”), bloating, abdominal pain or cramping, mucous in the stool is Irritable Bowel Syndrome (IBS).

Prevalence of IBS

According to the International Foundation for Gastrointestinal Disorders (IFFGD), approximately 10-15% of the population have IBS; with 40% having a mild form, 35% having a moderate form, and 25% having severe IBS. While many people think of IBS as being a woman’s health issue, 35% to 40% of people with IBS are men and 60-65% are women [1].

IBS is so common, that it is estimated that 12% of all visits to primary care providers (family doctors) is related to symptoms of IBS [1].

Physicians will sometimes suggest their patients try following a “low-FODMAP diet” but since IBS is so common, there are many different diets called by this name that differ significantly. Even if the doctor provides guidance as to which low-FODMAP diet they should follow, people often eliminate a whole host of foods and wind up eating a very limited diet, with no way of knowing which food they stopped eating actually helped.

Why Eating a Low-Carbohydrate Diet often Improves IBS Symptoms?

A low-FODMAP diet eliminates sources of very specific carbohydrates that are fermented by the gut bacteria and that result in the increased gas production that underlies the classic IBS symptoms of abdominal pain and bloating, and the water flooding into the intestine in response to these fermented carbohydrate is what causes the very common symptom of diarrhea. The constipation results when the contractions of the colon are impaired, resulting in the stool sitting longer in the colon resulting in more and more of the water being re-absorbed.

When people eat a low-carb diet, they either eliminate or greatly reduce sources of fructose (the sugar found in fruit and many processed foods, especially processed condiments like ketchup) and significantly reduce one of the key sources of fructans (inulin) found in wheat; which is a highly fermentable carbohydrate. Galactans, another fermentable carbohydrate found in beans, lentils and legumes such as soy is also eliminated or greatly reduced — which is why people with IBS feel so much better after beginning eating a low-carb diet!

Before I taught a low-carbohydrate approach, I used to have people take the IBS Package before the Complete Assessment Package, so we could find out what foods underlie their unpleasant symptoms and eliminate them before I designed their Meal Plan. Now, if they are planning to adopt a lower carb lifestyle anyway, then I recommend they don’t take the IBS Package, as it may not be necessary. I recommend focus on them adopting a diet that greatly reduces the sources of the fermentable carbohydrates mentioned above, plus a few more that I tell them about and see how they feel. If their symptoms are gone, then there is no reason for them to take the IBS Package! If however, they are feeling quite a bit better, but still have residual symptoms, then I suggest they take the IBS Package so that we can systematically determine what other non-FODMAP foods are contributing to them feeling unwell.

More Info?

If you would like more information about the IBS Package, you can find that under Services tab of my affiliate website, BetterByDesign Nutrition Ltd. and if you’re interested in the low-FODMAP teaching, you can find that in the Shop on that site.

Of course, 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/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd

References

Foundation for Gastrointestinal Disorders (IFFGD), https://www.aboutibs.org/facts-about-ibs/statistics.html

July 11, 2019July 16, 2019

Have You Been Diagnosed with Diverticulosis?

Have you recently been told by your General Practitioner (CP) or gastroenterologist that you have “diverticulosis” and wonder how you should be eating differently to keep it from getting worse?

What is “diverticulosis”?

Diverticulosis is where your colon (large intestine) has small “pockets” in it called diverticula which can cause a number of symptoms or in some people, no symptoms at all.

Diverticula can vary in number from one to literally hundreds. Generally, diverticula increase in number and size over time and range in size from 0.5-1 cm (0.2-0.4 inch) in diameter to 2 cm (0.8 inch)[1]. Diverticulosis occurs in about 5% of adults younger than forty years old, but rise to at least 50% of those older than sixty, with 65% of those who older than 85 having diverticulosis[1].

These little pouches were once thought to be cause by a diet that was too low in fiber[1] which caused the stools to move too slowly though the colon, resulting in constipation. Based on this “fiber hypothesis”, the remedy was thought to be to eat a diet high in fiber; including whole grain bread, unprocessed wheat bran, porridge and fruit. For the last 50 years or so, increased fiber intake has been the recommendation for treatment of diverticulosis, including by the GI Society of Canada and the American Gastrolenterology Association recommends at least 25 g of fiber per day[2,3]. It was thought that increased fiber would increase the volume of the stool and thus require less straining to move the bowels and prevent weakening of the bowel wall, reducing the occurrence of these “pouches”. Unfortunately, several recent studies have shed doubt on the “fiber hypothesis” [4-8].

Not only did a 2012 study find no association between a low fiber diet and diverticulosis [9], the study found that increasing total fiber intake in the form of grains, insoluble fiber and soluble fiber actually increased the prevalence of diverticulosis!

“People with the lowest fiber intake were 30% less likely to develop diverticula than people whose diets included the most fiber.” [9]

Subsequent studies have either found no association between the amount of fiber intake and diverticulosis [10] or that there was no association between diverticulosis and constipation symptoms [11].

These findings left researchers and clinicians with little evidence for continuing to recommend a high fiber diet in diverticulosis, but no alternative options.

ADDENDUM (July 17 2019): There are a number of hypotheses as to what causes diverticulosis with many thinking it could be related to colonic aging weakening of the smooth muscle bands, motor dysfunction, increased luminal pressure, as well of lack of dietary fiber.

Eating foods with soluble and insoluble fiber and drinking sufficient fluid is good, however the source of that fiber is now thought to be important, as I will outline below.

Logical Hypothesis for Diverticulosis

A recent hypothesis is that the increased pressure in the colon that resulted from the intake of so much fiber; particularly the types of fiber that are easily fermented by gut bacteria is what weakens the colon wall, resulting in these ‘pockets’ or diverticula.

What seemed to add credibility to this hypothesis is that historically (prior to WWII) diverticula were seen in a specific region of the colon (proximal colon) in people in Asian countries, with the condition only affecting the right side. This has been explained by the high prevalence of lactose intolerance (inability to digest the sugar in milk and dairy) which exists in Asians. As well, the incidence of this right-sided diverticulosis has been lowest in European populations, where lactose intolerance is very low [12]. Similarly, in Western countries, most of the diverticula are on the left side of the colon, which is thought to be associated with the higher ingestion of wheat, compared historically to Asian countries [12].

Both lactose and the fructans in wheat are carbohydrates that are easily fermented by gut microbes and which results in high amounts of water being drawn into the colon, resulting in increasing pressure on the colon wall from the gas produced by the microbes, possibly leading to the creation of these diverticula.

Of interest, consumption of wheat in Japan and in South Korea has increased considerably since WWII and there is now a considerably higher incidence of left colon diverticula now being observed there, as well [12].

Use of a low-FODMAP Diet in diverticulosis

FODMAPS is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols (sugar alcohols) which are the specific types of carbohydrate that are fermented by the gut bacteria, resulting in increased gas production, abdominal pain, bloating and either diarrhea and constipation or a combination of both. These are very similar symptoms as are observed in Irritable Bowel (IBS) Syndrome and a low-FODMAP diet has long been used to minimize the symptoms in IBS, and is now being used to reduce the same symptoms in diverticulosis.

It is thought that use of a low-FODMAP diet in those with diverticulosis may reduce the occurrence of diverticulitis; which is painful inflammation of these diverticula that often requires medical treatment ranging from antibiotics and pain medication, to bowel resection as is common in Inflammatory Bowel Disease (IBD), such as Ulcerative Colitis and Crohn’s disease.

I offer a Diverticulosis Option for those who want to have specific nutrition education to help them reduce their symptoms and lower the likelihood of their disease progressing to diverticulitis.

Even if you are already following a low-carbohydrate diet and not eating wheat, foods with lactose or fruit, it’s important to know that there are a number of low carbohydrate vegetables that also contain some of these fermentable carbohydrates, as do many of the sugar alcohols many people following a low carb diets use. Reducing the intake of these specific vegetables and sticking to sweeteners that are low FODMAP can greatly help!

More Info

If you would like a Meal Plan designed just for you in light of your diagnosis, as well as specific nutrition education services on how to minimize the symptoms of diverticulosis and lower the likelihood of it progressing to diverticulitis, please click on the Diverticulosis Option, under the Services tab to learn more.

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/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd

References

GI Society, Canadian Society of Intestinal research, https://badgut.org/information-centre/a-z-digestive-topics/diverticular-disease/
Painter NS, Diverticulosis of the Colon and Diet. Br Med J. 1969 Jun 21;2(5659):764-5.
American Gastroenterological Association. A Patient Guide: Managing Diverticulitis. Gastroenterology. 2015;149:1977—1978
Tan KY, Seow-Choen F. Fiber and colorectal diseases: separating fact from fiction. World J Gastroenterol. 2007;13:4161—4167.
Unlu C, Daniels L, Vrouenraets BC, Boermeester MA. A systematic review of high-fibre dietary therapy in diverticular disease. Int J Colorectal Dis. 2012;27:419—427.
Peery AF, Sandler RS. Diverticular disease: reconsidering conventional wisdom. Clin Gastroenterol Hepatol. 2013;11:1532—1537.
Tursi A, Papa A, Danese S. Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Aliment Pharmacol Ther. 2015;42:664—684.
Elisei W, Tursi A. Recent advances in the treatment of colonic diverticular disease and prevention of acute diverticulitis. Ann Gastroenterol. 2016;29:24—32.
Peery AF, Barrett PR, Park D, Rogers AJ, Galanko JA, Martin CF, Sandler RS. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012;142:266—272
Peery AF, Sandler RS, Ahnen DJ, Galanko JA, Holm AN, Shaukat A, Mott LA, Barry EL, Fried DA, Baron JA. Constipation and a low-fiber diet are not associated with diverticulosis. Clin Gastroenterol Hepatol. 2013;11:1622—1627
Braunschmid T, Stift A, Mittlbí¶ck M, Lord A, Weiser FA, Riss S. Constipation is not associated with diverticular disease – Analysis of 976 patients. Int J Surg. 2015;19:42—45.
Uno Y, van Velkinburgh JC. Logical hypothesis: Low FODMAP diet to prevent diverticulitis. World J Gastrointest Pharmacol Ther. 2016;7(4):503—512. doi:10.4292/wjgpt.v7.i4.503

July 9, 2019July 9, 2019

Experts: WHO Draft Guidelines Excludes Key Facts and Studies

An analysis was published last week in the British Medical Journal which raised several important concerns about the World Health Organization (WHO)’s draft guidelines on fatty acids; including saturated fat.

The international group of 16 nutrition experts who wrote the paper are concerned as “many governments consider the WHO dietary guidelines to be state of the art evidence, translating them into regional and national dietary guidelines” [1].

In fact, this is exactly the case in Canada. The new Canada Food Guide that was just released on January 22, 2019 relied extensively on the WHO’s 2017 Guidelines for it’s policy regarding decreasing dietary saturated fatty acids (SFA), as indicated by the table below from pg. 5 of Health Canada’s Interim Evidence Update 2018 [2].

Pg 5 Health Canada’s Interim Evidence Update 2018 [2]

Regarding the significance of the WHO Guidelines, the authors wrote:

“These guidelines have potential health implications for billions of people, so the consistency of the science behind such recommendations and the validity of the conclusions are crucial”.

The authors state that the WHO, in their draft guidelines released in May 2018 “excluded some important aspects and studies” concerning evidence linking saturated fat intake and cardiovascular (CVD) risk.

“They [WHO] recommend reducing intake of total saturated fatty acids to less than 10% of total energy consumption and replacing with polyunsaturated fat and monounsaturated fat to reduce incidence of cardiovascular disease and related mortality. But this fails to take into account considerable evidence that the health effects vary for different saturated fatty acids and that the composition of the food in which they are found is crucially important.”[1]

The authors point out that the composition of the food in which the fatty acid is found has a substantial effect on lipid digestion, absorption, as well as the amount of emulsified fat that is found in the blood after a meal (postprandial lipemia), which “is an independent risk factor for cardiovascular disease.”[1]

The authors point out that recently there have been several meta-analyses of observational studies and randomized controlled trials (RCTs) that found that total saturated fat is NOT associated with coronary heart disease, cardiovascular disease, and all cause mortality (i.e. deaths). In addition they report that a Cochrane analysis found no significant association between reducing saturated fatty acids and total mortality, cardiovascular disease deaths, fatal and non-fatal myocardial infarction (MIs), stroke, coronary heart disease events, and coronary heart disease deaths.

Continued Reliance on Surrogate Endpoints

The authors note that the WHO draft guidelines continue, as they have in the past to (1) rely heavily on “surrogate endpoints” of the effect of dietary saturated fat intake on the level of lipid and lipoproteins in the blood — and (2) ignores the food source of the saturated fat.

They raise three key points;

1. Not all saturated fatty acids are equal; the amount and even the direction of the effects (raises or lowers) both surrogate and long term endpoints vary, depending on which fatty acid is involved.

2. Influence of the food source that the fatty acid is found in; the authors note that it has still not been determined whether any changes in blood lipoproteins translates into a lowering of cardiovascular risk and death, regardless of food source.

“Most trials included in the meta-analysis did not investigate whole food sources of saturated fat.”[1]

That is, the studies that WHO considered compared the effect of diets supplemented with fats rich in saturated fatty acids — not the effect of saturated fats in a specific food matrix.

One example of saturated fat in a whole food matrix cited in the paper is one of eggs; where there is “no association with coronary heart disease, and there is a reduced risk of stroke, and that randomized control trial data show that two eggs a day has beneficial effects on cardiovascular disease biomarkers“. (table 1, [1]).

3. Using LDL cholesterol concentration as a marker for cardiovascular disease risk. As I’ve written about in several previous articles, the authors note that the degree to which LDL particles are atherosclerotic is determined by, among other things, their size.

“Small and medium LDL particles show the strongest association with risk of cardiovascular disease, whereas large particles show no association.” [1]

in fact, the authors point out as I did in a recent article about red meat and white meat “raising cholesterol”, that a rise in serum LDL cholesterol concentration from total saturated fat consumption has been linked to a parallel increase in particle size “so it might not translate into an
increased risk of cardiovascular disease.”[1]

Excluding Observational Studies and Prospective Cohort Studies

The authors point out that the WHO draft guidelines exclude two types of studies from consideration; observational studies and prospective cohort studies because they argue that the quality of the evidence is lower than from
analyses of RCTs, and that it was not possible to assess the potential differential effects of replacing saturated fatty acids with different nutrients.

