Tag: application

I often get asked what I recommend people do when it is a special occasion, or a holiday. Are we allowed a “cheat day”.  This is how I answer the question.

It may seem like a strange thing for a Dietitian to say, but when it comes to weight loss, or targeting lower blood sugars, or pressure or cholesterol, I don’t believe in “diets”. The way I look at it is, if people go on a diet,  then at some point, they go off of it. I prefer to think of what we eat in terms of “everyday foods” and “sometimes foods”.

Eating a low carb high fat (LCHF) diet is a choice, just like becoming a vegetarian. People become vegetarian for different reasons; sometimes it is for religion reasons or ethical reasons and sometimes it is for the perceived health benefits. It’s the same with the reason people start eating LCHF. For some, it is to lower insulin resistance, for others it’s to address high blood sugar or to lose weight.  Some decide to eat this way because it was the diet of our ancient ancestors.  Since the reasons people start eating LCHF are different, the reasons people might give to eat a high carbohydrate food also differ.

As far as an idea of a “cheat day”, I don’t find the idea of being “allowed” or “not allowed” foods, helpful.  It implies that there are rules that we are somehow ‘breaking’ – and this comes with baggage all its own. Restricting  calories or restricting food and weighing and measuring every bite that we put in our mouths is not a paradigm that has served most people well – and this type of obsession and attention to “how much” can, in theory, feed a predisposition to disordered eating.

I encourage people to learn to follow a LCHF style of eating and to become adapted to burning fat, rather than just carbohydrate.  Then I advise them to eat when they are hungry and stop eating when they are no longer hungry.  It sounds simple, but there is some physiology behind it. Without constantly high insulin levels driving food craving, eating a diet rich in healthy fats enables people to stop eating when they are no longer hungry.

Eating or not eating high carbohydrate foods comes with an opportunity cost. The questions I encourage people to ask themselves is “what will the results or conssequences be if I eat the specific food(s) I have in mind, and in what quantities?”

For example, if a person that normally eats ~100g of carbohydrate a day wants to eat a few slices of pizza, the physiological consequences will be different than a woman that normally eats 35g of carbohydrate, or a man that normally eats 50g of carbs per day. If either of them is insulin resistant or Diabetic, it will certainly impact their blood sugars (the symptom), but how long will it have an effect on their insulin levels?  That is the more important question.

For people who are in ketosis, eating foods very high in carbohydrates will cause that to cease for a time, and it might take several days of eating LCHF again until they are again in fat-burning mode.  Likely there will be a few days of being hungry through the day.  Are they okay with this?

I want people to have a healthy relationship with food – and that means that they can eat anything – but how much and how often?

Everyday (i.e. “everyday foods”), I choose to eat LCHF, but sometimes (i.e. “sometimes foods”) I will take a taste of something yummy – and I encourage my clients to feel free to do so too.  A bite of an ice cream or cake, in the grand scheme of things, won’t make a huge difference, in fact, I calculate the number of carbs that are in the food I am considering, and decide beforehand, if it is worth it for me.

Tonight I will be having my family over for a special dinner and I have decided in advance that I will have 2 oz of the bread, a spoonful of the noodle pudding and a 2″ x 1″ piece of the honey cake.  Sure I can have more, if I wanted, but I’ve come to realize that whether I eat 2 oz of the saffron honey egg bread or 10 oz of it, it will taste exactly the same!  Why eat more? I’ve never been a big fan of the noodle dish, so a small taste is fine with me, and the honey cake is only made once a year on this occasion, and it’s my mother’s recipe from 1954, so yes I am going to eat a bigger piece and enjoy every bite. So what am I going to eat?

Chicken! …and some red butter lettuce salad with raspberries on top and drowned in olive oil.  Oh! And an apple slice, dipped in honey, for a sweet year.

Eating LCHF is a choice, and a lifestyle and as such, we can choose to eat other things.  How much, how often and which things is up to us. If our goal is to lower our insulin levels, we will know (or need to learn) how much of something won’t have a large, lasting impact.

So eat! Enjoy!

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Note: I am a “sample-set of 1” – meaning that how I implement a low carb diet may differ from others who follow a similar lifestyle. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

When people think of getting enough “fiber” they often imagine foods like “bran” and prunes – foods not usually eaten when one is following a LCHF style of eating. But what is fiber and how do we get enough when we don’t generally eat grains or legumes?

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, un-milled brown rice and the outside of oats. It is also found in fruit, legumes (or pulses) such as dried beans, lentils, or peas, some vegetables and in nuts and seeds.

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.

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.

[Reference: Government of Canada, nutrients in food, https://www.canada.ca/en/health-canada/services/nutrients/fibre.html]

Both kinds of fiber are needed and most Canadians eating a conventional diet are getting half of what is recommended.

For those eating a Low Carb High Fat Diet, even though grains and legumes are generally not eaten, getting enough fiber is not that difficult.

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 fruit that I encourage people to use sprinkled on salads, as they 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 a single beet, and eaten with Middle Eastern foods.

Constipation

Even though passing stool is as natural a part of the process as eating is, most feel awkward discussing it. Many don’t know what “normal” is in that regard, or even if there is such a thing. Is once every few days okay, is it detrimental if it is only once a week?  Should it be every day and if so, is more than once a day too much? Does texture matter or is it only frequency?

Frequency and Texture

Many physicians consider normal bowel movement (BM) frequency from 3/day to every 3 days whereas I tend to lean towards daily to every two days as preferable. Even if BM frequency is in this range, hard, painful to pass stools are problematic and would be categorized as constipation.

Since the mid-1990s there is a standardized method to classify the texture of stools, called the Bristol Stool Chart based on research which indicated that stool is a useful surrogate measure of how long feces (stool) takes to go through the large intestine (called “colon transit time”).

While Type 3-7 are considered valid for diagnosing diarrhea, Type 1 and Type 2 stool can have normal “transit time”, but be compact and hard due to lack of fluid / water.

The fact is, many, if not most people either have a lack of fiber or a lack of sufficient fluid or both and are constipated to a greater or lesser degree. They eat every day, but they don’t pass stool often and when they do, it is hard and compact. Their bodily waste sits in their colon for several days before finally being eliminated – and when it is, it is hard, dry and compact and often painful to pass.

Constipation is usually due to two factors;

(1) not taking in foods with enough fiber and

(2) not drinking enough water

Sometimes, despite eating the foods mentioned above, people find it isn’t sufficient. This is where what I have dubbed “birdseed” comes in.  Of course, I don’t mean actual birdseed!

What I call “birdseed” is a mixture of 1 tbsp. freshly ground whole flax seed (3 gm fiber per tbsp.) to which 1 tbsp. of chia seed is added (5.5 gm fiber per tbsp.).

