Some people imagine that a low carb lifestyle involves plates laden with bacon and eggs, huge steaks and meals devoid of vegetables, dairy foods, and nuts or seeds, but this is a misconception.

While there are individuals that choose to eat ”zero-carb” for a variety of personal reasons, it is not something I promote outside of being prescribed by a physician for therapeutic management of a specific medical condition.

I encourage people to eat a wide variety of low carb vegetables, some fruit and dairy products, as well as nuts and seeds — all of which have some carbohydrate in them. There is no one-size-fits-all low carb diet, but there are a few low carbohydrate approaches which can be chosen from depending on a person’s medical and metabolic conditions, any medications they may be taking, as well as stage of life and lifestyle factors.

Another fallacy is that low carb diets involve ”lots of meat for dinner” and “eggs every morning for breakfast” but people eating low carb can eat a wide variety of food for breakfast and meals can be vegetarian or pescatarian (include fish and seafood) and involve no meat whatsoever. This makes a low carb suitable for those that don’t eat meat or eggs for religious or ethical reasons.

Three main low carb approaches are;

(1) low carb higher protein

(2) low carb higher healthy fat

(3) higher protein / lower fat intake during weight loss, then a moderate protein / high healthy fat intake during weight maintenance.

What makes a low carb diet ketogenic is the low amount of carbohydrate that is eaten relative to the overall caloric intake, so not all low carb diets are ketogenic.

Low carbohydrate and therapeutic ketogenic diets have a variety of clinical applications. For example, a ketogenic diet may be prescribed by a person’s physician for management of epilepsy or seizure disorder, for treatment of some kinds of cancer, or for weight loss before and after bariatric surgery. Different types of low carb diets may be used for improving insulin sensitivity in Type 2 Diabetics or those with pre-diabetes, improving fatty liver disease, for reducing symptoms of Polycystic Ovarian Syndrome (PCOS) or for gradual weight loss.

[Another misconception is that low carb diets are used for ”rapid weight loss”, which is not the case.]

For each type of low carb diet the ratio of protein to fat is specific to the clinical condition and person’s requirements. Everybody’s macronutrient  needs (the amount of protein, carbs and fat they require) as well as overall energy needs are different and are dependent on several factors including their gender, age, height, weight, clinical conditions and any medications they’re taking.

Our body requires essential amino acids found in the protein foods we eat, as well as essential fatty acids found in the different types of fat we eat, along with essential vitamins and minerals however there is no essential requirement for dietary carbohydrate – provided that ”adequate amounts of protein and fat are consumed” (Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids, 2005). This article will elaborate, but explaining it in simple terms, it means is that our body does not need to have carbohydrate in food if we eat sufficient protein with all the essential amino acids and sufficient fat with the essential fatty acids.

That doesn’t mean that I recommend that people without a clinical reason eat food with no carbohydrate in it (I don’t), as they wouldn’t be able to eat any vegetables, fruit, dairy, nuts or seeds – as these all of these have some carbohydrate in them.

I encourage people to eat a wide range of food from a variety of categories to ensure they have adequate dietary intake. I recommend whole, unprocessed foods that are naturally low in carbohydrate, including non-starchy vegetables, plant fats (such as olive oil, avocado oil, macadamia or walnut oil, coconut oil), low sugar fruit (such as tomato, lemon, lime, cucumber), meat, fish, poultry and seafood of all varieties, and small amounts of animal fat such as butter and cream.

If people working toward losing weight then the fat that is naturally found in meat is okay, but I would encourage them to trim excess visible fat. Unless there is a compelling reason not to, folks can add a bit of cream to their coffee or some butter on top of their cooked vegetables if they like it (especially if they’ll eat more veggies that way) but I don’t encourage people to ‘add fat’ to foods for the sake of adding fat (e.g. ‘bulletproof’ coffee or ‘fat bombs’).  That said, there is nothing intrinsically ‘dangerous’ about eating fat, even saturated fat but what needs to be considered is “how much” and “how often”.

High blood cholesterol and high triglycerides is the result of eating too much carbohydrate, not eating too much saturated fat, or dietary cholesterol.

A healthy person that eats more carbohydrate than their body can use will move the excess carbohydrate they eat off to their liver and will make triglyceride and LDL cholesterol and store the rest as fat.  A person who is insulin resistant or has Type 2 Diabetes may have high blood sugar levels but even if a person has normal blood sugar levels, their high carbohydrate intake may be reflected in their “cholesterol tests”.  Often what we see in such cases is high triglyceride results or high LDL cholesterol results or both. This easy-to-understand article titled Understand High Blood Sugar & High Cholesterol will explain the process in more detail. If eating excess carbohydrates continues for an extended period of time, it ‘s possible that non-alcoholic fatty liver disease (NAFL) may develop.

Each person’s ability to tolerate carbohydrate is different — depending whether they are insulin sensitive, insulin resistant or Type 2 Diabetic. Someone who is insulin sensitive for example can eat considerably more carbohydrate without causing a spike in their blood glucose level than someone who is insulin resistant. For those who are Type 2 Diabetic, both the degree of insulin resistance and the length of time they’ve been Type 2 Diabetic will affect the amount of carbohydrates they can tolerate. To explain this, I like to use the analogy of ‘lactose intolerance’.  Some people who are lactose intolerant can manage to drink and eat milk products, provided the quantities are small and the person doesn’t have it too often. Others who are lactose intolerant can’t even tolerate a small amount of lactose without symptoms. Ability to tolerate carbohydrate is similar.  People who are insulin sensitive or only mildly insulin resistance will be able to tolerate more carbohydrate than those who are very insulin resistant or have had Type 2 Diabetes a long time.