The problem with this is that (1) observational studies enable assessing the association between saturated fat and cardiovascular disease rather than simply looking at the association between surrogate endpoints” (i.e. saturated fat and LDL-c) and (2) observational studies enable examining of the actual foods that people eat, rather than just individual nutrients, as

“Longstanding evidence indicates that the food matrix is more important than its fatty acid content for predicting the effect of a food on risk of coronary heart disease.”

The authors concluded;

“A recommendation to reduce intake of total saturated fat
without considering specific fatty acids and food sources is not
evidence based; will distract from other more effective food-
based recommendations; and might cause a reduction in the
intake of nutrient dense foods that decrease the risk of
cardiovascular disease, type 2 diabetes, other serious
non-communicable diseases, malnutrition, and deficiency
diseases and could further increase vulnerability to nutrient
deficiencies in groups already at risk.

Final thoughts

This analysis adds a critical academic “voice” to the concern of limited saturated fat intake which may translate a reduction in the intake of nutrient-dense whole foods.

In fact, this was precisely the concern that I raised in my recent article about the Canada Food Guide “Snapshot” which came out at the end of June and which linked an image of ultra-processed foods with the message “limit foods high in sodium, sugars or saturated fat”. After all, meat is high in saturated fat and cheese is high in saturated fat and sodium, but are these really the types of whole, real foods that Canadians should be advised to limit?

More Info?

If you would like more information about choosing whole, real food and limiting ultra-processed foods, 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/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd

References

Astrup A, Bertram HCS, Bonjour J-P et al, WHO draft guidelines on dietary saturated and trans fatty acids: time for a new approach? BMJ 2019; 366: l4137 doi: 10.1136/bmj.l4137
Health Canada. Food, Nutrients and Health: Interim Evidence Update 2018. Ottawa: Health Canada; 2019.

July 2, 2019

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 â — 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).

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 cereal, muffins, 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.

To your good health!

Joy

You can follow me on:

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

References

Health Canada Snapshot: https://food-guide.canada.ca/en/?utm_source=canada-ca-foodguide-en&utm_medium=vurl&utm_campaign=foodguide
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.
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
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.
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
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.
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.
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
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

June 28, 2019June 28, 2019

CFG Snapshot – conflating Ultra-Processed Food and Whole, Real Foods?

Note: This article is a combination of a Science Made Simple article with 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” â — 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;

Be mindful of your eating habits
Cook more often
Enjoy your food
Eat meals with others
Use food labels
Limit foods high in sodium, sugars or saturated fat*
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 necessarily need do so with all sources of saturated fat and sodium), in my opinion the following photo would be a more accurate reflection of that 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, but 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 foodâ because they are high in refined carbohydrates and refined fats, and low in nutrient density â — 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.

To your good health!

Joy

You can follow me on:

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

References

Health Canada Snapshot: https://food-guide.canada.ca/en/?utm_source=canada-ca-foodguide-en&utm_medium=vurl&utm_campaign=foodguide
Health Canada, Canada’s Dietary Guidelines, https://food-guide.canada.ca/en/guidelines/
Health Canada, Healthy Eating Recommendations, https://food-guide.canada.ca/en/healthy-eating-recommendations/
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

June 24, 2019June 24, 2019

Only Half of People Have Newer Gene that Controls High Blood Sugar

The maintenance of blood sugar is very tightly regulated; with a healthy person’s blood glucose being kept in the range from 3.3-5.5 mmol/L (60-100 mg/dl) between meals, however a new study indicates that it may be newer variant of a gene that determines how well (or not) we are able to maintain these levels.

After eating, the higher levels of blood glucose that comes from the broken-down carbohydrate-based food triggers the release of insulin by the pancreas, which in turn causes the release of a special transporter called GLUT4. The GLUT4 transporter acts like a taxi to remove excess glucose from the blood, taking it into muscle and fat tissue.

Newer Variant of an Older Gene

Between meals and with the help of a special protein (CHC22) produced by the CLTCL1 gene, the GLUT4 glucose transporter remains inside muscle and fat, so that some blood sugar will continue to circulate.

A newly published study [1] by research specialists in population genetics, evolutionary biology, ancient DNA and cell biology analyzed the human genomes to understand how the gene producing CHC22 has changed over human history [2].

By examining the genomes of 2,504 people from the global 1000 Genomes Project compared to the genomes of ancient humans, researchers found that almost half of the people in various ethnic groups have a variant of CHC22 protein that is produced by a new variant of the CLTCL1 gene that became more common as humans moved away from being hunter-gathers and began farming and raising crops. Researchers postulate that the increased consumption of carbohydrates may have been the selective force driving this genetic adaptation.

Researchers found that the newer CHC22 variant of the gene is less effective at keeping the GLUT4 glucose transporter inside muscle and fat tissue between meals, which means that the transporter can more readily clear glucose out of the blood*.

As a result, people with the newer variant of the gene will have lower blood sugar than those with the older variant of the gene.

“The older version of this genetic variant likely would have been helpful to our ancestors as it would have helped maintain higher levels of blood sugar during periods of fasting, in times when we didn’t have such easy access to carbohydrates, and this would have helped us evolve our large brains”[2] — lead author Dr Matteo Fumagalli

*Note: It’s important to keep in mind that only GLUT4 transporters are insulin-dependent. There are other glucose transporters that allow glucose into the cell that don’t involve insulin, such as the GLUT1 transporter that works on a concentration gradient. That is, the effect of this gene is not on all glucose regulation, but only glucose regulation in adipose and muscle cells that use GLUT4 transporters.

The higher carbohydrate diets that came as a result of the advent of agricultural meant that this newer variant of the gene could be advantageous, as it moves the excess blood sugar from the blood into the muscle and fat tissue and having the older variant of the gene may make people more likely to develop Diabetes and may also make worse the insulin resistance that underlies the process of developing Diabetes.

“People with the older variant (of the gene) may need to be more careful of their carb intake, but more research is needed to understand how the genetic variant we found can impact our physiology”[2] — co-author Dr. Frances Brodsky

Along with the 2015 study from Israel[3] that demonstrated substantial differences in blood glucose response between both healthy individuals and those with Diabetes predictable by their gut microbiome, this new research adds to the knowledge that multiple factors are involved with determining whether people can tolerate specific dietary carbohydrate loads.

Nutritional guidelines for maintaining healthy blood glucose levels are portrayed as universally applicable, however this new study and the 2015 Israeli study demonstrates that blood glucose varies significantly between individuals based on genetics as well as on gut microbiota composition, which necessitates the need for personalized nutrition in managing blood glucose levels.

More Info

If you are interested in a personalized approach aimed at helping you gain control of your blood sugar levels, I can help.

I offer both in-person services in my Coquitlam, British Columbia office as well as remote services via Distance Consultation. You can find more information about my packages under the Services tab or in the Shop and if you would like to learn more about how Distance Consultation services work, you can click here.

Have Questions?

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/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd

References

Matteo Fumagalli, Stephane M Camus, Yoan Diekmann, Alice Burke, Marine D Camus, Paul J Norman, Agnel Joseph, Laurent Abi-Rached, Andrea Benazzo, Rita Rasteiro, Iain Mathieson, Maya Topf, Peter Parham, Mark G Thomas, Frances M Brodsky. Genetic diversity of CHC22 clathrin impacts its function in glucose metabolism. eLife, 2019; 8 DOI: 10.7554/eLife.41517
University College London. “Gene mutation evolved to cope with modern high-sugar diets.” ScienceDaily. ScienceDaily, 4 June 2019, https://www.sciencedaily.com/releases/2019/06/190604084857.htm
Zeevi D, et al. Personalized nutrition by prediction of glycemic responses. Cell. 2015;163:1079—1094.
Noecker C, Borenstein E. Getting Personal About Nutrition. Trends Mol Med. 2016;22(2):83—85. doi:10.1016/j.molmed.2015.12.010

June 23, 2019May 16, 2024

Lowering LDL and Saturated Fat to Lower Risk of Cardiovascular Disease

INTRODUCTION: There much debate in the health community about the effect of dietary fat — especially saturated fat on cholesterol levels and whether there is an association between dietary saturated fat intake and cardiovascular disease.

In the first part in this two-part series titled High Cholesterol and the Risk of Cardiovascular Disease, I explained what cholesterol is, the different types of cholesterol (HDL-C, VLDL, LDL-C and triglycerides (which are not actually cholesterol), what their role is, and what “high cholesterol” is.

In this article which is Part 2 in the two-part series, I will explain the association between dietary intake of saturated fat and higher levels of total LDL, and whether reducing total LDL — whether through the use of statin medication or diet lowers the risk of cardiovascular disease.

Dietary Saturated Fat and LDL

When people are told that they have “high cholesterol”, what is meant is that they have high total LDL. They are told they have high “bad” cholesterol, with no regard that there are different sub-fractions of LDL.

It is well known that eating foods high in saturated fat can raise LDL-C (total LDL cholesterol, but as covered in Part 1 of this two-part series, the first question one should ask when told they have “high LDL cholesterol” is “which LDL? The small dense ones or the large fluffy ones?”[1].

More often than not, the clinician that breaking the ‘bad news’ to the patients has absolutely no idea that there are different sub-fractions of LDL and that it is only the small, dense ones that are atherosclerotic [1].

Furthermore, there is almost a knee-jerk reaction on the part of many clinicians to prescribe statin medication in order to lower their LDL, on the assumption that lowering LDL will lower their risk of cardiovascular disease. In fact, aggressive treatment to lower total LDL-C has been at the (pardon the pun) heart of preventative cardiology for decades.

While statin medication (e.g. Lipitor®, Crestor®, etc.) is well-documented to reduce LDL-C levels, these are only surrogate markers (not direct markers) of cardiovascular disease (CVD). The assumption of an association between high LDL levels and CVD goes back as far as Ansel Keys and the Seven Country Study, and that the Diet Heart Hypothesis (covered in several previous articles) is simply an “establish fact”. But it is?

What evidence is there that lowering total LDL with statin medication lowers one’s risk of cardiovascular disease (CVD)?

The brand new guidelines on cholesterol management issued by the American Heart Association (AHA) and American College of Cardiology (ACC) which has just been published online ahead of print[2], places a renewed focus on LDL-C as a means to assess risk. In fact, these guidelines propose that non-fasting lipids be adopted as a screen in the general population, including “non-adults” (children and youth) [2]. As has been the case for decades., this is based on the assumption that total LDL (LDL-C) is an accurate surrogate marker for elevated cardiovascular risk, but does lowering LDL-C really lower CVD?

Of particular interest, the new American Heart Association (AHA) and American College of Cardiology (ACC) guidelines state that the traditional Friedewald equation which is used to calculate total LDL (i.e. LDL-C) as covered in Part 1 of this series of articles has been “prone to inaccuracy …at low-LDL-C and high triglyceride levels” — yet decades of statin treatment has been based on the previous “inaccurate” Friedewald equation. The new guidelines promote the use of a new Martin/Hopkins LDL-C calculation method which is said to “perform better in these settings”. The question remains ‘does lowering LDL-C lower the risk of cardiovascular disease?’.

There are 44 randomized controlled trials of drug or dietary interventions to lower total LDL ( LDL-C) published in the literature which show no benefit in lowering rates of death [3] and most did not reduce CVD events [4].

Furthermore, despite a 37% drop in LDL-C and a 130% increase in HDL-C (so-called “good cholesterol”), the ACCELERATE double-blind randomized control trial showed no significant reduction in CVD or death [3.4].

In addition, there does not appear to be a clear reduction in CVD deaths in Western European countries either as a result of using statins for prevention [5].

This begs the question as to whether using statin medication to aggressively lower LDL-C has any benefit.

A 2018 article published in Expert Review of Clinical Pharmacology concluded;

“For half a century, a high level of total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated and that statin treatment, in particular when used as primary prevention, is of doubtful benefit.” [6]

What about lowering the intake of dietary saturated fat? Does that lower the risk of cardiovascular disease?

A 2014 meta-analysis of data of 72 studies involving more than 600,000 participants from 18 countries published in the journal Annals of Internal Medicine in 2014 [7] concluded that total saturated fat; whether measured in the diet or in the bloodstream showed no association with heart disease [7].

Take away: While eating dietary fat may raise the level of total LDL cholesterol (LDL-C), lowering its intake does not show any benefit in reducing the incidence of heart disease, nor does lowering LDL-C using statin drugs.

Which LDL?

A brand new study published June 4, 2019 in the American Journal of Clinical Nutrition sheds some very helpful light [8].

The study enrolled 113 people and randomized them to either a high saturated fat diet (40% carbs, 24% protein, 35% fat; 14% saturated fat) or a low saturated fat diet (40% carbs, 24% protein, 35% fat; 7% saturated fat replaced by monounsaturated fat).

Each group changed their diet every 4 weeks from (a) a high red meat diet (mostly from beef), (b) a high white meat diet (chicken and turkey) and (c) a non-meat protein diet (legumes, nuts, grain and soy).

Researchers found that LDL cholesterol and Apolipoprotein B (explained in the first part of this article) were higher with red and white meat alike and that the increase “was due primarily to increases in large LDL particles” with no change in the small particles and no significant change in the total cholesterol to HDL ratio.

This is highly significant!

What this means is that yes, eating meat; whether it’s red meat (such as beef, lamb or goat) or white meat (such as chicken or turkey) DOES increase LDL —but it’s the large, fluffy LDL particles that are increased; the ones that are not associated with cardiovascular disease[1]!

In fact, in the paper, the researchers acknowledge;

“Large LDL particles, measured by several different methodologies, have not been associated with CVD in multiple population cohorts in contrast to the associations observed for concentrations of medium, small, and/or very small LDL… Thus, the estimated impact of red meat, white meat, and dairy-derived saturated fatty acids (SFA) on CVD risk as reflected by their effects on LDL cholesterol and ApoB concentrations may be attenuated by the lack of their effects on smaller LDL particles that are most strongly associated with CVD.

Essentially, there has been on over-reliance on total LDL cholesterol (LDL-C) as a marker of cardiovascular disease, without distinguishing the atherosclerotic small, dense LDL from the non-atherosclerotic large, fluffy LDL.

The authors conclude;

“…the impact of high intakes of red and white meat, as well as saturated fatty acid (SFA) from dairy sources, which selectively raised large LDL sub-fractions may be overestimated by reliance on LDL cholesterol, as is the case in current dietary guidelines.”

This means that eating red meat (such as beef or lamb) or white meat (such as chicken or turkey) or eating saturated fat from full-fat dairy (such as full fat milk, cheese and yogurt) are associated with increased levels of the large, fluffy LDL sub-fraction and based on multiple population studies the large, fluffy LDL subfraction has not been found to be associated with cardiovascular disease.