The chia seeds are ground a little bit with the previously ground flax seed, and then the two ground seeds are placed in a small bowl.

An added portion of psyllium husk (1 tbsp.) is optional.

Drinking “Birdseed”

To drink this mixture, diluted coconut milk can be added, the mixture briefly stirred and then drunk quickly, followed by a good amount of water (I recommend at least 2 cups (500 ml).

Eating “birdseed”

For even more fiber and a delicious taste, 2 tbsp. of tahini (ground sesame paste) can be added and the mixture eaten with a spoon.

Tahini has 0 net carbs, and almost 4 gm of fiber for 2 tbsp.

Note: people often ask if they can make “chia pudding” to which they add ground flax seed, but the idea here is to have the flax and chia seeds do their magic in the intestines, not in a container, beforehand.

Water – how much is sufficient?

Dehydration is another factor that contributes to constipation. Often people simply don’t drink enough water to form a bulky, pliable stool.

The Reference Daily Intake (RDI) for water for men over 18 years is 3.7 liters per day and for women over 18 years, 2.7 liters per day and this is from all water, including that contained in beverages.

Fiber and water together

Drinking one liter of water or club soda / seltzer with each batch of “birdseed” is a good idea, because the last thing we want is to have all this insoluble and soluble fiber this in our intestines, with insufficient water. In the worse case scenario, this can result in an intestinal blockage, so be sure to drink sufficient water when taking “birdseed”.

I usually recommend that people start off with having 1 tbsp of flax seed and 1 tbsp of chia seed once a day – increasing after a few days if needed to twice (or if needed, three times) a day – making sure to drink a liter of water immediately afterwards.

What about carbs in “birdseed”?

While flax seed, chia seed and psyllium are grains, they have very few net carbs.

1 tsp of whole flax seed (3.4 gm) is so high in fiber that it has no net carbs.

1 tsp of whole chia seed has only .3 gm of net carbs.

Even if you add 1 tsp of psyllium husk, that adds only 1 gram of carbs.

“Birdseed” can be drunk as described above, eaten with sesame paste (also very high in fiber and a good source of healthy fat), or sprinkled on salads or omelettes.

…and remember to drink a liter or so of water each time you take “birdseed”, so that passing stools daily, just like eating daily, will be the norm.

To your good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

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

When people think of “fasting” what comes to mind is an almost-intolerable short period of time without food, and with nothing to drink (except maybe water) and where people usually spend most of the time counting until they can eat again. This is the case when we are used to burning carbs as our fuel source and then just stop eating. Our body slows its metabolism in response to the severe calorie restriction in an effort to spare energy.  We feel cold, tired, lethargic and we find it difficult to concentrate because our body is in starvation mode.

When we are fat-adapted, we use the fat in our diet (dietary fat) and our own fat stores (endogenous fat) as our fuel source. When we “fast”, we stop supplying our body with dietary fat, so our body relies solely on our fat stores to supply its energy needs.  Most of us who are following a low carb high fat diet have plenty of endogenous fat, so when we aren’t eating, we don’t feel hungry, tired or cold because our body has a plentiful source of energy! Our basal metabolism doesn’t drop.  Rather than feeling cold and tired and finding it difficult to think, we are able to think clearly using ketones produced from fat to fuel our body, rather than glucose.

“Intermittent fasting” is simply increasing the amount of time between meals.  Fasting is not eating or rather, not eating now. It’s different than “starving” because our basal metabolic rate is being maintained through our fat stores. When we are in starvation mode, our basal metabolism drops significantly in order to spare energy – that’s why we feel cold and tired, because our body is saving calories for our brain and our heart to function. Fasting also doesn’t mean that we can’t consume anything! There are plenty of things we can have during the delay before our next meal. The most natural “intermittent fast” is the one between after supper and breakfast the next morning.  Yes, that is why it is called “breakfast”.

Why Fast?

When we eat, insulin is released in response to the presence of carbs in the food we eat and functions to (a) move glucose out of the blood and to (b) store the glucose that is not immediately needed for energy, as fat.

When we are accustomed (as most of us have been) to eating three meals a day plus having a couple of snacks, insulin is released every few hours. If we have been “grazing”, we have been constantly releasing insulin. As a result of this, our cells have become insensitive to insulin – something known as “insulin resistance“, or insulin tolerant.  To conceptualize this, think of going into a room with loud music.  At first your ears buzz and your auditory system is overwhelmed, but after a bit of time, your body adapts. It’s similar with smell.  When you’re exposed to a pungent odor, at first that’s all your can concentrate on, but after time passes, your brain starts to “tune out” the signals from your nose and you become less aware of the smell.  It’s not that the odor decreases, but our response to the odor, decreases as we become “tolerant” to that molecule bound to our olfactory receptors.

The difference with “insulin resistance” is that it is more than our body becoming “tolerant” of the circulating insulin, it actually responds less to it.

Think of someone that drinks considerable amounts of alcohol.  They can have 3 or 4 drinks and not feel intoxicated, because they have a “high tolerance” to the ethanol in the drink.  It takes more and more alcohol for them to respond. When someone is “insulin tolerant” (also called “insulin resistant”), the same amount of insulin has less and less effect, so to adapt, to be able to move the glucose out of the blood and store the excess energy as fat, the body needs to release more and more insulin. From years and years of eating 3 carb-based meals plus a couple of carb-laden snacks each day, our insulin levels simply don’t fall to baseline.

When someone is not insulin resistant, delaying the time before the next meal enables their insulin levels to fall to baseline (10-30 pMol) in approximately  12 hours, so if they don’t eat anything after dinner and their first meal of the day is breakfast the next morning, that time period is usually close to 12 hours. However, for people who are insulin resistant,  a longer time period is often needed for their insulin levels to fall to baseline. Just as insulin resistance developed over time, gradually, a new lower baseline can be set over time by increasing the length of time that one intermittently fasts.

Twelve-Hour Fast

A twelve-hour fast is the easiest one for most people to do, because during most of it, they’re asleep!

This is the one I suggest to my clients once they’re fat-adapted (usually after ~4 weeks of eating low carb high fat) as all it entails is not eating anything after supper until breakfast the next morning.

That’s it.

So, say they finish dinner at 6:30 PM, then the next time they eat is breakfast the next morning at 6:30 AM. This simple, short 12-hour “fast” is just enough to enable their insulin to fall to baseline. Doing this often, if not daily is the goal. This is entirely do-able and an important first step in restoring insulin sensitivity and it is certainly not something “radical”. Years ago, people didn’t eat after supper!

People who have Type 2 Diabetes should check with their doctor before beginning doing any form of Intermittent Fasting – and definitely should do so if they are on any kind of medication to manage their blood sugar, blood pressure or cholesterol, without having their doctors oversee it.  Medication will often need to be adjusted downward (and sometimes eventually discontinued entirely) as insulin sensitivity returns, so don’t do this without involving your doctor, first!

Eighteen Hour Fast

Once people have become used to not eating from supper until breakfast, they may want to wait to eat their first meal until noon the next day, especially if they don’t feel particularly hungry in the morning. Some people are not “breakfast” people and if they eat well the night before, they may not want to eat in the morning. An eighteen hour “fast” is from after someone has finished dinner (say, at 6:00 PM) until noon the next day.

Many do want their cup of coffee, which is totally fine provided it is unsweetened. I don’t recommend that people use sugar substitutes, especially the sugar alcohols such as sorbitol, mannitol or xylitol which have the same number of carbs per teaspoon as ordinary table sugar.

Cream can certainly be added to drip coffee and there’s no need to give up your morning latte or cappuccino – just a little creativity to replace the milk (which has almost as many carbs per cup as a slice of bread!).

My trick is to foam 1/2 an ounce of cream with an ounce or ounce and a half of cold, filtered water.

This makes fasting until lunch entirely possible!!

Twenty-four Hour Fast

Note: I don’t do these and I don’t recommend that my clients do these unless they are being very closely monitored by their doctor, however I want to describe them, so people know what they are.

A twenty-four hour “fast” is from the end of supper one day, until the start of supper the following day (technically it is a 23-hour fast unless you add the extra hour  ). As with the eighteen-hour fast, one can have unsweetened coffee or tea with a drop of cream, club soda (seltzer) with a twist of lime or lemon, or “bone broth”. “Bone broth” can be made from any kind of meat, fish or poultry bones, but for me, when I think of “bone broth”, I think of a wonderful, rich broth made from beef marrow bones, that is gently simmered overnight on the stove, ready to be sipped as desired, on a fast day.

To avoid getting constipated, many people will take psillium fiber with water each morning and which can be added to cups of “bone broth” or dissolved in a little bit of diluted coconut milk.

What’s not to love about sipping this when “fasting”?

The main purpose of delaying the time between meals (“intermittent fasting”) is to restore insulin sensitivity. When we aren’t eating, we aren’t releasing insulin – and as we continue eating low carb high fat and delaying the time between meals, our insulin receptors become sensitive to insulin once again.

Normalized blood sugar levels (both fasting blood glucose and HbA1C) is a natural byproduct, not the goal.  The goal is releasing less and less insulin in response to the food we eat and our body’s sensitivity to the insulin that we do release, being restored.

Weight loss is another added benefit!

Have questions about how I can help you? Please send me a note using the “Contact Us” form on the tab above.

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

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

Many people who are accustomed to eating a carb-based diet, restrict their salt intake to avoid blood pressure, but when eating low carb high fat, there is the need to add salt to replace sodium right from the beginning. That is how “keto-water” came to be.

When eating low carb and when intermittent fasting (extending the amount of time between meals) insulin levels fall, and with it so does the kidney’s retention of sodium (salt). The kidneys excrete sodium in a process called naturesis so replacing the missing sodium is important. Sodium and potassium (as well as calcium and magnesium) are used in pairs in a number of systems in the body, so when the kidneys ‘dump’ a lot of sodium, potassium is soon excreted too, in order to balance the two electrolytes. If someone on a low carb diet doesn’t supplement sodium soon enough, their potassium levels could fall too low as a result, which may cause them to have excruciating headaches and/or irregular heart beat (heart palpitations).

It is fairly difficult to meet the Dietary Reference Intake for potassium on a conventional  carb-based diet, but on a low-carb diet – even with a very high non-starchy vegetable intake, it is still challenging as many of the good sources of potassium, such as potato and yams are not part of a low carb high fat diet. Mushrooms and avocado are some of the best sources, so include those foods often.

To be sure to get sufficient sodium and potassium, I make what I call ”keto-water”.

NOTE: People with kidney disease (e.g. CKD) must avoid any salt substitutes or half-salts with potassium. Those taking blood pressure medication such as Ramipril have increased potassium retention and should also not use half-salts containing potassium.

”KETO-WATER”

Keto-water is 1 liter of club soda / seltzer to which 1/8 tsp of “half salt” has been added.

“Half salt” is a half-sodium / half-potassium salt that is sold under a number of brand names, including “Nu Salt” and “no Salt”.

I add a tiny twist of lime or lemon to round out the taste and also to add a source of Vitamin C and voila, ”keto-water”!

Unless it is particularly hot out, or one’s needs are increased because they are exercising or have a fever, two liters a day of ”keto-water” is probably sufficient for most people.

Keep in mind that drinking keto-water will result in your body retaining more water along with the sodium, so it may appear as if your ‘weight went up’, but it is only the natural water retention that occurs (and is supposed to occur) when your body has sufficient electrolytes. Remember, weight form most people can fluctuate by as much as 4 – 4 1/2 pounds per day solely from the natural fluctuation in body water, so don’t weigh yourself too much.  I recommend a maximum of once a week, on the same day and at the same time.  When you are replacing the body’s necessary electrolytes (such as sodium and potassium), it is better to judge fat loss by loss of inches around various parts of your body (mid-arm, mid-thigh, neck, abdomen) than by the scale. Even easier, go by how your clothes feel!

Please don’t restrict sodium when eating low-carb for the sake of a number on the scale!  Your body needs the sodium and potassium to function properly.

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Copyright ©2017 The Low Carb High Fat Dietitian (a divisions of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read or heard in our content. 

As mentioned in the previous article, a new study published Monday, June 12, 2017 in the New England Journal of Medicine analyzed data from 68.5 million adults and children in 195 countries and found that 1/3 of people worldwide are overweight or obese and are at increased risk of chronic disease and death, as a result.

Data from one country, China, stood out among all of them due to record high rates of childhood and adult obesity;

• In 2015, China had the highest incidence of obese children in the world (~10%) along with India.
• In 2015, China along with the US had the highest incidence of obese adults (>35%).

I wanted to have a look at the Dietary Guidelines for Chinese Residents (Chinese: 中国居民膳食指南) in the years prior to 2015, to determine how they may have contributed to these high rates of overweight and obesity.

The Food Guide Pagoda

The Chinese Dietary Guidelines, known as the ‘Food Guide Pagoda’ was first published in 1989 and revised in 1997. The 2007 revision was developed in conjunction with a committee from the  Chinese Nutrition Society, in association with the Ministry of Health.  A new revision came out in 2016.