Simply put, this means that eating foods high in saturated fat does not raise small LDL particles (which are the atherosclerotic sub-fraction) and results in no change to the total cholesterol to HDL ratio, and increases the large, fluffy LDL-subfraction (which are NOT found to be associated with cardiovascular disease)!

While this is a small pilot study, it adds further evidence that eating saturated fat does not increase cardiovascular risk.

Note: high levels of the small, dense LDL sub-fraction is thought to be genetic, but is also associated with intake of trans fatty acids and high intake of refined carbohydrates. More on that in future articles.

More Info?

If you would like to learn more about my services, you can find more information under the Services tab or in the Shop and 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
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References

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.
Cao J, Devaraj S, Recent AHA/ACC guidelines on cholesterol management expands the role of the clinical laboratory, Clinica Chimica Acta 495 (2019) 82—84, Available online 03 April 2019.
DuBroff R. Cholesterol paradox: a correlate does not a surrogate make. Evid Based Med,2017;22(1):15—9. doi: 10.1136/ebmed-2016-110602
Demasi M, Lustig RH, Malhotra A, The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance, Clinical Pharmacist, 14 July 2017.
Vancheri F, Backlund L, Strender L et al. Time trends in statin utilisation and coronary mortality in Western European countries. BMJ Open 2016; 6(3):e010500. doi: 10.1136/bmjopen-2015-010500
Ravnskov U, de Lorgeril M, Diamond DM, et al, LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature, Expert Review of Clinical Pharmacology, 2008;11:10, 959-970, DOI: 10.1080/17512433.2018.1519391
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 Intern Med. 2014;160:398—406. doi: 10.7326/M13-1788

June 20, 2019June 23, 2019

High Cholesterol and Risk of Cardiovascular Disease

INTRODUCTION: There is much debate in the scientific community about the effect of dietary fat — especially saturated fat on cholesterol levels and risk of cardiovascular disease. To best understand this complex topic, I have broken the subject into two articles. In this first part, I explain the different ways cholesterol values are assessed, what they are used for and what they mean. In the next part I will explain whether lowering LDL and dietary saturated fat lowers the risk of cardiovascular Disease.

What is Cholesterol?

Cholesterol is a essential structural component of all the cell membranes in the body and is used in the making of steroid hormones such as cortisol and aldosterone by the adrenal glands, sex hormones such as estrogen, testosterone and progesterone by the gonads, and is also used in the making of bile acid. Approximately 80% of cholesterol made daily by the body occurs in the liver and intestines, with the remainder being made in the adrenal glands and reproductive organs.

Different Types of Cholesterol

Triglyceride isn’t actually a type of cholesterol, but is measured on lipid panels along with cholesterol.

Triglyceride is made up of three fatty acids (hence “tri-“) attached to a glycerol molecule (also known as glycerine), which is a sugar alcohol. Some triglyceride is taken in through the diet and the rest is manufactured by the body during lipogenesis (literally meaning the ‘making of fat’). Lipogenesis is how the body stores the excess carbohydrate we eat in our diet that isn’t immediately needed for energy. Yes, excess dietary carbohydrate is stored in the body as glycogen and when glycogen stores are full, it is stored as fat.

As for cholesterol itself, there are several different types found in the blood;

high density lipoprotein (HDL)
low density lipoprotein (LDL)
very low density lipoprotein (VLDL)

Most people think of high density lipoprotein (HDL) as ”good cholesterol” and low density lipoprotein (LDL) as ”bad cholesterol” but there are actually two sub-fractions of LDL; the small, dense LDL sub-fraction which is associated with atherosclerotic plaque, and the large, fluffy LDL sub-fraction which is considered protective against cardiovascular disease[1].

This is important, because when people are told they have “high cholesterol“, this is usually implies that they have high LDL. This is often presented to them as them having a high level of “bad” cholesterol.

High Cholesterol

A couple of things need to be clarified about “high cholesterol”;

Firstly, “high LDL” cholesterol means high total LDL cholesterol. When blood tests are said to indicate “high LDL” a good question to ask is “which LDL cholesterol is high; the small dense ones or the large fluffy ones?”. More on this below.

Secondly, it is important to note that lab tests don’t actually measure total LDL but calculate it from the Friedewald formula; which (in mg/dl) is calculated by total cholesterol (TC) – HDL lipoprotein (HDL)-cholesterol – triglycerides (TGs) / 5.

When people are told that they have “high LDL” results on a blood test, they are often presented with a recommendation to begin statin medication, but does high total LDL provide sufficient information about cardiovascular risk? More on this below. The use of statin medication will be covered in the subsequent article.

Very low density lipoprotein (VLDL) is produced in the liver and the best way to understand its role is to think of it as a “taxi” which the liver makes and then release into the bloodstream to shuttle triglycerides around to the various tissues. VLDL cholesterol on blood test results isn’t actually measured either, but estimated as a percentage of the triglyceride value. High VLDL is said to be a risk for cardiovascular disease but as elaborated on below, a more accurate measure is the ratio of Apopoprotein B (the lipoprotein in VLDL) compared to the Apoprotein A (the lipoprotein in HDL).

Where does LDL come from?

Once a large amount of triglyceride has been unloaded in the tissues by the VLDL “taxi”, it becomes a new, smaller lipoprotein called low density lipoprotein, or LDL which contains mostly cholesterol and some protein.

Some LDLs are removed from the circulation by cells around the body that need the cholesterol contained in them and the rest is taken out of the circulation by the liver.

A key point here is that the only source of LDL is VLDL. This is important.

LDL is what is left once the VLDL which is made by the body has offloaded its triglyceride ‘passenger’ to the tissues.

LDL and Heart Disease

Research has often reported that elevated LDL-cholesterol is a risk factor for cardiovascular disease, including heart disease and stroke and it has been assumed that lowering LDL-cholesterol in the blood would decrease cardiovascular deaths and illness. It is this premise that lead to recommendation of treatment of high LDL with statin drugs.

One major problem is that these studies looked at total LDL which doesn’t distinguish between the small, dense sub-fractions of LDL that are atherosclerotic, and the large, fluffy ones that are not [1].

Total LDL (LDL-C) calculates (not measures!) the total content or concentration of cholesterol within all the LDL particles.

LDL particle number (LDL-P) measures the particle concentration.

Since the amount of cholesterol in each particle varies, measuring LDL-C does not necessarily reflect the actual number of particles — but an increased number of LDL particles occurs in patients with lots of small, dense particles.

Therefore, LDL-particle number (LDL-P) is a more accurate predictor of cardiovascular events than total LDL (LDL-C).

An NMR lipid profile test directly measures the number of LDL particles (as well as HDL particles). For LDL particles, a value of less than 1.000 in nmol/L is considered ideal, a value of 1000-1299 is considered moderate, a value of 1300-1599 is considered borderline high, and a value >1600 is considered high.

Apolipoprotein B:Apolipoprotein A

Apolipoprotein B (apo B) is the main lipoprotein in VLDL, and subsequently in LDL after the VLDL has offloaded its triglyceride to the tissues. ApolipoproteinB is correlated with the actual number of LDL-particles, which makes it a very good assessor of the risk of cardiovascular disease,

Apolipoprotein A (apo A) is the main lipoprotein in HDL (commonly called “good” cholesterol).

Measuring ApoB to ApoA requires special blood tests, but a proxy can be calculated by dividing triglycerides (TG) by HDL-cholesterol (HDL-C) from a standard lipid panel. Studies have found this to be a very good assessor of cardiovascular risk.

Triglyceride:HDL Ratio

In Canada (as well as Europe), values are expressed as mmol/L and the ratios are interpreted as follows [2];

TG:HDL-C < 0.87 is ideal

TG:HDL-C > 1.74 is too high

TG:HDL-C > 2.62 is much too high

In the US, values are expressed in mg/dl and the ratios are interpreted as follows [2];

TG:HDL-C < 2 is ideal

TG:HDL-C > 4 is too high

TG:HDL-C > 6 is much too high

Several studies have found that TG:HDL-C ratio also reflects particle size;

One study from 2004 reported that almost 80% of people with a TG:HDL-C ratio of greater than 3.8 (when values are expressed in mg/dl) had mostly small, dense LDL particles, indicating cardiovascular risk. This same study found that more than 80% with a TG:HDL-C ratio of less than 3.8 (when values are expressed in mg/dl) had mostly large, fluffy LDL particles, indicating lower cardiovascular risk[3].

A 2005 study [4] reported that a TG:HDL-C ratio of 3.5 or greater was highly correlated with atherosclerosis in men, as well as insulin resistance and metabolic syndrome.

A recent 2014 [5] study found that a high TG:HDL-C ratio was a strong independent predictor of cardiovascular disease, coronary heart disease and all-cause mortality both before- and after adjustment for age, smoking, BMI and blood pressure.

Based on this metric, lower cardiovascular risk would be associated with lower triglycerides, raising HDL or both.

But how?

Lowering TG:HDL-C ratio

Losing weight will lower triglycerides, however low-fat diets are not usually helpful in this regard because they are often also high in carbohydrate[2].

Decreasing intake of carbohydrates — especially fructose which is found in fruit, as well as processed products made with high fructose corn syrup has been anecdotally reported to decrease hunger, making weight loss easier. Most importantly, clinical studies using well-designed low carbohydrate diets (already covered in several previous articles) are associated with both a lowering of triglycerides and a increase in HDL.

Lowering the risk of cardiovascular disease through weight loss, along with a lowering of triglycerides and an increase in HDL is where I can help.

UPDATE (June 23, 2019): Part 2 of this article titled Lowering LDL and Saturated Fat to Lower the Risk of Cardiovascular Disease is available by clicking here.

More Info?

To your good health!

Joy

You can follow me on:

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

References

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.
Sigurdsson AF, The Triglyceride/HDL Cholesterol Ratio, updated January 12, 2019, https://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/
Hanak V, Munoz J, Teague J, et al, Accuracy of the triglyceride to high-density lipoprotein cholesterol ratio for prediction of the low-density lipoprotein phenotype B, The American Journal of Cardiology, Volume 94, Issue 2, 2004, Pages 219-222, https://doi.org/10.1016/j.amjcard.2004.03.069
McLaughlin T, Reaven G, Abbasi F, et al. Is there a simple way to
identify insulin-resistant individuals at increased risk of cardiovascular
disease? Am J Cardiol. 2005;96(3):399Y404.
Vega GL, Barlow CE, Grundy SM et al, Triglyceride to High Density Lipoprotein Cholesterol Ratio is an Index of Heart Disease Mortality and of Incidence of Type 2 Diabetes Melletus in Men, Journal of Investigative Medicine & Volume 62, Number 2, February 2014

June 18, 2019November 7, 2022

Distinguishing Food from Food-like Products

INTRODUCTION: National dietary guidelines in both Canada and the US focus on the variety of foods available in each of several defined ‘food groups’ and make recommendations about “healthy eating” based on how much of particular nutrients are in specific foods. In Canada for example, foods that are rich in saturated fat, sodium or sugar are said to undermine health. This type of classification results in dishes rich in cheese and fried chicken both being deemed as unhealthy, as both are high in saturated fat and sodium.

This article outlines an internationally established way of classifying foods that is based on the degree of food processing they have undergone — which I believe provides a better framework to help people to choose which foods they should aim to eat most often.

Many of us have heard the alarming health statistics in both the US and Canada, but they are worth repeating.

Obesity has risen in Canada from < 10% in 1970-1972 to almost 15% in 1989, to over 23% in 2004 [1,2]. That is, in the early 1970s, only one in 10 people in Canada was obese and now almost 1 in 4 people in Canada are obese [3]. The prevalence of obesity among American adults is almost 40% as of 2015-6 [4].

And it’s not only adults.

As of 2015, over 10% (1 in 10) children between the ages of 5 and 17 years of age in Canada were obese[3] and that figure rises to 20% (1 in 5 kids) in the United States [4].

It’s not only obesity.

As of 2015, >25% of Canadians adults have been diagnosed with high blood pressure[3] and as of 2013, >30% of American adults have high blood pressure [5]. That’s 1 in 4 in Canada and 1 in 3 in the US [4] with hypertension; a major risk factor for heart attack and stroke.

Over 8% in Canada have been diagnosed with coronary heart disease (CHD) [3] and in the US, coronary heart disease accounts for ~13% of deaths as of 2016 [6] and over 8% of Canadians has diabetes [3] and in the US, almost 9.5% of Americans has diabetes [7].

What has changed over this time period to account for this?

Too Many Carbs?

When I first started writing articles about obesity and the increased rates of metabolic diseases ~ 4 years ago, I thought it was largely related to the increased in carbohydrate content of the diet due to changes in the national dietary guidelines that occurred in Canada and the US in 1977. To some degree there is a relationship between these, but it is not as clear-cut as I once thought.

Industrial Seed Oils (Polyunsaturated Vegetable Oil)

With further reading in the scientific literature, I came to believe that it was the inclusion of novel “seed oils” (also called “polyunsaturated vegetable oil”) including canola, soybean, corn and cottonseed oil — along with too much carbohydrate in the diet that lay at the root of obesity and metabolic disease and while this is certainly part of the story, I was still missing a vital piece of the puzzle.

Manufactured Food-like Products

As national dietary guidelines in both Canada and the US in 1977 focused on reducing dietary intake of fat — especially saturated fat, food manufacturers sought to fill the gap left by the removal of butter, cream, lard and tallow (saturated fats) from the diet, and began to manufacture products that were made up of both refined carbohydrate and industrial seed oils (“polyunsaturated vegetable oils”). The food industry heavily marketed these manufactured products and promoted them as being “low in saturated fat”, which was perceived by the general public as being equivalent to “healthy”.

Since the mid-1980s, the food supplies of high-income countries such as Canada, the US, Australia and the UK have been dominated by pre-packaged, ready-to-eat “convenience foods” [13]. In fact, the percentage of energy (calories) in the diet of Canadians of these “ultra-processed foods” rose from <25% in 1938 (when manufactured products such as Crisco and soy oil were first created) to almost 54% in 2011 (9). Similar trends have been observed worldwide (10-12).

It is my now my conviction that it has been the over-consumption of these ultra-processed “convenience foods” that are high in both refined carbohydrate and seed oils which precipitated the huge deterioration of the Western diet, and which has fueled the concurrent epidemics of obesity, diabetes and other chronic diseases, such as hypertension and coronary heart disease [8].