The 2007 Food Guide Pagoda’ (the one that was in effect at the time the 2015 overweight and obesity statistics came out) was divided into five levels of recommended consumption corresponding to the five Chinese food groups.

1. Cereals – in the form of rice, corn, bread, noodles, crackers and tubers make up the base of the Pagoda.
2. Vegetables and Fruits – form the second level of the Pagoda
   According to the Chinese Dietary Recommendations, the majority of foods in each meal should be made up of cereals, including rice, corn, bread, noodles, crackers and tubers (such as potatoes), followed by Vegetables and Fruit.
3. Meat, Poultry, Fish & Seafood and Eggs form the third level, and it is recommended that should be ‘eaten regularly’, but ‘in small quantities’.
4. Milk & Dairy and Bean & Bean Products – form the fourth level.
5. Fat, Oil and Salt – form the roof of the Pagoda and are recommended to be eaten in moderation.

Specific Dietary Recommendations (2007-2015)

The main recommendations of the 2007 Chinese Dietary Guidelines were as follows:

• Eat a variety of foods, mainly cereals, including appropriate amounts of whole grains.
• Consume plenty of vegetables, fruits and tubers (e.g. potato, taro, yam etc.)
• Consume milk, beans, or dairy or soybean products every day
• Consume appropriate amounts of fish, poultry, eggs and lean meat.
• Reduce the amount of cooking oil
• Divide the daily food intake among the three meals and choose suitable snacks.

The Results (2005-2015)

1. Leading cause of death

In 2015, heart disease overtook Chronic Obstructive Pulmonary Disease (COPD) as the second leading cause of death, followed by stroke.

In 1990, the leading cause of death in China was Chronic Obstructive Pulmonary Disease (COPD) largely contributed to by smoking, followed by heart disease and diarrhea.

2. Leading cause of premature death

In 2015 as in 2005, stroke was the leading cause of death, followed by heart disease.

3. What caused the most death and disability combined?

In 2015, stroke was leading cause of death in China, followed by heart disease.

Magnitude of the Problem – China compared to the US and Canada

In 2015, for every 100,000 people in China, 2,237 people died from heart disease and 1,672 people died from stroke.

In the US, for every 100,000 people, 457 people died from heart disease and 1,617 died from stroke.

In Canada, for every 100,000 people, 327 people died from heart disease and 1,106 died from stroke.

Rates of stroke in the China and US were quite similar. Both China and the US had the highest number of obese adults (>35%) in the world.

China’s “solution”?

China concluded that “dietary risks drive the most death and disability” – especially stroke and heart disease which were the two leading causes of all forms of death, of premature death and of disability in 2015.

In response to these high rates of stroke and heart disease among Chinese, the Chinese government, with the assistance of the Chinese Nutrition Society produced a revised version of the Chinese Food Pagoda in 2016.

New Dietary Recommendations (2016)

The Chinese have stated that “there have been no significant changes in dietary recommendations” (Wang et al, 2016) when compared with the previous version of the 2007 Food Pagoda and are emphasizing the following recommendations:

Eat a variety of foods, with cereals as the staple – The daily amount of cereals and potatoes consumed for body energy production should be 250—400 g, including 50—150 g of whole grains and mixed beans, and 50—100 g of potatoes. The major characteristic of a balance diet pattern is to eat a variety of foods with cereals as the staple.

Balance eating and exercise to maintain a healthy body weight – this is based on the same “calorie in / calorie out” model that the US and Canadian recommendations have been based on. “Avoiding ingesting excessive food and physical inactivity is the best way to maintain energy balance”.

Consume plenty of vegetables, milk, and soybeans – The daily vegetable intake should be in the range of 300—500 g. Dark vegetables, including spinach, tomato, purple cabbage, pak choy, broccoli, and eggplant, should account for half this amount and should appear in every meal. Fruits should be consumed every day. The daily intake of fresh fruits, excluding fruit juice, should be between 200 and 350 g. A variety of dairy products, equivalent to 300 g of liquid milk, should be consumed per day. Bean products and nuts should be frequently eaten in an appropriate amount for energy and essential oils.

Consume an appropriate amount of fish, poultry, eggs, and lean meat – The consumption of fish, poultry, eggs, and meat should be in moderation. The appropriate weekly intake is set at 280—525 g of fish, 280—525 g of poultry, and 280—350 g of eggs with an accumulated daily intake of 120—200 g on average. Fish and poultry should be chosen preferentially. The yolk should not be discarded when consuming eggs, and less fat and fewer smoked and cured meat products should be eaten.

Final Thoughts…

China now has some of the highest rates of childhood obesity in the world (~10%) and is tied with the US for the highest rate of adult obesity (>35%) yet to address the issue of incredibly high rates of stroke and high rates of heart disease, the 2016 Chinese Dietary Recommendations define a balance diet pattern as a daily adult intake of;

1/2 lb – 1 lb (250-400 gm ) of cereals, grains and potatoes

1/3- 3/4 lb (200 – 350 gm) of fresh fruit

1 1/2 cups of milk

and

1/4 lb – 1/3 lb of fish, poultry or eggs (with meat “in moderation”)

These “new” recommendations seem to be based on the same “calorie in / calorie out” model familiar to us in the West and that fail to take into account how the body compensates on a carbohydrate-based calorie restricted diet diet (see previous blogs).

The Chinese are being told that “the best way to maintain energy balance” (Wang et al, 2016) is to;

1. exercise more (150 minutes/week plus 6000 steps/day)
2. eat less fat and animal protein
   and
3. consume most of their calories as rice, corn, bread, noodles, crackers and potatoes 

Over the last four decades,  Americans and Canadians have reduced their fat consumption from ~40% in the 1970’s to ~30%, increased the amount of carbohydrate as whole grains, fruits and vegetables, are consuming low fat milk, eating more fish and drinking less pop and presently, 2/3 of adults considered overweight or obese.

Should we expect different results in China?

If you are looking to achieve a healthy body weight, lower blood sugar, blood pressure and triglycerides, I can help.

I take a low carb high health fat approach and can teach you how to eat well, without weighing or measuring food, or counting “points”.

Want to know more? Send me a note using the “Contact Us” form, on the tab above.

To our health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2017 The Low Carb High Fat Dietitian (a division of BetterByDesign Nutrition Ltd).  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 

You can follow me at:

 https://twitter.com/joykiddieRD

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References

Global Burden of Disease (GBD) 2015 Obesity Collaborators, Health Effects of Overweight and Obesity in 195 Countries over 25 Years, N Engl J Med, DOI: 10.1056/NEJMoa1614362

Global Health Data Exchange (GHDx), http://ghdx.healthdata.org/geography/china

Wang S, Lay S, Yu H, Shen S. Dietary Guidelines for Chinese Residents (2016): comments and comparisons. Journal of Zhejiang University Science B. 2016;17(9):649-656. doi:10.1631/jzus.B1600341.

One of the challenges with trying to lose weight is reaching a plateau – where one’s weight stays the same for an extended period of time. When eating a low-carb or ketogenic diet, some foods such as nuts are a common pitfall. Despite being a rich source of heart healthy monounsaturated fats, some nuts contain high amounts of carbohydrate.

Carbs Per Serving of Nuts

Serving Size

A serving size* of nuts is generally considered one ounce (1 oz.) which is about a handful of an ‘average-sized hand’. The problem with using this kind of measurement is that not all nuts have the same mass per volume, nor does everybody have the same size hand!

Here are the number of nuts per ounce for common varieties:

1. Cashew 16-18 nuts per ounce
2. Pistachio 45-47 nuts per ounce
3. Almond 22-24 nuts per ounce
4. Pine Nuts ~3 Tbsp. (160 kernels) per ounce
5. Hazelnut 10-12 nuts per ounce
6. Walnut 8-10 halves per ounce
7. Peanut 27-29 nuts per ounce
8. Macadamia 10-12 nuts per ounce
9. Pecan 16-18 halves per ounce
10. Brazil Nuts 6-8 nuts per ounce

* When eating shelled nuts, many people eat a few palm fulls, so I’m going to indicate the carbs for a 1 oz and 3 oz serving.

Carbs are listed as “net-carbs” (i.e. once fiber (which is not digestible) has been subtracted from the total amount of carbohydrate).

Carbohydrates per Ounce

1. Cashews

Cashews contain the most carbs per serving; a whopping 9 g per 1 oz serving, which is about 16-18 nuts.

2. Pistachio
Pistachios contain 6 gms of carbs per 1 oz serving ~ 46 nuts – that’s 18 gm of carbs in an average 3 handful serving (3 oz) – a little more than a slice of bread.

3. Almonds

Almonds contain 6 gms of carbs per 1 oz serving ~ 22-24 nuts.

4. Pine Nuts

Pine nuts (also called pignolias) contain 3 gms of carbs per oz. (which is about 3 Tbsp.)

5. Hazelnut

Hazelnuts (~11 nuts per ounce) contain ~2 1/2 gms of carbs for a 1 oz serving (~11 nuts) / 7 gms of carbs for 3 oz / 3 average handfuls.

6. Walnut

An ounce of walnuts (9 halves per ounce) contain the same amount of carbs as an ounce of hazelnuts (~2  1/2 gms of carbs for a 1 oz serving / 7 gms of carbs for 3 average handfuls or ~ 27 halves.

7. Peanut

An ounce of peanuts (~28 shelled peanuts per ounce) also contain the same amount of carbs as an ounce of hazelnuts or walnuts (~2  1/2 gms of carbs for a 1 oz serving.

Top three low carb high fat / keto-friendly nuts:

Macadamias, Pecans and Brazil nuts are the 3 most low-carb and keto-friendly nuts – having between 4 and 5 gms of carbs for a 3 oz serving! That’s far better than the 27 gm of carbs for 3 oz of cashews and 18 gm of carbs for 3 oz of pistachios!

8. Macadamia

Macadamias have slightly more than 1  1/2 gms of carbs for a 1 oz serving (~11 nuts) / 5 gms of carbs for a 3 oz serving.

9. Pecans

Pecans have 1.3 gms of carbs for an ounce of nuts (~17 halves) / 4 gms of carbs for a 3 oz serving.

10. Brazil nuts

Brazil Nuts also have only 4 gms of carbs for a 1 oz. serving (~ 7 nuts)

A Tough Nut to Crack

Back in the day, eating nuts meant cracking nuts.

It was common to see living room tables with bowls of nuts in their shell, with nutcrackers and nut-picks readily available for use.

Each house had its preference for the style of nutcrackers they insisted were the best.  Growing up, we had ones like those above.

Nuts and “Carb Creep”

“Carb creep” is when we think we are eating low carb, but hidden sources of carbs are sneaking into our diet without us being aware of it.

When I was pondering why I had reached my own weight plateau, I knew carb creep had to be the reason – but from where?

After analyzing my diet, it seemed that nuts might be the source and it was.

My biggest single downfall was that I like to crack and eat pistachios on the weekend, while working on my foreign language studies – and it is WAY too easy to crack them and eat copious amounts!  In fact, I am somewhat of an expert at shelling them, as my brother and I were placated by our parents with bags of pistachios, on long car trips. To get my “fair share”, I learned to be quite efficient at shelling them and so it seems, I haven’t lost that ‘skill’.

Over the course of several hours I can shell and eat 1/2 to 1 lb of pistachios without really noticing eat, and in the worst case scenario that’s almost 100 gms of hidden carbs!

Add to that a handful or two of almonds a day (another hidden 10 gm of carbs per day) and the source of my “carb creep” became clear.

Portioning

Of course to try to prevent eating too many, nuts can be portioned out in 1 oz or 3 oz ‘servings” and the rest put away for another time, but it is still way too easy for someone who is hungry or tired to mindlessly reach for a handful or two of nuts. It seemed to me that having large containers of shelled nuts that are too easy to reach for, may not be the best solution.

Unshelled Nuts

Replacing shelled nuts with nuts in the shell, like we ate in the “old days”, turns out to be a far more effective solution.

It’s very hard to over eat nuts you have to shell first.

Bingo!

Since pecans are a much lower carb nut than pistachios, they have become my go-to nut from the nut-bowl…and let me assure you, it takes quite a while to shell 17 halves for a mere 1.3 carbs! In fact, I’m pretty sure I expend more energy cracking them, than I take in, eating them.

The Right Tools for the Right Job

Despite having a variety of nutcrackers, I found pecans a “very tough nut to crack” – with them frequently flying out of the standard pinch-style cracker.

I found out that there is a special “pecan cracker” that one can order that apparently does the job very well and looks like this:

…but the little contraption below that I invented in my garage (with a d-clamp and a stick-on felt pad, works great, and I use it for pecans, walnuts and even hazelnuts. Even eating walnuts, which are a higher carb nut – it takes quite a while to shell 9 halves (2  1/2 gms of carbs).

How I can help

For the last 2 years, I have helped my clients lose weight and keep it off using a low-carb approach. More recently, I am ‘practicing what I preach‘ (as you can read about in the blogs titled “A Dietitian’s Journal”). The things I am learning “doing it” adds to what I know academically – which makes me able to coach people much more effectively.

Have questions?

Why not send me a note using the “Contact Us” form on the tab above.