Hundreds of thousands of people in Canada, and millions worldwide are metabolically unwell because the bulk of the diet has centered around eating these manufactured food-like products — from our morning sweetened cereal or spreads on toast to the burger with ‘plastic cheese’ and French fries we grab in place of real food.

So how do we distinguish real food from food-like products?

The NOVA Food Classification system – defining “processed food”

From the time food is harvested to when it is eaten, most food is processed in some way. Some of this processing may be as simple as peeling and chopping it, to cooking it, but food doesn’t become “unhealthy” just because it is processed. The issue is how much it is processed.

NOVA is a food classification system developed in Brazil and used in the US, Canada and other countries around the world to define the level of food processing.

The NOVA definition of types of food processing are as follows [13]:

Minimally processed foods are defined as ”unprocessed foods altered in ways that do not add or introduce any new substance (such as fats, sugars, or salt) but often involve removal of parts of the food.” Examples of these include fresh, dry, or frozen vegetables, root vegetables, grains and legumes, fruits and nuts, and meats, fish, seafood, eggs, and milk [13]. For the most part, minimal processing is what’s involved in preparing it for eating and/or improving its palatability.

Processed foods are defined as ”foods made by adding fats, oils, sugars, salt, and other culinary ingredients to minimally processed foods to make them more durable and usually more palatable, and by various methods of preservation“. They include simple breads and cheeses; salted, pickled or cured meats, fish and seafood; and vegetables, legumes, fruits and animal foods preserved in oil, brine or syrup.

Canned fish in oil would fall in this category, as would hummus (ground chickpeas with sesame seed butter, garlic and lemon juice), as well as bacon and sausages.

These foods can be part of a healthy diet, depending on how they are prepared and used in dishes and meals [13] and how much of these are eaten at a time.

Ultra processed foods are defined as ”not modified foods, but formulations of industrial ingredients and other substances derived from foods, plus additives. They mostly contain little if any intact food. The purpose of ultra-processing is to create products that are convenient (durable, ready-to-eat, -drink or -heat), attractive (hyper- palatable), and profitable (cheap ingredients). Their effect all over the world is to displace all other food groups. They are usually branded assertively, packaged attractively, and marketed intensively.“

Foundations for Healthy Eating using Degree of Food Processing

I like to define foods as being either “everyday foods” or “sometimes foods”. The issue is how much and how often we eat them.

“Everyday Foods”

Choosing foods to make up a meal should aim to include mostly unprocessed foods (whole foods in their original state) and minimally processed foods. This is how our grand-parents and great-grandparents ate (when obesity, hypertension and diabetes rates were a fraction of what they are now!).

Another way to determine what foods to include in a meal is to eat food that your great-grandparents would recognize as food.

“Sometimes Foods”

For people who are metabolically healthy, eating “processed foods” such as breads and cheese, salted, pickled or cured foods (including meat, fish, seafood, vegetables, legumes) and whole foods preserved in oil or brine are perfectly fine to add to unprocessed foods (whole foods in their original state) and minimally processed foods to make up a meal.

For those who are already overweight or metabolically unhealthy, focusing on making up a meal of real, whole foods in their original state (i.e. unprocessed foods) and minimally processed foods is best, while limiting processed foods. How much bacon, olives, bread and cheese can be eaten really depends on a person’s metabolic health. This is where having a Meal Plan designed by a Dietitian is helpful because everybody’s needs are different.

Ultra-Processed Food

Ultra-processed food isn’t food. They are products made from a combination of refined carbohydrates (including sugar) and seed oils. These are convenient, hyper-palatable and cheap, and displace real food in the diet.

According to a 2015 study, some of the most addictive foods are in this category; including breakfast cereal, muffins, pizza, cheeseburgers, French fries and fried chicken — as are the desserts that often eaten with them including chocolate, ice cream, cookies and cake, and the soda we wash them down with. Even our favourite snacks like popcorn and chips are really nothing more than a combination of refined carbs and industrial seed oil eaten in place of real food.

Fifteen Most Addictive Fast Foods

These ultra-processed food-like products are intended to displace real food in the diet and as such are not something we should consider as components for making up a meal.

Does that mean we should never eat a slice of pizza or a cheeseburger? Of course not. But let’s be fully aware that this is not real food. It is something we eat in place of real food.

As well, there is a huge difference between a homemade burger with real melted cheddar cheese on top — sandwiched between fresh leaf lettuce and tomato, and what can be picked up at a 1000 drive-throughs in cities around the Western world.

National Food Guidelines as foundations for healthy eating

National food guidelines in both Canada and the US have traditionally categorized food based on the variety available in each food group; including grains and cereals, vegetables &/or fruit. milk and dairy, and meats and alternatives.

In the case of the new Canada Food Guide, it recently eliminated the Milk and Dairy food group and combined those foods with Protein foods. The other two food groups are now Grains and Vegetables and Fruit.

The new Guide centers it’s dietary advice around 3 “Guidelines”.

Guideline 1 of the new Canada Food Guide focuses on eating from the different food groups and stresses that Canadians should eat plant-based foods more often because they lower intake of saturated fat.

Guideline 2 of the new Canada Food Guide encourages Canadians to limit processed or prepared foods and states the reason is because they contribute excess sodium, sugar and saturated fat.

Based on this definition, dishes made with lots of cheese and fried chicken are high in saturated fat and sodium, and thus are categorize as foods that undermine healthy eating.

Does eating cheese really undermine healthy eating?

Or a rib steak?

Or milk?

As covered in previous articles I’ve written on the new Canada Food Guide, I am not convinced that there is a compelling reason to limit real, whole food simply because it is high in saturated fat.

Guideline 3 of the new Canada Food Guide encourages Canadians to learn how to prepare and cook their own food and promotes the use of nutritional food labels as a tool to help them make informed choices.

The fact is, there are no nutrition food labels on unprocessed food (real, whole foods).

Choosing Healthy Food

As I’ve said in prior articles, Canadians can use the new Canada Food Guide to make up healthy meals by focusing on the part of Guideline 1 which encourages them to eat “real, whole food” and on the part of Guideline 2 which encourages them to “limit processed or prepared foods” — and by defining “processed foods” using the NOVA category of “ultra-processed foods” given above. In this way they will be able to design meals with a wide range of healthy and interesting foods.

Defining what is healthy based on how much a food is processed makes good sense. In this way people are free to add bread and cheese, and salted, pickled or cured foods (including meat, fish, seafood, vegetables, legumes) to their unprocessed foods (whole foods in their original state) and minimally processed foods to make up an interesting and healthful meal.

Furthermore, categorizing food using the NOVA categories based on the degree of food processing avoids lumping foods made with lots of real cheese with fried chicken as those that undermine healthy eating, based on their saturated fat and sodium content.

More Info?

If you would like to have a Meal Plan designed to meet your health and nutritional needs, I can help.

To your good health!

Joy

You can follow me on:

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

some image(s) © https://traineracademy.org/

References

Public Health Agency of Canada, Canadian Institute for Health Information. Obesity in Canada. A joint report from the Public Health Agency of Canada and the Canadian Institute for Health Information. Ottawa: Public Health Agency of Canada & Canadian Institute for Health Information; 2009. 62 pages.
Katzmarzyk PT. The Canadian obesity epidemic: an historical perspective. Obes Res. 2002, Jul;10(7):666-74.
Public Health Agency of Canada. Canadian Chronic Disease Indicators, Quick Stats, 2017 edition. Ottawa: Public Health Agency of Canada; 2017. 4 pages
NCHS Data Brief, Prevalence of Obesity Among Adults and Youth: United States, 2015-2016, https://www.cdc.gov/nchs/data/databriefs/db288.pdf
American Heart Association, Statistical Fact Sheet 2013 Update, High Blood Pressure, https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf
American Heart Association, Heart Disease and Stroke Statistics-2019 At-a-Glance, https://healthmetrics.heart.org/wp-content/uploads/2019/02/At-A-Glance-Heart-Disease-and-Stroke-Statistics-%E2%80%93-2019.pdf
Centers for Disease Control and Prevention, New CDC report: More than 100 million Americans have diabetes or prediabetes, https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
Liu AG, Ford NA, Hu FB, Zelman KM, Mozaffarian D, Kris-Etherton PM. A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion. Nutr J. 2017 Aug 30;16(1):53. doi: 10.1186/s12937-017-0271-4.
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.
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 Nov;14 Suppl 2:21-8. doi: 10.1111/obr.12107.
Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultraprocessed food and drink industries. The Lancet. 2013 Feb 23;381(9867):670-9. doi: 10.1016/S0140-6736(12)62089-3.
Baker P, Friel S. Food systems transformations, ultra-processed food markets and the nutrition transition in Asia. Global Health. 2016 Dec 3;12(1):80.
Moubarac JC. Ultra-processed foods in Canada: consumption, impact on diet quality and policy implications. Montréal: TRANSNUT, University of Montreal; December 2017.
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

June 16, 2019June 17, 2019

A Little Black Dress – a personal health and weight loss update

Yesterday I had an occasion to wear a new little black dress that I had bought, and remembered the last time I wore one. Ironically, it was for my Master’s convocation just over 11 years ago, and the dress was a size 16. My degree was in Human Nutrition, yet I was very overweight and had pre-diabetes.

The degrees on the wall did not help me understand why â — despite my best efforts to “exercise more and eat less”, I was still overweight. Despite my research related to the neurotransmitter dopamine, it was not known at the time how dopamine is involved in the potent joint reward system of eating foods that are a combination of both carbohydrate and fat (you can read more about that here).

I did not understand why following the advice of my physician didn’t help. I ate according to the (then) Canadian Diabetes Association (now called Diabetes Canada)’s recommendation to eat 65 g of carbohydrate at each meal and 25-45 g of carbs at each snack â — along with lean protein and monounsaturated and polyunsaturated fat and participated in exercise several days each week. I ate “plenty of healthy whole grains” and “lots of fruit and vegetables“, along with low fat dairy, yet a year later progressed to Type 2 Diabetes; what I was told was a “progressive, chronic disease”.

My studies didn’t help me understand the impact of high levels of circulating insulin on obesity and the effect of the after-meal and after-snack rise in insulin and then it’s drop shortly later on hunger. The reality was, the advice we were taught to “eat less and move more” did nothing to address the underlying issue of being hungry every few hours. In fact, the detrimental effects of high circulating levels of insulin weren’t taught; only the effects of high blood sugar.

My studies didn’t help me understand that “plenty of healthy whole grains” for someone who is already insulin resistant, with high levels of circulating insulin isn’t helpful. I didn’t understand how eating plenty of fruit was further contributing to my problems; both because of it’s high carbohydrate load, as well as it being a high source of fructose. I drank 3 glasses of low-fat milk daily, but didn’t understand the effect of all of those extra carbohydrates on my blood sugar, as well as underlying insulin response. It was not part of what I studied â — either in my undergraduate degree or Master’s studies, because it simply was not well known.

It is only recently (April 18, 2019) that the American Diabetes Association (ADA) issued their Consensus Report which indicated that “reducing carbohydrate intake has the most evidence for improving blood sugar” (you can read more about that here). In fact, the ADA now includes both a low carbohydrate eating pattern and a very low carbohydrate (keto) eating pattern as Medical Nutrition Therapy for the treatment of those with pre-diabetes, as well as adults with Type 1 or Type 2 Diabetes.

While these are not currently part of Diabetes Canada‘s options, they are recommendations available to those in the United States. In fact, the European Association for the Study of Diabetes (EASD) also classifies low carb diets as Medical Nutrition Therapy and Diabetes Australia released their own updated position paper for people diagnosed with Diabetes who want to adopt a low carbohydrate eating plan.

Many studies already demonstrate that a well-designed low carbohydrate diet is both safe and effective for the treatment of obesity and Diabetes (see the Physician and Allied Health Provider tab on my affiliate low carbohydrate web site for more information) but much of this has only come to light in the years since I graduated with my Master’s degree.

In the last 4+ years since I first learned about the therapeutic use of a low carbohydrate diet, I have read scores of studies in an effort to become well-informed and continue to do so in order to stay current with the emerging evidence.

On March 5, 2017 I began what I have called “A Dietitian’s Journey”. Over the subsequent two years, I put my Type 2 Diabetes into remission, lowered my dangerously high blood pressure and achieved a normal body weight and optimal waist circumference.

You can read my story under A Dietitian’s Journey on my affiliate site.

I have been in maintenance mode for more than three months and have been able to maintain my weight loss and health gains with little effort.

This photo was taken of me yesterday in my new “little black dress”.

The bulk of my Dietetic practice in the past focused on food allergy and food sensitivity (including Celiac disease, Irritable Bowel Syndrome, Inflammatory Bowel Disease), but I am now able to provide a range of options for weight loss and improvement in many metabolic conditions, including Type 2 Diabetes, hypertension and abnormal cholesterol that I was unable to offer a few years ago. I offer variety of evidence-based approaches, including a Mediterranean Diet, a plant-based whole foods approach (vegetarian or including meat, fish and poultry), as well as a low carbohydrate approach (which is what I follow).

If you would like to learn how I can help you, 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/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd

June 2, 2019July 4, 2019

The Three Things 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 an 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 reference 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. As to the matter as whether one can exclude an entire food group is addressed in this article on my affiliate low carb website.

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 your 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;

Real, whole foods are nutritious and should be foundational for healthy eating
It is preferable to limit processed and prepared foods
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.

To your good health!

Joy

You can follow me on:

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

References

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

May 31, 2019July 8, 2019

Problems with Counting Net Carbs

People who eat a low carb or ketogenic diet often ask about calculating “net carbs” and are surprised by my reply, as it differs from what they’ve read online. The commonly held advice is to subtract “fiber” from the total amount of carbohydrate on the label to arrive at “net carbs” can lead to an underestimation of nutrient intake, as well as possibly an underestimation of the effect of the food on blood glucose and insulin release when those foods are processed into other foods by grinding and/or heating.

As with other evidence-based meal patterns, a “whole foods” approach when following a low-carb lifestyle, is preferable. That doesn’t mean that people shouldn’t enjoy the occasional low-carb treat, as long as they understand that a baked good prepared from almond flour is not equivalent in terms of nutrient availability to the whole almonds from which it is made.

“Net Carbs” and the Perils of Food Processing

In a two-part series of articles posted in March 2018 on my dedicated low-carb website that were titled The Perils of Food Processing, I showed that both the amount and type of food processing applied to a food impacts the amount of nutrients available for absorption by the body, as well as having varying effects on the body’s insulin and blood sugar response.

“Food processing” in this context means that amount that a food undergoes cutting or grinding and/or cooking in some way, including baking.