To our good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2017 The Low Carb High Fat Dietitian (a division of BetterByDesign Nutrition Ltd).  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 

Long before the ‘hybrid car” there was the human body – a hybrid ‘machine’ perfectly designed to use either carbohydrates or fat for energy. Like a hybrid car, we can run on one fuel source or the other at any one time.

If we are eating a largely carbohydrate based diet, we will be in ‘carbohydrate mode’ by default. Carb-based foods will be broken down by our bodies to simple sugars and the glucose used to maintain our blood sugar levels. Our liver and muscle glycogen will be topped up, then the rest will be shuttled off to the liver where it will be converted into LDL cholesterol and triglycerides and stored in fat cells.

Historically, in times of plenty, we’d store up glycogen and fat and in lean times, we’d use up our glycogen and then switch fuel sources to be in “fat-burning mode” — accessing our own fat stores, for energy.

The problem is now that we rarely, if ever access our stored fat because we keep eating a carb-based diet.  So we keep getting fatter and fatter.

GLUCOSE OR FAT AS FUEL

When we are in “carb burning mode”, the carbs we eat are broken down by different enzymes in our digestive system to their simplest sugar form (monosaccharides) such as glucose, fructose and galactose.

Glucose is the sugar in our blood, so starchy foods such as bread and pasta and potatoes are broken down quickly so they are available to maintain our blood sugar levels.

Monosaccharides are the building blocks of more complex sugars such as disaccharides, including sucrose (table sugar) and lactose (the sugar found in milk), as well as polysaccharides (such as cellulose and starch). When we drink milk for example, the galactose found in it is broken down into lactose and glucose.  When we eat something sweetened with ‘sugar’ (sucrose), it is quickly broken down to glucose and fructose.

Any glucose that is needed to maintain our blood sugar level is used immediately for that purpose and the remainder is used to “top up” our glycogen stores in our muscle and liver. There are only ~ 2000 calories of glycogen – enough energy to last most people one day, so when our glycogen stores are full, excess energy from what we eat is converted to fat in the liver and stored in adipocytes (fat cells).

One problem is that most of our diets are high in fructose – naturally found in fruit but also as high fructose corn syrup in many processed foods. Fructose can’t be used “as is”, so it is brought to the liver.  If our blood sugar is low, it will be used to make glucose for the blood (via gluconeogenesis) otherwise it will be converted into LDL cholesterol (so-called “bad cholesterol”) and triglycerides and stored as fat.

Feasting and Fasting

When we don’t eat for a while, such as would have occurred when our ancestors were hunter-gatherers, we’d use up our glycogen stores hunting for an animal to eat, or gathering other edible foods and if we weren’t successful at finding food to eat, then our bodies would access our fat stores, for energy.  This is known as lipolysis. This process is regulated mainly by a hormone called glucagon, but other hormone such as epinephrine (the “fright and flight” hormone), cortisol (the “stress hormone”) as well as a few others (ACTH, growth hormone, and thyroxine) also play a role.

In times of plenty, we’d store up glycogen and fat and in lean times, we’d use up our glycogen, switch into “fat-burning mode” and then rely on our stored fat for energy.

The problem for most of us in North America and Europe is that we have access to food in our homes, in stores and at fast food restaurants 24/7. We can’t go for a walk without passing places selling or serving food and if the weather is bad or we are too tired, food is just a phone call or web-click away. So we just keep storing up our fat for ‘lean times’ that never come.

In addition, irrespective of our cultural background, our eating style is carb based; pasta, pizza, sushi, curry and rice or naan, potato, pita – you name it.  Every meal has bread or cereal grains, pasta, rice or potatoes – and even what we consider “healthy foods” such as fruit and milk have the same number of carbs per serving as bread, cereal, pasta, rice and potatoes. That wasn’t always so. Our indigenous cultural foods were very different.

Compounding that, many “low-fat” products have added sugar (sucrose) in order to compensate for changes in taste from reducing naturally occurring fat, which then adds to excess carb intake.  Sucrose (ordinary table sugar) is made up of half fructose, so a diet high in sugar adds even more fructose transport to the liver, for conversion to cholesterol and fat.

The vilification of fat

In 1977, both the Canadian and US food guides changed in response to the promoted belief that eating diets high in saturated fat led to heart disease. Multiple studies and reanalysis of the data of older studies indicates that saturated fat is not the problem, but that diets high in carbohydrate combined with chronic inflammation and stress, is.

In 2016, it came to light that the sugar industry funded the research in the 1960’s that downplayed the risks of sugar in the diet as being related to heart disease and highlighted the hazards of fat instead – with the results having been published in the New England Journal of Medicine in 1967 with no disclosure of the sugar industry funding*. The publication suggested that cutting fat out of the American diet was the best way to address coronary heart disease, and which resulted in the average American and Canadian as inadvertent subjects in an public health experiment gone terribly wrong. Overweight and obesity has risen exponentially and with that Diabetes, hypertension (high blood pressure) and high cholesterol.

*(Kearns CE, Schmidt LA, Glantz SA. Sugar Industry and Coronary Heart Disease Research A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016;176(11):1680-1685. doi:10.1001/jamainternmed. 2016. 5394). 

Over the last 40 years the promotion of “low fat eating” by governments and the food industry has resulted in carbohydrate-intake skyrocketing. Every high-carb meal is followed by another high-carb meal, and if we can’t wait, a snack, too. We eat every 2-3 hours, and eating carb-based foods every 2 or 3 hours all day, every day is quite literally killing us.

How do we get fat out of “storage”?

The “key” to unlocking our fat stores, is decreasing overall intake of carbohydrates by decreasing the amount of carbohydrates we eat, both by eating much less of it and on occasion, by delaying the amount of time between meals.

Decreasing carb intake lowers insulin, the fat-storage hormone. At first our bodies access liver and muscle glycogen for energy, but since that is only about a one day’s supply, our bodies then turn to our own fat stores as a supply of energy.

By eating a diet rich in fat and keeping protein at the level needed by the body but not in excess, dietary protein is not used to synthesize glucose, but fat is.

An added bonus is that since insulin also plays a role in appetite, as insulin falls, appetite decreases.

This is the role of a low carb high healthy fat diet, a topic covered in this article.

Have questions?

Why not send me a note, using the “Contact Me” form above?  I’d be happy to answer your questions.

To your health!

Joy

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

you can follow me at:

 https://twitter.com/lchfRD

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

Intro: Since 1977, Health Canada and Canada’s Food Guide have been promoting a diet which is high in carbs (45-65%) and low in fat (20-35% ) and which recommends that no more than 7% of fat comes from saturated fat — with the goal of lowering heart disease.