Mechanical processing, such pounding or grinding food is an ancient form of food processing which has an effect on how many nutrients are available to be digested. That is, the nutrients available to the body when food is eaten raw and whole versus raw and pounded is significant, and this holds true whether the food is animal protein such as meat or a starchy vegetable such as sweet potato. It is also true for foods such as almonds.

The availability of carbohydrate and energy is different for whole, raw almonds versus ground almonds such as almond flour — a staple in low carb and keto baking. More on that, below.

Changes in Insulin and Blood Glucose Response Resulting from Food Processing

As covered in the first article linked to above, mechanical processing of a food doesn’t change the amount of carbohydrate that is in it. That is, when we compare 60 g of whole apple with 60 g of pureed apple or 60 g of juiced apple, there is the same amount of carbohydrate in each. The Glycemic Index of these three are very similar so this isn’t very helpful to inform about the blood glucose response to actually eating these different foods.

When these foods are eaten, the insulin response and blood glucose response 90 minutes later is significantly different.

As can be seen by the graph on the right, in healthy individuals blood insulin level goes very high with the juiced apple and in response, blood glucose then goes very low, below baseline. The response seen with the juiced apple is typical of what is seen with ultra-processed carbohydrates.

The Effect of Mechanical Processing of Fruit on Blood Glucose Response – Gabor Erdosi – Food News 2018

The same effect that is true for fruit is true when grain is ground; plasma insulin response increases the smaller the particle size of the grain.

The Effect of Mechanical Processing of Wheat on Blood Glucose Response – Gabor Erdosi – Food News 2018

Whole grain releases less insulin than the same amount of cracked grains, which is 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.

What is true for wheat is also true for rice and of interest, there isn’t a big difference between the insulin response with brown rice versus white rice.

The Effect of Mechanical Processing of Rice on Blood Glucose Response – Gabor Erdosi – Food News 2018

While there is no difference in the Glycemic Index or Glycemic Load of whole wheat versus ground wheat or whole rice versus ground rice, there is a huge difference in the insulin response with difference types of mechanical processing.

Also as outlined in the previous articles (links above), the amount of fiber that was in the grain did not make a difference in the amount of insulin released, only the amount of mechanical processing of the grain. So, eating brown rice versus white rice won’t change the amount of insulin that is released.

Remember, insulin is a hormone that signals the body to store energy (calories), so increased insulin response in response to grinding food is important.

In short, it is the amount of cell disruption caused by grinding that increases insulin and glucose response; not the specific amount of carbohydrate in the whole food, nor the amount of fiber in the food.

For those with Type 2 Diabetes or pre-diabetes, applying “net carb” calculations to foods that have been ground is a problem; as it does not take into account the increased insulin release and resulting change in glucose response, as well as the change in energy availability caused by the grinding.

NOTE (June 2 2019): The fiber in the whole food and the ground food remains unchanged and is indigestible by the body, although it is digested by the gut microbiome into fatty acids. While fiber may slow the gastric emptying of the ground product (compared to the same product with the fiber removed), in and by itself the presence of fiber in the ground product compared to the whole food does not reduce the impact on insulin and glycemic response that the grinding causes.

The Effect of Cooking on Nutrient Availability

Also as documented in the first of the two articles on food processing, cooking also has an effect on nutrient availability. When grains are cooked they become much more digestible — meaning that more of the nutrients are 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 and these calories are now available to the body where they weren’t when they were raw.

When foods that are high in fat (lipid) such as peanuts are cooked, the amount of energy the body is able to derive from the food, increases.

The Effect of Cooking Lipid (fat) and Protein-rich Foods on Nutrient Availability – Gabor Erdosi Food News 2018

Does Food Processing Affect Almonds?

Yesterday, in preparing to write this article, I was curious if there was any information available specifically about almonds as almond flour is used in most low-carb and “keto” baked goods.

I went looking and found a September 2016 article in the International Journal of Food Science and Technology titled “A review of the impact of processing on nutrient bioaccessibility and digestion of almonds” [1] which documents the most common processing technique used on almonds and their effect on the digestion of nutrients.

In short, lab studies and animal and human studies demonstrate that there are marked differences in the way various forms of almonds (whole raw, whole roasted, blanched, milled flour) are digested and the amount of different macronutrients that are absorbed.

What is true with grinding grain, apples and peanuts holds true for almonds.

It is reasonable to assume that the body’s release of insulin and the corresponding glucose response is similarly changed by the increased bioavailablity of nutrients in those processed foods.

Ultra-processed foods, whether fruit, grains, or nuts are not treated by the body the same as whole, unprocessed foods. The macronutrient availability (i.e. amount of carbohydrate and energy) in whole, unprocessed foods is not the same as in the same foods that have been ground and/or heated, and the amount of insulin released and glucose absorbed can differ too.

Final Thoughts on “Net Carbs”

One cannot simply subtract the fiber that is contained in the whole, unprocessed food from the total carbohydrate content of the processed food and arrive at “net carbs” because the amount of macronutrient absorption of the food is increased due to the cell disruption of grinding and heating. For those with Type 2 Diabetes or pre-diabetes, one also needs to factor in the differential impact on insulin and blood glucose release that results from the food processing.

One can subtract the fiber in whole, raw almonds and arrive at “net carbs” on the assumption that the fiber is indigestible by the body and that the other nutrients listed on the label apply to the food in it’s current form, but roasting and grinding those same almonds into almond butter or grinding those almonds into almond flour and then baking (i.e. cooking) them into a host of low carb or keto ‘treats’ on the basis of their low “net carb” content can significantly underestimate their total macronutrient content.

Should one choose to use the idea of “net carbs”, it should be applied only to whole, unprocessed (not ground or heated) foods.

Ultra-processed foods, irrespective of the carbohydrate content of the original whole, unprocessed foods from which they are made are not equivalent in nutrient availability or the body’s response to them as to whole, unprocessed foods.

While low-carb and keto ‘treats’ may be nice as “sometimes foods”, they are not ideal as “everyday foods” if weight loss and lowering blood glucose and insulin response are goals.

More Info?

If you would like to know more about following a low carbohydrate lifestyle or to adopt it for health reasons, 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/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd

Copyright ©2019 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

Grundy MM, Lapsley K, Ellis PR. A review of the impact of processing on nutrient bioaccessibility and digestion of almonds. Int J Food Sci Technol. 2016;51(9):1937—1946. doi:10.1111/ijfs.13192

May 14, 2019

Is the Glycemic Index Reliable for Predicting Blood Sugar Response?

The infographic below has been making the rounds recently on social media and is based on the idea that high Glycemic Index (GI) foods can be represented by the effect those foods have on people’s blood sugar, compared to teaspoons of sugar.

The infographic below is one that I designed to explain the work of Dr. David Unwin who communicates the concept of Glycemic Index (GI) & specifically Glyemic Load (GL) in terms of how they impact blood sugar compared to teaspoons of ordinary table sugar, as outline in this post on my affiliate web site.

Here is one of Dr. Unwin’s infographics which describes the effect each food has on blood glucose based on Glycemic Index (1).

Infographic for health professionals to show how the glycemic index helps inform dietary choices (from Unwin D, Haslam D, Livesey G. It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited. Journal of Insulin Resistance. 2016;1(1))

The problem is, these tools are only as useful as Glycemic Index is reliable, so the question is, is GI (and GL which is derived from it) reliable for predicting blood sugar response?

If the Glycemic Index (GI) values (1) change between individuals for the same amount of the same food or (2) if they change value within the same individual when they are assessed at different times, then they cannot be relied on to predict blood sugar response in an individual.

Is Glycemic Index Reliable for Predicting Blood Sugar Response?

A study published in the American Journal of Clinical Nutrition (2) reported that individual response to individual carbohydrate-containing food vary so much that Glycemic Index values may not be useful in indicating blood sugar response in individuals.

The Study

Randomized, controlled, repeated tests on 63 healthy adults participated in 6 testing sessions over a twelve week period and fasted and abstained from exercise and alcohol before each session.

During each session participants ate either (1) white bread (test food) or (2) a standardized glucose drink (reference control).

Blood sugar values were measured at several points over the next 5 hours, and Glycemic Index was derived by testing the test food and reference in the same participant according to standard method. This is usual practice to control for the variability between people which may be caused by biological differences.

Results

Out of the 63 participants, in 22 participants blood sugar response was classified as “low”, in 23 participants it was classified as “medium” and in 18 participants it was classified as “high’ for the same amount of bread.

That is, white bread fell in all three Glycemic Index categories with different individuals. In addition, responses within the same individual varied by as much as 60 points between tests.

Interpretation of the Results

The study indicated that blood glucose response is affected by differing physical structure of similar foods, the effect of food processing and preparation methods, as well as meal consumption patterns (single or mixed meals).

The study authors concluded that the high inter- (between people) and intra-individual (within the same person) variation that was observed in the GI value of foods essentially resulted in the results being of no practical value.

“In summary, our data indicate substantial variability in GI value determinations for white bread despite the use of standardized methodology and multiple testing in a large number of healthy volunteers. The high degree of variability demonstrates that there is potential to misclassify foods into the 3 commonly used GI categories (low, medium, and high), which would result in the inability to distinguish between foods, thus invalidating the practical applicability of the GI value.“

The authors also indicated that this variability was also partly explained by differences in baseline HbA1c (i.e. glycated hemoglobin) which is an estimate of 3 month average of blood glucose control, as well as the insulin index (the differing insulin response to foods) both affect the GI value.

Individual Glycemic Response

It should be noted that inter-individual and intra-individual variation in glycemic response isn’t only to white bread, as in the above small study.

A 2015 study from Israel(3) involving 800 people who were monitored with continuous glucose monitors (CGMs) indicates that there isn’t a universal’ blood sugar response to either low Glycemic Index foods or high Glycemic Index foods, and that glycemic (blood sugar) response is very individual.

“We continuously monitored week-long glucose levels in an 800-person cohort, measured responses to 46,898 meals, and found high variability in the response to identical meals, suggesting that universal dietary recommendations may have limited utility”.

Some Final Thoughts…

One cannot reliably predict that a specific amount of carbohydrate-based food will raise a person’s blood sugar the same amount as a certain number of teaspoons of sugar, because each carbohydrate based food will have different effects on different people, and different effects within the same individual, at different points in time.

More Info?

If you would like to know how to determine how you respond to specific carbohydrate-based foods and how to know which carbohydrate-based foods spike your blood sugar and which don’t, I can help.

You can learn more about my services including individual appointments and packages 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

You can follow me on:

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

Reference

Unwin D, Haslam D, Livesey G. It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited. Journal of Insulin Resistance. 2016;1(1), a8. http://dx.doi.org/10.4102/jir.v1i1.8
Matthan NR, Ausman LM, Meng H, Tighiouart H, Lichtenstein AH. Estimating the reliability of glycemic index values and potential sources of methodological and biological variability. Am J Clin Nutr. 2016;104(4):1004—1013. doi:10.3945/ajcn.116.137208
Zeevi D, Korem T, Zmora N, et al. Personalized Nutrition by Prediction of Glycemic Responses. Cell. 2015 Nov 19;163(5):1079-1094.

May 8, 2019May 8, 2019

Cancer Cases Related to Excess Weight Will Triple Over Next 20 Years

A new study published today in Preventive Medicine estimates that excess body weight, including overweight and obesity is expected to become the second leading cause of preventable cancer in Canada, after tobacco over the next 20 years.

Cancer Rates Expected to Triple

The results of the new ComPARe study (Canadian Population Attributable Risk of Cancer) stemming from research conducted by the Canadian Cancer Society and a Canadian team of experts in epidemiology, biostatistics, cancer risk factors, and cancer prevention provides estimates of the number and percentage of more than 30 cancer types in Canada.

It found that if current trends continues, it is expected that new cancer cases related to overweight or obesity will triple over the next 20 years, from the current 7,200 cases per year to 21,200 cases per year. These figures are due to overweight and obesity alone and do not include the increase number of cancer cases that are expected due to smoking, physical inactivity / sitting too much or alcohol consumption.

Excess body weight increases the risk of esophageal and endometrial cancer by about 50% and increases the risk of kidney, gallbladder, stomach and liver cancers by 20-30%. Achieving and maintaining a healthy body weight can substantially lower the risk of these, and other cancers. The study estimates that if Canadians maintained a healthy body weight (BMI â©½ 25), that approximately 110,600 cancer cases could be prevented by the year 2042.

UPDATED (May 8, 2019 5:00 PM): It is not body weight per se that increases the risk of cancer. There are several proposed mechanisms where excess body weight may increase cancer risk, including alterations in the levels of hormones and growth factors, chronic inflammation, excess insulin and leptin. It is thought that excess insulin may help promote cancer cell growth and cause insulin resistance, which
increases the risk of colon, endometrial and kidney cancers in particular.

If you’d like to know how I can help you with symptoms of overweight or obesity (or some of the metabolic disorders that often accompany them), please let me know.

You can learn more about my services and their costs above under the Services tab or in the Shop and 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 our good health!

Joy

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Copyright 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.

May 5, 2019July 8, 2019

ADA: Brain’s Need for Glucose can be Fulfilled by the Body

In its recently published Consensus Report (April 18, 2019), the American Diabetes Association confirmed something that I have written about in several previous articles, including most recently in Part III of Carbohydrates are Not Evil and that is that it isn’t biologically essential to eat carbohydrate containing foods in the diet. From the top of page 4 of the Consensus Report:

“The amount of carbohydrate intake required for optimal health in humans is unknown. Although the recommended dietary allowance for carbohydrate for adults without diabetes (19 years and older) is 130 g/day and is determined in part by the brain’s requirement for glucose, this energy requirement can be fulfilled by the body’s metabolic processes, which include glycogenolysis, gluconeogenesis (via metabolism of the glycerol component of fat or gluconeogenic amino acids in protein), and/or ketogenesis in the setting of very low dietary carbohydrate intake.”

Body can make all the glucose it needs for the brain

That is, the body can make all the glucose the brain needs from the glycogenolysis (which is the breakdown of glycogen to glucose), via gluconeogenesis (which is the generation of glucose from glycerol or glucogenic amino acids) and via ketogenesis(which is from ketones generated in a very low dietary carbohydrate [ketogenic] diet). In short, dietary intake of carbohydrate is not essential. While there is no biological need to eat carbohydrate-based food, one certainly can and there are many good reasons to include some types of carbohydrate-containing food in the diet.

Because there is no essential need to eat carbohydrate because the body can make all the glucose it needs itself, the American Diabetes Association includes among its eating patterns both a low carbohydrate pattern (26-45% daily calories as carbohydrate) and a very low carbohydrate (ketogenic) eating pattern (20-50 g carbohydrate / day). How much carbohydrate is a major consideration for those who are pre-diabetic or Diabetic because as the ADA stated in this new consensus report;

“Carbohydrate is a readily used source of energy and the primary dietary influence on postprandial blood glucose.

That is, it is the carbohydrate in a meal that is the biggest predictor of how high blood sugar will rise after a meal, and how quickly. For those who want to improve their blood sugar levels (glycemia) the same report also makes it clear that;

“Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia* and may be applied in a variety of eating patterns that meet individual needs and preferences.”

For those adults with Type 2 Diabetes who are not meeting their blood sugar targets or who need to, or want to have their physician reduce their need for Diabetes medications, a low carbohydrate or very low carbohydrate (keto) eating pattern is a viable option;

“For select adults with type 2 diabetes not meeting glycemic targets or where reducing anti-glycemic medications is a priority, reducing overall carbohydrate intake with low or very low- carbohydrate eating plans is a viable approach.”

Remember, carbohydrate-based foods are not necessary for your brain because your body can make all the glucose it needs from the metabolic processes listed above. That’s not to say one has to avoid carbohydrate-based foods, but how much and how often can and is best determined based on people’s individual needs and glycemic response to carb-based foods. I recently outlined in another article based on the American Diabetes Association’s Consensus Report and which was posted on my affiliated low carbohydrate-focused website, that in the US a well-designed low carb or ketogenic diet to lower blood sugar need not have all the same foods or food groups as a diet based on The Dietary Guidelines for Americans because it is used as Medical Nutrition Therapy (i.e. is a therapeutic diet).

While these are the guidelines in the US, in Canada individuals have the right to choose a low carbohydrate lifestyle if that is their personal preference.

If you would like some professional support to begin eating this way or to continue eating this way, I can help. I provide Registered Dietitian services to those in any province in Canada (except PEI), and for those in the US, I can provide nutrition education to help you know how to eat according to a low carb eating pattern.

You can learn more about my services including individual hourly appointments and sessions as well as packages above under the Services tab or in the Shop and 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

Here are the links to other articles that I wrote about the new ADA Consensus Report:

April 24, 2019 – ADA Eating Patterns Differ from The Dietary Guidelines for Americans April 23, 2019 – ADA includes use of a Very Low Carb (Keto) Eating Pattern in New Report

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Reference

Evert, AB, Dennison M, Gardner CD, et al, Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report, Diabetes Care, Ahead of Print, published online April 18, 2019, https://doi.org/10.2337/dci19-0014 Copyright

April 23, 2019July 8, 2019

ADA includes use of a Very Low Carb (Keto) Eating Pattern in New Report

On April 18, 2019, the American Diabetes Association published a new Consensus Report which not only includes the use of a low carbohydrate eating pattern of 26-45% of total daily calories as carbohydrate, but in this report also includes the use of a very low carbohydrate (ketogenic) eating pattern of 20-50 g carbs per day. The report is clear that there is no “one-size-fits-all” eating pattern for the prevention or management of diabetes, and that it unrealistic to expect that there should be just one eating pattern for everyone; especially given the wide variety of people affected by diabetes and pre-diabetes, including their varied cultural backgrounds, personal preferences, co-occurring conditions and the variety of socio-economic backgrounds from which they come.

The new report underlines several eating patterns that are effective to varying degrees for achieving different goals, with potential benefits including HbA1C reduction, weight loss, lowered blood pressure, improved lipids (higher HDL-c, lower LDL-c), lower triglycerides (TG), but says clearly that low carb eating patterns show the most evidence for blood glucose control;

“Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia (blood sugar) and may be applied in a variety of eating patterns that meet individual needs and preferences.”

The new Consensus Report includes low carb eating patterns and very low carb (keto) eating patterns among the choices of eating patterns for those with pre-diabetes as well as adults with Type 1 or Type 2 Diabetes.

The various eating patterns with their different potential benefits are summarized in Table 3, below;

Table 3 – Eating Patterns reviewed for this report

The report also indicates that for adults with Type 2 Diabetes not meeting their blood sugar targets, or where there is a need to lower anti-glycemic medications that lower blood sugar, that

“reducing overall carbohydrate intake with low- or very low- carbohydrate eating plans is a viable approach.”

If you have been recently diagnosed as pre-diabetic or as having Type 2 Diabetes (T2D) and would like support to reverse the symptoms through a low carbohydrate or very low carbohydrate eating pattern, then I can help. I also don’t believe there is a “one-sized-fits-all” approach to either of these and will work within you needs to design an individual plan just for you.

You can learn more about my services including individual hourly appointments and sessions as well as packages 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

You can follow me on: Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd

Copyright ©2019 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

April 18, 2019July 8, 2019

Eating one slice of bacon per day does NOT increase your colon cancer risk

Yesterday, the headlines screamed out from around the world that a new study from Oxford University found that there is a 20% higher chance of developing colorectal cancer from eating as little as one strip of bacon per day. This sounds terrible, but is it true? To understand what this study is reporting, it is important to understand the difference between relative risk and absolute risk.

Absolute Risk

It was known before this study, that regardless what people eat, there is approximately a 5% chance of developing colorectal cancer in a person’s lifetime (whether they eat bacon every day or not). This is known as the absolute risk.

A 5% likelihood means that for every 100 people, 5 will get colorectal cancer regardless what they eat.

Illustrated, this looks as follows;

Absolute Risk: 5% = 5 per every 100 people

Relative Risk

The study reported that there is a 20% higher chance of developing colorectal cancer by eating as little as one strip of bacon per day.

This means that compared to not eating bacon daily, eating it daily results in one more person per 100 people developing colorectal cancer in their lifetime.

This is known as relative risk and illustrated that looks as follows:

Headlines as click-bate

“People who ate 76 grams of red and processed meat per day — that’s in line with current guidelines and roughly the same as a quarter-pound beef burger — **had a 20% higher chance of developing colorectal cancer** compared to others, who ate about 21 grams a day” – https://www.cnn.com/2019/04/17/health/colorectal-cancer-risk-red-processed-meat-study-intl/index.html

It wasn’t only the American media that reported this, Canadian new outlet CTV did also.

“**Scientists found that colorectal cancer risk rose 20 per cent with every 25 grams of processed meat people ate per day, equivalent to a strip of bacon or slice of ham.**“ (https://www.ctvnews.ca/health/just-a-strip-of-bacon-a-day-increases-cancer-risk-u-k-study-finds-1.4383867)

Each individual person’s increased risk of getting colorectal cancer by eating as little as 1 strip of bacon per day is NOT 20%! Their increased absolute risk of getting colorectal cancer (*based on this study) is 0.08%.

*this study was an epidemiological study, not a clinical study and can only show if there is an association between two factors and cannot make any conclusions about cause. The difference is explained below.

The study found that for every 10,000 people who ate 21g a day of red and processed meat, 40 were diagnosed with colorectal (bowel) cancer, and a single slice (or rasher) of bacon is ~23g.

i.e. 40 / 10,000 = 0.4%

The study also found that for every 10,000 people who ate 76g a day of red and processed meat, 48 were diagnosed with colorectal (bowel) cancer.

i.e. 48/10,000 = 0.48%

The actual chance of a person getting colorectal cancer (i.e. absolute risk) from eating bacon daily is the difference between these two numbers; i.e. 0.4% – 0.48% = 0.08%

Association is not Causation

This was an epidemiological study based on population data, and was not a clinical study.

Epidemiological studies are the study of diseases in populations and are helpful for researchers to know which areas warrant clinical studies.

It is important to know that epidemiological studies cannot attribute “cause” of disease or death. When an epidemiological study finds an “association” between two factors such as bacon and higher colon cancer rates — this does NOT mean that eating bacon ’causes’ heart disease.

Based on this study, all that can be said is that there was an increase in the association between eating bacon and absolute rates of colon cancer of 0.08%.

Not so impressive now, is it?

If you are having trouble sifting through all the information you read and in knowing if it is accurate, or even says what it seems to be saying, I can help. Sometimes people start by booking an appointment just to ask me those types of questions, because they want credible answers.

You can learn more about my services including individual hourly appointments and sessions as well as packages 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

You can follow me on:

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

Reference

Kathryn E Bradbury, Neil Murphy, Timothy J Key, Diet and colorectal cancer in UK Biobank: a prospective study, International Journal of Epidemiology, , dyz064, https://doi.org/10.1093/ije/dyz064

April 11, 2019July 8, 2019

New Study: Vitamin and Mineral Supplements Won’t Help You Live Longer

A newly published large-scale epidemiological study has reported that taking vitamin and mineral supplements does not reduce the risk of cardiovascular disease such as heart attack and stroke, cancer rates or other causes of health-related death. The study published Tuesday, April 9, 2019 in the Annals of Internal Medicine analyzed US nutritional data from 30, 899 adults over the age of twenty from the NHANES survey between 1999 to 2010 and linked it to mortality data from the National Death Index [1]. During the six year follow-up period there were 3613 deaths; of which 945 were cardiovascular-related and 805 were from cancer.

Vitamin and Mineral Supplement versus Nutrient Intake from Food

The study found that use of vitamin and mineral supplements was not related to improved outcomes in rates of death from cardiovascular disease, cancer or all-cause health related death. Adequate intake of vitamin A, vitamin K, magnesium, zinc and copper was associated with reduced rates of cardiovascular disease and death from all health-related causes, but these improved associations only applied to those who obtained these nutrients from food.

Calcium Supplements – too much of a ‘good’ thing

So many adults take calcium supplements, however calcium intake from supplements of â‰¥ 1000 mg/day (which many adults take!) was associated with increased risk of death from cancer.

Want to Live Longer? Eat Whole, Real Food

Based on this large-scale epidemiological study, eating foods rich in vitamin A, vitamin K, magnesium, zinc and copper was associated with reduced rates of cardiovascular (CVD) disease and death from all health-related causes. Good news! All of these nutrients are widely available in whole, real foods that also happen to be low in carbohydrate.

Zinc and Copper

Meat and seafood are some of the richest sources of zinc and copper.

Vitamin K

Dark, leafy greens are excellent sources of vitamin K. Vitamin K is needed to help the body absorb vitamin D and to help with proper calcium utilization.

Magnesium

Nuts and seeds, including cocoa beans (think ‘dark chocolate’!) are very good sources of magnesium, as are avocados

Vitamin A

…and yellow and orange vegetables are excellent sources of vitamin A.

Final thoughts…

Epidemiological studies (which are the study of diseases in populations) are helpful to know what areas warrant good quality clinical trials, but aren’t useful for attributing “cause” of disease or death. When an epidemiological study finds an “association” between two factors, this does NOT mean that one causes the other. For that, clinical trials are necessary. That said, eating whole, real foods that also happen to be low in carbohydrate are an excellent way to get all of the nutrients that this study found are associated with lower rates of cardiovascular disease and death from all health related causes and it is pretty difficult to eat too much of any nutrient when eating whole, real food. Since taking vitamin and mineral supplements is not associated with lower rates of disease or death, and in the cases of calcium supplements may even be associated with negative health outcomes, eating a whole-food diet rich in the above foods is the safest way to ensure adequate intake of these nutrients. If you would like more information about how much of these foods you should be eating, I’d be glad to help. Please have a look at the Services tab or the Shop for more information. To your good health! Joy You can follow me on:

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

Copyright ©2019 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

Chen F, Du M, Blumberg JB, Ho Chui KK, Ruan M, Rogers G, et al. Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults: A Cohort Study. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-2478

April 9, 2019July 8, 2019

Complex Carbohydrates as Long Chains of Sugar Molecules

An analogy is a comparison between similar ideas to help illustrate one of them. The featured photo for this post are sugar crystals on a string and the reason for this will become clear. The idea for this article came when someone I follow on social media (Dr. RD Dikeman*) posted the graphic below, which shows complex carbohydrates as long strings of glucose, which starches are. But there are also other types of complex carbohydrates that are long strings of different sugar molecules that can impact blood glucose differently. I thought a simple explanation of what “complex carbohydrates” are, how they are digested and how these can affect blood sugar differently might be helpful, so that is what this article is about.

*Dr. RD Dikeman holds a PhD in Theoretic and Mathematical Physics and has become very knowledgeable in carbohydrate metabolism as a result of his son having been diagnosed in 2013 with Type 1 Diabetes. His son was eating 40-60 g of carbohydrate per meal and was experiencing a “roller-coaster ride” of high and low blood sugars, including an incidence of “ketoacidosis”; which is a life-threatening condition when the body produces high levels of ketones due to an insufficiency of insulin. This should not be confused with “ketosis” where the body switches to using fat stores for energy, such as after an overnight fast. Five years ago, Dr. Dikeman’s son began to follow the low carbohydrate protocol of Dr. Richard Bernstein MD (outlined in his book “Diabetes Solution”) and since that time has been able to maintain normal normal blood sugar levels with the minimum required doses of insulin.

I liked the analogy of Dr. Dikeman’s graphic and wanted to use it as a ‘jumping off point’ for this article.

Glucose Explain Simply

Glucose (also called dextrose) is the type of sugar found in the blood which is why the common term “blood sugar” and the more clinical term “blood glucose” refer to the same thing. Glucose is one of the two sources of energy (along with ketones) that are used to fuel the body’s cells. Even people that don’t eat “low carb” will make ketones after a night’s sleep, so the body of healthy people runs on both glucose and ketones. The carb-containing foods that we eat are broken down into glucose for energy or the body makes the glucose it needs for the brain and red blood cells from other substances in a process called gluconeogenesis.

The Glucose-Complex Carb Analogy

In the graphic above, Dr. Dikeman questions whether people such as Diabetics that have trouble metabolizing glucose should be eating complex carbohydrates which are essentially just long strings of glucose molecules strung together like beads on a chain. As in Dr. Dikeman’s illustration, some complex carbohydrates such as starch are just long chains of glucose molecules, however other complex carbohydrates are made up of other sugars such as galactose and fructose, along with glucose. Because of that I wanted to expand on Dr. Dikeman’s illustration.

Simple and Complex Carbs

One way that carbs are sometimes classified is as “simple” or “complex”; with starch and fiber being categorized as complex carbs and all sugars being categorized as simple carbs.

Simple Sugars

There are two types of simple sugars; monosaccharides and disaccharides. Mono means “one” and saccharides means “sugar” so a monosaccharide is just a single sugar molecule. Di means “two”, so a disaccharide is two sugar molecules joined together.