As elaborated on in an earlier blog, prior to 1977, the obesity rate [measured as Body Mass Index (BMI) ≥ 30 kg / m2] of Canadian adults was <10% and in 1978, only 15% of children and adolescents were overweight or obese.

As a result of lowering dietary intake from fat and increasing it substantially from carbohydrates, what happened to obesity statistics? Diabetes statistics?

Obesity became an epidemic.

In adults the prevalence of obesity [body mass index (BMI) ≥30 kg/m2] went from 10% in 1970-72 to 26% in 2009-11! In children, that rate doubled to 29% of children and adolescents being overweight or obese by 2007 and by 2011, obesity prevalence for boys was 15.1% and for girls was  8.0% in 5 to 17 year olds.

Based on waist circumference, 37% of adults and 13% of youth are currently considered abdominally obese.

Diabetes rates almost doubled.

In the 1970s, the rate of Type 2 Diabetes in women was 2.6% and 3.4 % in men, in the 1980s that number rose to 3.8% for women and 4.5% for men.  In the 1990s the rate was almost double what it was in 1970; 4.7% for women and 7.5% for men.

Now get this: Type 2 Diabetes contributes to increased risk of heart disease.

So in an effort to reduce rates of heart disease by lowering fat intake and increasing carbohydrate intake, rates of Type 2 Diabetes doubled — which in turn, raised the risk of heart disease! Ironic.

If eating a high carbohydrate, low fat diet is associated with higher rates of obesity which in turn results in a higher incidence of Type 2 Diabetes, what is the option? Isn’t it also a problem to eat a low carbohydrate / high fat diet… isn’t a high fat diet bad for you?”.

This is the question that we will begin to answer in this article and conclude in the next one.

Are all fats the same? Is extra virgin olive oil in the same category as bacon? Or fish oil as lard?

The Health Canada guidelines recommend eating low fat dairy products, lean meat and using a “small amount — 2 to 3 tablespoons (30 to 45 mL ) of unsaturated fat each day. This includes oil used for cooking, salad dressings, margarine and mayonnaise“.

1. We are told to use a small amount of unsaturated fat per day; what is an unsaturated fat and are they all the same?

2. Is the fat in dairy products and meat “bad” for you?

I am going to answer the first question in this article and the second question in the next one.

1. What are the different type of fats.

There are two main classes of fats — saturated fats and unsaturated fats.

Unsaturated fat can be further classified as polyunsaturated fats and mono-unsaturated fats. Polyunsaturated fats include everything from omega-3 fats from fish oil to the fat found in omega-6 fats found in canola oil and corn oil. More about what makes it an ‘omega-3’ or ‘omega-g’ below. Omega-3 fats, especially the long chain ones from fish oil (e.g. DHA, EPA) are heart-healthy and are anti-inflammatory and have been found to be protective against heart disease. Refined seed oils that are high in omega-6 fats are pro-inflammatory.

Monounsaturated fats such as those found in avocado and nuts or cold-expressed from olive oil or avocado or nuts and seeds are considered by Health Canada and the writers of Canada’s Food Guide as the healthiest (and thus, preferred) kind of fat.

We’ve been told to eat a “low fat diet” but are all fats the same? Are omega-3 fats from fish to be lumped together with fat from bacon? And if we eat a diet low in saturated fat, will our “bad” cholesterol (LDL) go down?

Most people have heard that of the fats taken in from the diet, saturated fat is “bad” for you and mono-unsaturated fat and polyunsaturated fat is “good” for you.  Before we deal with whether this is true, let’s define what these are.

There are some basics that we need to cover, to ‘follow’ the discussion as to whether saturated fat in the diet results in high LDL cholesterol and high Triglycerides (TG). I’ll try to make this much less painful than it may have been when you first learned this.

• fatty acids are molecules made up of a carbon backbone.  Think of it like a train with cars connected together.  Actually think of it more like “fuselage” of a plane (which will become clear as to why, below). The body is made up of carbons all in a row.

• if there are no double bonds in the carbon chain, it is a saturated fatty acids because something can bond at every carbon along the carbon chain.  Think of those molecules that bond to a carbon as “wings” sticking off the fuselage.

• if there is one double bond in the carbon chain, it is an unsaturated fatty acid. It is “unsaturated” because no other compound can bond where the double bond is. So it can have “wings” every where else along the carbon chain (which makes it unsaturated) but not at the place where the one double bond is.

• if the carbon chain has more than one double bond, it is called a polyunsaturated  fatty acids (PUFAs).

• there can be a double bonds off one of the carbons in the carbon backbone chain.

• where the double bond off the carbon backbone is located determines whether it is an omega-3 polyunsaturated fatty acid or an omega-6 polyunsaturated fatty acid.

• all omega-3 fats have their first double bond in the same place on the carbon chain (away from what is called the ‘carboxyl’ end).  All omega-3 fats have their first double bond starting at the 3rd carbon (away from what is called the ‘carboxyl end’).

• all omega 6 fats have their first double bond starting at the 6th carbon (away from the carboxyl end)

That’s pretty well all the chemistry you need to know.

So we’ve heard that we should decrease our intake of all fat, especially saturated fat as it leads to high LDL cholesterol, high triglycerides (TG) but is that true?   2. Is the fat in dairy products and meat “bad” for you?

3. Is saturated fat in the diet the only source?

Spoiler alert!

Our bodies not only make fat, they synthesize saturated fat!

We will cover the making of endogenous (“in the body”) saturated fat in Part 2, coming soon!

Have questions about the services I offer? Please click on the “Contact Us” tab above, to send me a note.

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

follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/

People often assume that the answer to the question why do we gain weight is obvious and it is because people eat more calories than they burn; the old ”calorie in, calorie out” paradigm.  That is, calories not used in some form of exercise are converted to fat and stored.  If we assume that the cause of weight gain is that simple, then the solution must be equally simple; eat less and exercise more, right? But is it?

Many Physicians and Dietitians continue to hold to this ”calorie in, calorie out” model and to counsel their patients that in order to lose the stored fat, they need to eat less and exercise more.  If it is really that simple, then why are 4.7 million adults in Canada classified as obese and more than 40% of men and 27% of women classified as overweight? If it is that simple, why do obesity statistics continuing to rise? Because it isn’t that simple.

There is an underlying assumption that ”calories in” and ”calories out” are two independent events.  That is, if you reduce ”calories in”, ”calories out” is unaffected. The difficulty lies in that the body decides where it is going to ”spend” the calories taken in. Let’s say we take in 2000 calories; some will be used for the energy we need during a 24-hour period by our body during resting conditions (Basal Energy Expenditure) and some will be used to synthesize muscle, bone or other proteins.  ”Calories out” is not just exercise.

Another underlying assumption is that all calories are created equal. But are they? First what is a calorie?