Monosaccharides

As mentioned above, monosaccharides are made up of only a single sugar molecule and examples of these are glucose, fructose and galactose. All three monosaccharides have 6 carbons and the same chemical formula but look entirely different from each other. For example, glucose and galactose are 6-ring sugars and fructose is a 5-ring sugar. Glucose is usually found in food bound either to other glucose molecules, as in Dr. Dikeman’s illustration above, or may be bound to other types of sugar molecules in a disaccharide (2 sugar molecules) or a starch or fiber (long chain of sugar molecules). Fructose is the sugar found in fruit and since it is a 5-ring sugar, it can’t simply be broken down into glucose, which is a 6 ring sugar. Galactose is a six ring sugar that rarely exists on its own in food but that can be broken down in the body through digestion. It is usually found bound to glucose to form lactose, the sugar found in milk and dairy products.

Disaccharides

Disaccharides are two monosaccharide sugar molecules bound together. Sucrose is ordinary table sugar and made up of glucose-fructose. Lactose is the sugar in milk and milk products and is glucuse-galactose Maltose which rarely occurs naturally in foods, is glucose-glucose. Maltose is used in food processing such as the shiny glaze on Chinese roast duck.

complex carbohydrates

Complex carbohydrates are made up of more than two monosaccharides (sugar molecules). Oligosaccharides (where oligo means “scant” or “few”) are made up of 3-10 sugar molecules, whereas polysaccharides are made up of hundred or even thousands of monosaccharides (sugar molecules).

Oligosaccharides

Oligosaccharides are made up of 3-10 sugar molecules and the two most common are some of the complex carbohydrates found in dried beans, peas and lentils[1]. Raffinose is an oligosaccharide made from 3 sugar molecules: galactose-glucose-fructose and stachyose is an oligosaccharide made from 4 sugar molecules: galactose-galactose-glucose-fructose. The body can’t break down either raffinose or stachyose, but this is done by the bacteria in the intestine.

Polysaccharides

Polysaccharides are made up of hundreds or thousands of sugar molecules linked together. When those sugar molecules are only glucose, the polysaccharide is called “starch”. Some polysaccharides form long straight chains while others are branched like a tree. These structural difference affect how these carbohydrates behave when they’re heated or put in water. The way the monosaccharides are linked together makes the polysaccharides either digestible as in starch, or indigestible as in fiber. Polysaccharides found in plant foods such as fiber, cellulose, hemicellulose, gums and mucilages (such as psyllium) are indigestible by the body so won’t be covered in this article, but it should be noted that they can slow down the absorption of digestible carbohydrate.

Starch

Starches are long chains of glucose molecules strung together like beads on a string and are the ones illustrated in Dr. Dikeman’s illustration, above. Starches are found in grains such as wheat, corn, rice, oats, millet and barley as well as in legumes such as peas, beans and lentils* and tubers such as potatoes, yams and cassava.

*Recall as mentioned above that peas, beans and lentils also have the complex carbohydrates called oligosaccharides which are not broken down by the body, but by the bacteria of the gut.

There are two types of starches; the long unbranched chains called amylose and the long branched chain ones call amylopectin. What is important in this context is that the long branched chain starches called amylopectin are more easily digested. The body digests most starches very easily, although those with a high percentage of amylopectin (such as cornstarch) are digested much more easily than those with a high amount of amylose, such as wheat starch [1]. Since starches are just glucose molecules linked together and they are easily broken down to individual glucose molecules, starches can quickly affect the blood sugar of those who are pre-diabetic or have Diabetes. That is the “point” behind Dr. Dikeman’s illustration, above which I have modified slightly, below.

adapted from graphic by RD Dikeman by Joy Y. Kiddie, MSc, RD

Those who are Diabetic (or pre-diabetic) already have challenges with their blood glucose, so does eating foods such as starches that are nothing more than long strings of glucose really make sense?

Note: While the fiber content of whole grain pasta will slow down its digestion compared to refined pasta, it is still long strings of glucose molecules. Think of whole wheat pasta as a string of pearls with in addition to the pearls, in this case fiber.

Digestion of Carbohydrates

Carbohydrate digestion begins in the mouth where an enzyme in saliva called amylase breaks starch down into shorter polysaccharides and maltose. The acidity of the stomach temporarily stops the effect of the salivary amylase, but the digestion of carbohydrate starts up again in the small intestine where most carbohydrate digestion takes place.

Digestion of carbohydrates begins again when the pancreas secretes pancreatic amylase into the small intestine. In the small intestine, starch is broken down in to many, many individual units of the disaccharide maltose, which are simply two glucose molecules linked together.

Then, enzymes located to the brush border of the small intestine break the alpha bond which holds the two glucose molecules together. It’s easy to understand how starch, which is simply long chains of glucose molecules strung together are so easily broken down when digestion already starts in the mouth and is completed in the small intestine where the disaccharide (maltose) is broken down into 2 glucose molecules.

In the small intestine, other enzymes split other disaccharides into monosaccharides; so for example, the enzyme sucrase splits the disaccharide sucrose into glucose and fructose and the enzyme lactase splits the disaccharide lactose into glucose and galactose. Note that these other disaccharides are only 1/2 glucose.

Absorption of Carbohydrates

Monosaccharides are absorbed into the mucosal cells of the small intestine and travel to the liver, where galactose and fructose are converted to glucose and the glucose is stored in the liver as glycogen. Glycogen is long, highly branched chains of glucose molecules (similar to amylopectin, but much more highly branched).

When needed, the liver can break down glycogen into glucose at a rate of 100 mg to 150 mg of glucose per minute for up to 12 hours [2]. When glycogen stores of the liver are already full, the glucose from the broken down carbohydrate with the help of the hormone insulin converts the excess glucose into fat and sends to other parts of the body to be stored in adipose tissue.

Carbohydrate-based Foods in the Diet

As covered in previous articles including this one , there is NO requirement for people to eat carbohydrate-based food” provided that adequate amounts of protein and fat are consumed“[3] which are used to provide essential glucose for the brain via gluconeogenesis. This does not mean that I recommend people don’t eat any carbohydrate-based food!

Which carbohydrate-based food people are able to eat and in what quantity without it affecting their blood sugar to any large degree varies considerably from person to person[4], whether or not they are Diabetic. For those who already have Type 2 Diabetes or are pre-diabetic, a personalized nutrition approach is needed. This is often called “eating to your meter“; testing a specific quantity of a food by itself, to see how your blood sugar responds.

Based on research, some people with Type 2 Diabetes can do well eating certain types of legumes (pulses) including black beans, white navy beans, pinto beans, red and white kidney beans, chickpeas and fava beans [5] which is helpful for those who follow a plant-based vegetarian diet. Once people have lowered their HbA1C and fasting blood glucose levels and achieved remission of Type 2 Diabetes symptoms, I work can work with them in determining which foods they can re-introduce into their diet and in what quantities and how often, so as not to adversely impact their blood sugar. Some do better than others.

Over the last 4 years of my clinical practice, I have found that many people with pre-diabetes or Type 2 Diabetes can often manage their blood glucose well while including small servings (1/2 cup / 125 ml) of whole-food starchy vegetables such as winter squash (butternut, acorn, kobacha, etc.), as well as small servings of other starchy whole-food vegetables such as orange or purple yam, or peas. For those eating a moderately-low level of carbs (non-ketogenic) or want to keep eating these foods, I encourage them to choose these more often over starch-based foods such as pasta, rice and bread.

That doesn’t mean that people with Type 2 Diabetes shouldn’t ever eat whole, unmilled brown rice or quinoa but that avoiding refined starches such as white bread, pasta and rice is best preferable. I hope that you found this article helpful to understand what complex carbohydrates are, and why certain types of complex carbs are more of a challenge to those with Type 2 Diabetes or pre-diabetes.

If you have questions about how I can help you eat in a way to lower your blood sugar levels, please send me a note through the Contact Me form above and for information about the types of services I offer, please have a look under the Services tab or in the Shop.

To your good health,

Joy

You can follow me on: Twitter: https://twitter.com/lchfRD Facebook: https://www.facebook.com/BetterByDesignNutrition/ Instagram: https://www.instagram.com/lchf_rd

References

Chapter 4, Carbohydrates: Simple sugars and Complex Chains, http://samples.jbpub.com/9781284064650/9781284086379_CH04_Disco.pdf
Rappaport B, Metabolic factors limiting performance in marathon runners. PLoS Comput Biol. 2010; 6(10). doi: 10.1371/journal.pebi.1000960
National Academies Press, Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005), Chapter 6 Dietary Carbohydrates: Sugars and Starches”, pages 265-275
Zeevi D, Korem T, Zmora N, et al. Personalized Nutrition by Prediction of Glycemic Responses. Cell. 2015 Nov 19;163(5):1079-1094.
Sievenpiper, J.L., Kendall, C.W.C., Esfahani, A. et al. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diabetologia (2009) 52: 1479.

April 7, 2019May 16, 2024

Dietary Saturated Fat is Not Associated with Increased Risk of CVD

A recently published meta-analysis of 43 cohort or nested case-control studies up until July 1, 2018 [1] did not find that higher saturated fat intake is associated with higher risk of cardiovascular disease (CVD) events. This is the first study to examine the effect of total dietary fat intake and the intake of specific fatty acids on CVDs risk based on dose-response meta-analysis of prospective cohort studies.

It has been proposed that saturated fat (SFA) and trans fatty acids (TFA) contribute to CVD via inflammatory mechanisms and oxidative stress, mediated through the production of reactive oxygen species (ROS) [2,3]. With respect to trans fatty acids, this new study found that dietary TFA intake had a dose-response association with CVDs risk; specifically a 16% increased risk of CVD with an increased TFA intake of 2% of energy per day, however no association was observed between total fat or dietary saturated fatty acid (SFA) intake and the risk of CVDs [1]. In addition, this meta-analysis found no protective effect from the consumption of either monounsaturated fatty acids (MUFA), or polyunsaturated fatty acids (PUFA) and risk of CVDs, except PUFAs showed a protective effect in sub-group analysis followed up for more than 10 years [1].

These findings do not support 2010 recommendations of the WHO / FAO [4] which continue to influence national dietary guidelines around the world to recommend reducing intake of saturated fat in order to lower the rates of CVD.

As well, these new findings call into question the findings of the PREDIMED study [5] and the Lipid Research Clinics Prevalence Follow-up Study [6] that indicate that diets high in polyunsaturated fatty acid (PUFA) and monounsaturated fatty acid (MUFA) and low in saturated fatty acid (SFA) and trans fatty acids (TFA) are associated with reduced CVDs events.

The authors caution that;

“it is possible that the role of dietary fat played in the development of CVDs might be confounded by the fat sources. For instance, vegetables and fruits play protective roles in the development of CVDs. However, we could not investigate the different effects of fat from animal, vegetables and fruit separately in this current meta-analysis.” [1]

Some thoughts…

For almost 50 years it has been believed that dietary saturated fat intake was a risk factor for CVDs based on the assumption that dietary fat can increase low density lipoprotein (LDL) cholesterol and blood pressure and in turn, increase CVDs risk, however this meta-analysis of 43 cohort studies did not find a positive association between total dietary fat intake or saturated fat intake and CVDs risk.

The 2017 Prospective Urban Rural Epidemiological (PURE) study (covered in this earlier article) is the only prospective study to date which covered multiple world regions and which found that total dietary fat and types of dietary fat were not associated with cardiovascular disease or mortality and further, that dietary saturated fat had an inverse association with stroke and a risk of all-cause mortality with higher intake (up to ~14% of energy intake). That is, dietary saturated fat intake was protective.

The findings of the current meta-analysis study, combined with the findings of the 2017 PURE study call into question current dietary recommendations which continue to recommend that people limit dietary saturated fat in order to reduce cardiovascular risk. Such recommendations are included in the most recent Canada’s Food Guide which encourages Canadians to ”choose foods with healthy fats instead of saturated fat” and to ”prepare meals and snacks using ingredients that have little to no added sodium, sugars or saturated fat” (see this article for details) .

Post publication note (April 7, 2019): As I’ve stated in previous articles, I am not opposed to Canada’s new Food Guide. It is a huge improvement over it’s predecessor for many reasons already discussed. My two concerns that I’ve expressed previously remain; (a) that the recommendations for the general population to continue to limit saturated fat because it contributes to CVD has not been conclusively demonstrated. The only thing that has been shown is that saturated fat can raise LDL, but which LDL; the large fluffy sub-fraction, or the small dense sub-fraction? Please see article linked to above for an elaboration. My second concern is that; (b) the amount of carbohydrate in the diet is too high for the large percentage of the population that are metabolically unhealthy. Please see this article for an elaboration.

Author’s Conclusions

The study’s authors concluded that;

“This current meta-analysis of cohort studies suggested that total fat, SFA, MUFA, and PUFA intake were not associated with the risk of cardiovascular disease. However, we found that higher TFA intake is associated with greater risk of CVDs in a dose-response fashion. Furthermore, the subgroup analysis found a cardio-protective effect of PUFA in studies followed up for more than 10 years. Dietary guidelines taking these findings into consideration might be more credible.” [1]

If you would like to learn about the types of fats in your diet and how they may impact your health or those of your family, please send me a note through the Contact Me form on the tab above. You can learn more about the services I provide by clicking on the Services tab or having a look in the Shop.

To your good health,

Joy

You can follow me on:

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

References

Zhu Y, Bo Y, Liu Y, Dietary total fat, fatty acids intake, and risk of cardiovascular disease: a dose-response meta-analysis of cohort studies, Lipids in Health and Disease (2019) 18:91, https://doi.org/10.1186/s12944-019-1035-2
Sverdlov AL, Elezaby A, Qin F, Behring JB, Luptak I, Calamaras TD, Siwik DA, Miller EJ, Liesa M, Shirihai OS, et al. Mitochondrial reactive oxygen species mediate cardiac structural, functional, and mitochondrial consequences of diet-induced metabolic heart disease. J Am Heart Assoc. 2016;5:e002555.
Ruparelia N, Chai JT, Fisher EA, Choudhury RP. Inflammatory processes in cardiovascular disease: a route to targeted therapies. Nat Rev Cardiol. 2017;14:133—44.
Nations FaAOotU. Summary of conclusions and dietary recommendations on total fat and fatty acids in fats and fatty acids in human nutrition—report of an expert consultation. Geneva: FAO/WHO; 2010.
Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, Gomez- Gracia E, Ruiz-Gutierrez V, Fiol M, Lapetra J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279—90.
Guasch-Ferre M, Babio N, Martinez-Gonzalez MA, Corella D, Ros E, Martin-Pelaez S, Estruch R, Aros F, Gomez-Gracia E, Fiol M, et al. Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. Am J Clin Nutr. 2015;102:1563—73.
Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V, Iqbal R, Kumar R, Wentzel-Viljoen E, Rosengren A, 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;390:2050—62.

March 24, 2019April 3, 2019

Green Tea Should not be like Buckley’s®

Recently, I came across a social media post about someone that wanted to drink green tea for it’s health benefits, but just couldn’t get over it’s “bad taste”. I followed the origin of the thread to Reddit, where people guessed whether green tea’s “off taste” for that person may be genetic, like the taste of cilantro. While that can be the case (i.e. genetic sensitivity to a compound called 6-n-propylthiouracil which is found in some flavonoids), others touched on whether it was because the person was making tea using supermarket green tea bags rather than loose tea, whereas a few people hit on the complexity of the issue. In this post I will discuss some of the factors that affects whether your green tea has a pleasant or “off taste”, because after all green tea should be something you actually enjoy and not only drink for it’s health benefits.

NOTE: The first part of this article are some personal details of my experience learning to prepare multi-ethnic food and beverages and the second part of the article is specifically about the preparation of green tea and its health benefits.

Once a Foodie, Always a Foodie

I have been adventurous in trying different kinds of food and beverages since I’m little and I remember my parents taking me to an authentic Japanese restaurant even as a kid. As a teen, I enjoyed cooking multi-ethnic food and learned authentic Cantonese cooking in the 1970s when my mom took a course in Chinatown. In the 1980’s, I learned authentic Thai cooking from the friend of a family business associate who was from Thailand and in those days one couldn’t buy pre-made Thai curry pastes that are available everywhere now, so I sourced the raw ingredients in Lao-Thai groceries and hand-pounded them myself in a mortar and pestle (that I still own and use!). I still have the recipe books sent to me from Thailand.

It didn’t matter whether it was Asian, Middle Eastern or Jamaican, I was a bit of a purist; wanting the ingredients and cooking method to be as authentic as possible. For me, the best way to find out how to make something was to ask someone from that culture that loved to cook.

What was true about food was also true for beverages.

I couldn’t just enjoy a cup of coffee or glass of wine without knowing more. Whether it was the origin of the coffee beans, the length of time the beans were roasted, or how long the water is in contact with the beans — I needed to know, and I was interested in such things when it was not popular either.

Before “West Coast coffee” was a thing and before there ever was Starbucks® or Peet’s, there was a place called La Vieille Europe on St. Laurent Blvd in Montreal which was where I got my single origin, whole bean coffee. As I found out years later, the son of the roaster that owned that store taught the original roaster from Peet’s in the US how to roast beans. Small world.

When I lived in wine country (Sonoma county) of California for a few years in the early 2000s, I was determined to educate my palate to distinguish between different types of wine, which I did. I knew what I liked — which turned out to be an expensive habit when I returned to Canada after 9/11. At the beginning I explored the wines of Australia and found some I really liked, but missed the delicious and inexpensive wines of Sonoma and Napa.

Once again, my palate returned to coffee, but finding a decently roasted coffee in Vancouver BC was harder than I thought. Given that this was the “West Coast”, I was discouraged how difficult it was to find good quality Arabica beans that weren’t over roasted. I stumbled across a few small roasters that did an excellent job, but in time they modified their roasts for “local tastes”, so once again, I was back looking for a new roaster. On a few occasions, I ordered from La Vieille Europe in Montreal because in the 40 or 50 years they have been in business, they never lost their passion for properly roasted, single origin coffee.

Over the 20 years I have lived in Vancouver, I discovered the world of quality tea that is largely unknown to most non-Asian born Chinese. There was one excellent tea importer in the Chinatown that I knew of and one that is still in the Richmond Public market that have single origin estate teas that rival the diversity of the best coffee roaster. Over the past 20 years, I’ve explored different types of tea from China and have come to like a few; my favourite of which is a fermented tea known as Pu-ehr.

A number of years ago, I stumbled across matcha tea in a specialty Japanese store before it was a “thing”. Knowing nothing about it, I have since found out that I had been using ‘culinary matcha‘ (designed for making Japanese sweets) for drinking. No wonder it tasted bitter and I needed to blend it with other ingredients to make it palatable. Thankfully, when fresh it had the same health benefits, which I wrote about in 2013 in this article about the Role of Green Tea Powder (Matcha) in Weight and Abdominal Fat Loss. As you’ll read below, I have since learned about making and enjoying real ceremonial-grade matcha, which is intended for drinking from large matcha bowls.

Learning about Japanese Green Tea

At the beginning of this year, I began to explore green teas from Japan when I discovered Hibiki-An, an online tea importer from Uji region of Kyoto. My culinary world expanded once again.

Unable to decide between the many different types and grades of tea that they carry, I order a sampler of 3 types of green teas (Sencha, Gyokuro Superior and Sencha Fukamushi). They came in 4 oz individual bags — the quantity that can be reasonably be used up within 3 months, when it is fresh. All 3 teas were all of “superior” grade, which is not the best quality (as my palate is not developed yet) but is a high grade tea.

When the tea arrived, it came with very specific brewing instructions (a summary of the much more detailed instructions on their web page). I’ve since learned that different types of green tea require different water temperatures and different lengths of brewing time.

Wow, who knew?

For the purpose of “cooling” the water to just the right temperature, there is a yuzamashi — which is a small ceramic cup with a spout that the boiled water gets poured into to cool momentarily before being poured into the kyuzu; a special tea pot with a single handle, built in mesh filter and large opening for the water (see photo, above).

You don’t need the get fancy, though. I had these things for years from my days exploring different regional teas, but one can use an ordinary bowl to cool the water and any plain ceramic tea pot to brew the tea in!

Tea to Water Ratio, Water Temperature and Steeping Time

Each type of green tea has a very specific ratio of green tea leaves to water, and very specific water temperatures and steeping time.

For example, of the three teas in my sample set, Sencha is brewed at 80° Celsius (176 ° Fahrenheit) for one minute, Gyokuro is brewed at 60-70 ° Celicus (140-158° Fahrenheit) for 1 -1/2 to 2 minutes and Sencha Fukamushi is brewed at the same temperature as regular Sencha, but for only 40-45 seconds.

I’ve discovered that following these guidelines using good quality, fresh tea leaves makes a cup of tea that is like nothing I’ve tasted anywhere before. It is not simply snobbery, but the science of what makes for a good cup of tea.

Note: I downloaded several studies that have researched the difference in brewing time, water to tea leaf ratio and water temperature but have decided against boring anyone with the details.

Recently, I became ready to move onto “real” matcha tea and ordered some from the same supplier in Japan.

It came in tiny cans (quantities that should be used up in a 3 week period).

The colour was a bright jade green and the taste had no hint of bitterness whatsoever!

It tastes amazing!

My teas ordered from Japan are my “weekend teas” and during the week I used run-of-the-mill Sencha purchased locally at a Japanese store.

I drink them because I like them and for the health benefits.

Health Benefits of Green Tea

The health benefits of green tea are many. Several large-scale population studies have linked increased green tea consumption with significant reductions in the symptoms of metabolic syndrome; a cluster of clinical symptoms which include insulin resistance and hyperinsulinemia (high levels of circulating insulin), Type 2 Diabetes, high blood pressure, and cardiovascular disease including coronary heart disease and atherosclerosis.

Catechins make up ~ 30% of green tea’s dry weight, of which 60—80% are catechins. Oolong and black tea which are produced from partially fermented or completely fermented tea leaves contains approximately half the catechin content of green tea.

It is believed that epigallocatechin gallate (EGCG) which is the most abundant catechin in green tea actually mimics the action of insulin, which has positive health effects for people with insulin resistance or Type 2 Diabetes [Kao et al].

EGCG also lowers blood pressure almost as effectively as the ACE-inhibitor drug, Enalapril, having significant implications for people with hypertension (high blood pressure) and cardiovascular disease [Kim et al].

Green tea catechins also have benefit for weight loss. A 2009 meta-analysis of 11 green tea catechin studies found that subjects consuming between 270 to 1200 mg green tea catechins / day (1 — 4 tsp of matcha powder per day) lost an average of 1.31 kg (~ 3 lbs) over 12 weeks with no other dietary or activity changes [Hursel].

Drinking 8-10 cups of green tea per day is enough to increase blood levels of EGCG into a measurably significant range [Kim et al], but matcha contains 137 times greater concentration of EGCG compared to green tip tea [Weiss et al].

WARNING TO PREGNANT WOMEN While EGCG has also been found to be similar in its effect to etoposide anddoxorubicin, a potent anti-cancer drug used in chemotherapy [Bandele et al], high intake of polyphenolic compounds during pregnancy is suspected to increase risk of neonatal leukemia. Bioflavonoid supplements (including green tea catechins) should not be used by pregnant women [Paolini et al].

Green Tea Shouldn’t Taste Bad!

The reason someone would find green tea has an “off flavor” was because the tea was either not fresh, not of a half-decent quality, was brewed at the wrong temperature or for the wrong length of time. Think about it this way; it all a person ever drank was cheap pre-ground coffee, they might think coffee tasted bad, too.

The fact is, one doesn’t need to order tea from Japan to enjoy a decent cup of green tea! I found the green teas below at a local Japanese grocery store and when brewed properly they are great as everyday tea.

If you aren’t adventurous to explore ethnic markets or time is limited, I can highly recommend the online supplier I mentioned above as having excellent price for the quality of green tea, very good explanations on their web page and quick delivery.

For everyday use, I have a little water cooler (yuzamashi) bowl and small single handed tea pot (kyuzu) so brewing a decent quality sencha green tea (my daily tea of choice) has become second nature, but as I mentioned above, one doesn’t need special equipment to make a decent cup of green tea! All you need is the right amount of fresh, good quality tea leaves steeped for the right length of time in hot water that’s at the right temperature. The only thing to keep in mind is that once the package of tea is opened, it needs to be stored in a sealed, airtight, light-proof container and used up within 3 months or sooner.

Making a good cup of green tea is not really much different than brewing a good cup of coffee. To make a good cup of coffee, one needs to consider the country / countries of origin of the beans, the bean roasting time and temperature, the brewing method involved (drip, espresso, French press, etc), the required water temperatures needed for that method, and the different grind of beans and a specific water-to-ground-bean ratio required for that brewing method. It sound’s complicated, but if you a few types of coffee regularly, it’s not hard.

It’s the same with green tea.

In one sense, there is a lot to learn at first to make a good cup of green tea but on the other hand, once you know a few basics and find a green tea or two you really enjoy, the rest is easy!

Tea has amazing health benefits, but unlike the cough medicine Buckley’s®, there is no need to drink tea that “tastes terrible, but it works”!

If you would like to know more about what I do as a Dietitian and how I can help you with weight loss or to seek to reverse the symptoms of metabolic syndrome, including Type 2 Diabetes, high blood pressure and other related markers, 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

You can follow me at:

https://twitter.com/lchfRD

https://www.facebook.com/BetterByDesignNutrition/

https://www.instagram.com/lchf_rd

References

Gayathri Devi A, Henderson SA, Drewnowski A. Sensory acceptance of Japanese green tea and soy products is linked to genetic sensitivity to 6-n-propylthiouracil. Nutr Cancer. 1997;29(2):146-51

Hursel R, Viechtbauer W, Westerterp-Plantenga MS. The effects of green tea on weight loss and weight maintenance: a meta-analysis. Int J Obes (Lond) 2009;33:956—61.

Paolini, M, Sapone, A, Valgimigli, L, ”Avoidance of bioflavonoid supplements during pregnancy: a pathway to infant leukemia?”. Mutat Res 527 (1—2): 99—101. (Jun 2003)

Kao YH, Chang MJ, Chen CL, Tea, Obesity, and Diabetes, Molecular Nutrition & Food Research, 50 (2): 188—210, February 2006

Kim JA, Formoso G, Li Y, Potenza MA, Marasciulo FL, Montagnani M, Quon MJ., Epigallocatechin gallate, a green tea polyphenol, mediates NO-dependent vasodilation using signaling pathways in vascular endothelium requiring reactive oxygen species and Fyn, J Biol Chem. 2007 May 4;282(18):13736-45. Epub 2007 Mar 15.

Weiss, DJ, Anderton CR, Determination of catechins in matcha green tea by micellar electrokinetic chromatography, Journal of Chromatography A, Vol 1011(1—2):173-180, September 2003

March 22, 2019July 8, 2019

The 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

You can follow me at:

https://twitter.com/lchfRD

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https://www.instagram.com/lchf_rd

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

March 18, 2019July 8, 2019

Now Licensed for Virtual Dietetic Practice Across Canada

If you live almost anywhere in Canada and are looking for a Registered Dietitian with experience in food allergy or sensitivity, including celiac disease and IBS as well as the specific of providing low carbohydrate or ketogenic diet support, I can help.

Whether you live in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, Newfoundland or Labrador, I am now licensed to provide you with services.

I currently can’t provide Dietitian services to Prince Edward Island (PEI) but if I have enough demand, that may change.

Registered in British Columbia since 2002

I have been registered with the College of Dietitians of British Columbia since 2002 as an RD(t) and since 2008 as a full registrant. This registration enables me to provide services to people across Canada, with the exception of Alberta and PEI but since I’ve had several physicians in Alberta who have asked to refer patients to me as well as individuals from Alberta requesting services, I recently applied to- and was accepted into the College of Dietitians of Alberta.

Provincial Registration Requirements for Virtual Dietetic Practice

As can be seen from the table below, Registered Dietitian such as myself that provide virtual Dietetic practice services (Distance Consultation) to other provinces are required to meet very specific registration requirements, as well as observe other regulatory regulations.

Virtual Dietetic Practice (Telepractice) – from the Alliance of Dietetic Regulatory Bodies. August, 2017

In the US or overseas?

I am a member of the College of Dietitians of British Columbia as well as the College of Dietitians of Alberta and am licensed to provide Registered Dietitian services in most provinces in Canada (except PEI), but if you live in the USA or elsewhere, I can provide you with nutrition education services that would not be considered medical nutrition therapy (MNT) and that would be provided for information purposes only.

More Info

If you would like more information, you can find out more under the Services tab or by looking in the Shop. If you have specific questions, please send me a note using the Contact Me form on the tab above and I’d be glad to reply as I am able.

To your good health!

Joy

You can follow me at:

https://twitter.com/lchfRD

https://www.facebook.com/BetterByDesignNutrition/

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

https://www.instagram.com/lchf_rd