A calorie is the amount of heat that is released when certain foods are burned in a laboratory.  It doesn’t matter if the food is protein, fat or carbohydrate, if they have 100 calories then 100 calories of heat is released when they are burned. So in the ”calorie in, calorie out” model it really doesn’t matter what we eat whether it is broccoli or butter, in the end it only matters how many calories they add up to.  Period.

If we start with the assumption that ”calories in” are independent of ”calories out” then the only thing that really matters is how many calories we take in, not from what sources. In this model, since all food is burned and a certain amount of calories are released, then we arrive at the conclusion that weight gain is simply a matter of comparing what goes in (energy) to what goes out (energy expenditure).  In this simplistic view, weight gain is caused by having too many calories (energy) compared to too little exercise (energy expenditure).  But it is not that simple.

Some of the energy expenditure will be for building tissue, staying warm, cognitive function and our bodies determine whether ”calories in” go to those involuntary functions over voluntary exercise Looking at weight loss in terms of the ”calorie in, calorie out” model fails to take into account that the body will slow its metabolism in response to reduced calories, because it needs to use those calories for vital functions so restricting calories doesn’t necessarily translate to weight loss.

Furthermore, assuming that all foods can be boiled down to how many calories they contain fails to take into consideration that the composition of different types of foods actually increases or decreases hunger and thus eating when and what and how much we eat. The assumption by many health care professionals has been that obese people are overweight because their metabolism has slowed and that keeps them from burning off the calories they take in.

To explain this in terms of the ”calories in calories out” model, say a slim person takes in 2000 calories and has a Total Energy Expenditure (TEE) [the amount of calories they burn per day] of 2000 calories, which means they don’t gain or lose weight. An obese person will take in the same 2000 calories, but assuming their TEE is lower, say 1500 calories, 500 calories are store as fat and they gain a pound. But is that in fact so?

A recent study however has disproved this.

When measured in the laboratory, obese people had a Total Energy Expenditure (TEE) of 3244 calories compared to lean people who had a TEE of 2404 calories. That is, when excess calories are eaten in someone who is already obese, the body will actually increase its Basal Energy Expenditure (BEE) to try and get rid of those calories.

So why are obese people obese?

Shouldn’t this increase in Total Energy Expenditure over time caused them to burn off those calories and become lean again? Actually, body weight, like other functions in our body is a closely regulated system and we have so something called a ”Set Point” which acts to regulate it. When too many calories are taken in, the body tries to get rid of them and when too few calories are taken in, the body tries to conserve them. The body does this to maintain its set point’. So if we are overweight, the body will adjust its processes to maintain that set point. More on that below. It is not about how many calories we take in but what changes the Set Point.

People also make the assumption that how much we eat (”calories in”) is voluntary; that is we can choose to eat or not eat, but there are a number of hormones such as leptin, ghrelin, cholecystokinin, and peptin YY that tell our body when we are hungry and we are not. Hunger and satiety (feeling full) are under hormonal control and as such, when we eat (”calories in”) is not voluntary.

People also assume that Calories Out’ is voluntary; that we control how much exercise we do and assuming that our basal energy expenditure is stable and unchanging over time, we ignore it.  But it is not. This mistaken belief that the only variable that changes is the energy expended in voluntary exercise and that this consumes a major proportion of our calories leads to the conclusion that ”diet” and ”exercise” are equal partners in weight management and they aren’t.

The fact is, most of our Total Energy Expenditure is used for generation of body heat and other metabolic processes (called Basal Energy Expenditure). Furthermore, Basal Energy Expenditure is not stable and can increase or decrease by as much as 50%. This up-regulation and down-regulation of our body processes contributes way more to weight loss or gain than exercise does. But that is not what we’ve been told.  We have believed that if we just exercise more and eat less we will lose weight. Let’s look at this a little more closely.

What happens to our body if we suddenly restrict caloric intake? According to ”calories in calories out” model, a reduction in calories will result in Total Energy Expenditure (TEE) using fat for energy and the person would lose weight.  Sounds great except that is not what happens.

In fact, Total Energy Expenditure drops substantially — by as much as 30-50%.  People complain of being unable to stay warm even with plenty of clothing and that is because calories are spared in heating the body. Heart rate and blood pressure drop to conserve energy (calories).  People even find it difficult to concentrate because the brain is very metabolically active and restricting calories suddenly turns that down. Calories are needed to move, so in sudden calorie restriction people feel weak during physical activity. In other words, metabolism slows.

Why does the body do this? It’s survival.

Consider a person normally eating 3000 calories a day suddenly starts eating 2000 calories a day.  If they were to continue to burn 3000 calories daily, they would soon deplete all their fat stores, then their protein stores and then they would die. The body tightly regulates body weight and compensates for this sudden decrease in calories by saving calories from its Total Energy Expenditure.  Instead of burning fat in storage, the body reduces its caloric expenditure on body functions to 2000 calories a day and restores balance.

The ”calorie in calorie out” model does not factor in that basal energy expenditure is not stable.  It ignores that restricting calories results in down-regulation in Total Energy Expenditure. That is, ”calories in” and ”calories out” are not independent.

The ”calorie in calorie out” model of weight gain also ignores that hunger, eating and fat storage are regulated by numerous hormones. Leptin (a hormone correlated to the amount of body fat) is one such mechanism, adiponectin (a hormone suppressed in obese people) may be another mechanism and there are others being researched.  It is also believed that cortisol, the stress hormone may play a role.  But there is one well-known hormone that plays a very significant role in hunger, eating behavior and fat management and that is insulin. Insulin’s effect will be covered in detail in future blogs. A little teaser’; we as health care practitioners have been focusing on blood glucose while overlooking insulin, which regulates it.

So in summary,

1. ”calories in” and ”calories out” are not independent, but one affects the other.
2. ”Calories in” is not only under voluntary control (what and how much we choose to eat) but several hormone play a significant role in terms of hunger and fat storage.
3. ”Calories out” is not only controlled voluntarily through exercise but also involuntarily by up-regulating and down-regulating basal metabolic expenditure (tissue synthesis, heat generation, etc).
4. Fat storage is not simply a result of having more ”calories in” than ”calories out” burned as exercise.

So what causes us to gain weight? This will be the topic of future blogs.

REFERENCES

DeLany J P, Kelley D E, Hames K C et al, High energy expenditure masks low physical activity in obesity, International Journal of Obesity 37, 1006-1011 (July 2013)

Fung, Jason, Intensive Dietary Management, The Aeteology of Obesity, August 2013

Health Canada, Overweight and Obese Adults (2102), http://www.statcan.gc.ca/pub/82-625-x/2013001/article/11840-eng.htm

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