The average intake of carbohydrate in the Canadian diet is ~ 300 g per day, which is a lot. People who are insulin sensitive or mildly insulin resistance may do well lowering their carbohydrate amount to a moderate level whereas those who are insulin resistant or Type 2 Diabetic will likely need to eat considerably less carbohydrate in order to begin to see their blood sugar levels or cholesterol / triglyceride levels come down.

Factors that can affect how much carbohydrate a person can tolerate include gender, whether or not they are insulin sensitive or insulin resistant (and to what degree) and whether they have Type 2 Diabetes and if so, for how long.

What some people find challenging about deciding to follow a low carb lifestyle is knowing how much protein they need to eat, the amount and types of fat they can use, as well as the total amount of carbohydrate they can tolerate, as well as how those carbohydrates should best be distributed throughout the day.

Where it becomes particularly challenging is when people have Type 2 Diabetes or high blood pressure and are prescribed medications for these conditions.  In such cases, it’s not as simple as them just “cutting carbs” because by not doing so gradually it could result in a sudden drop in blood sugar or blood pressure which could be dangerous. People taking medications for these conditions (or for some other conditions) need to be monitored by their doctors and the reality is that not all doctors have more than a few minutes to see patients and may not feel equipped to counsel them on diet. This is where working with a Dietitian that’s knowledgeable and familiar with the use low carb diet is very helpful as they can coordinate dietary and lifestyle changes with your doctor while they monitor your health and adjusts the levels of prescribed medications, as needed.

Another situation where it can be very helpful to have a Dietitian’s support is when youth or teenagers need to lose weight, or bring down their blood sugar, cholesterol or blood pressure levels, because a there’s a need to ensure that they have adequate intake to support healthy growth.

Have questions?

Please send me an note using the “Contact Me” form on the tab above and I will reply as I am able.

To our good health!

Joy

You can follow me at:

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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.

 

 

There is more than one way to eat a low carb diet, in fact there are many variations. In this article I will outline three approaches including (1) a low carb high protein, similar to a Paleo diet as promoted by Dr. Ted Naiman and Dr. Tro Kalayjian (2) a low carb high fat approach, as promoted by Dr. Jason Fung and (3) a low carb higher protein moderate fat as promoted by Dr. Stephen Phinney and Dr. Jeff Volek.

Three Types of “Low Carb” Diets

1 – Low Carb High Protein

One proponent of a low carb high protein lifestyle is Dr. Ted Naiman, a board-certified family medicine physician who practices in Seattle, Washington. His videos on the subject of insulin resistance filmed at low carb conferences had a profound impact on me when I first adopted a low carb lifestyle in March of last year.  

On the popular low carb site, Diet Doctor, Dr. Naiman oulines how much fat, protein and carbohydrates he believes that a person should eat on a low carb ketogenic diet[2], depending on whether they are doing it for weight loss or weight maintenance.

For someone seeking fat loss, Dr. Naiman recommends ~120 gm of protein, ~30 gm of net carbs, ~120 gm of ‘whole food fats’ (fat found naturally in food) and ~30 gm of added fat (such on top of vegetables, salads and cooking). He bases his protein calculations on 1 g protein per pound of ideal (or desired) body  weight, while keeping net carbohydrate as low as possible and eating whole food fats (fats inherent with meat, fish or poultry) but avoiding added fat, if trying to get leaner. To the left is an illustration he recently posted on social media.

But how much food does one have to eat to get 120 gm of protein? A lot as you’ll see below.

Another proponent of a low carb high protein approach is Dr. Tro Kalayjian, a board certified Internal Medicine physician who currently practices in Greenwich, Connecticut. He lost 145 pounds over a two-year period following a low carb high protein diet and like Dr. Naiman does a great deal of high intensity interval training (HIIT) and resistance training (RT). Dr. Kalayjian does ~10 hours of HIIT and RT training a week with a goal of increasing muscle mass (hypertrophy) and body recomposition, so what he eats himself is very different than what he recommends to his patients.  He eats 200-350 g per day when doing heavy weight training, trims his meats and doesn’t eat the skin, and eats a variety of nuts and uses olive and avocado oil as desired. Dr. Kalayjian recommendations to his patients however depends on (1) what their goal is, (2) what their current medical / metabolic status is and (3) any lifestyle details that will impact their dietary requirements.

How many grams of protein is in what we call ‘protein foods’?  Here are some examples;

Egg (1 large) — 6.3 grams
Sausage, pork link (14 gm / 0.5 oz each) – 2.5 grams
American cheese (28 gm / 1 oz.) — 7 grams
Cottage cheese (250 ml / 1 cup) — 28.1 grams
Salmon (170 gm / 6 oz.) — 33.6 grams
Ham (170 gm / 6 oz.) — 35.4 grams
Tuna (170 gm / 6 oz.) — 40.1 grams
Chicken, breast (170 gm / 6 oz.) — 37.8 grams
Broiled Beef steak (170 gm / 6 oz.) — 38.6 grams
Hamburger (170 gm /  6 oz.) — 48.6 grams
Turkey, dark meat (170 gm / 6 oz.) — 48.6 grams
Pork Chop (170 gm / 6 oz.) 49 grams
Beef (170 gm / 6 oz.) — 54 grams

So, what would Dr. Kalayjian’s daily intake of 200-350 gm. of protein look like in terms of food? Let’s look at how much food one would need to eat  meet only 200 gm of protein per day, which is the ‘low end’ of Dr. Kalayjian’s intake;

Three eggs at breakfast would only supply less than 19 gm of protein.
Four pork link sausages would supply another 10 gms of protein.
He’d only have eaten less than 30 gms of protein.

Eating a 340 gm (12 oz) broiled beef steak at lunch-time would add another 77 gms of protein.

After these two meals, he would have eaten 106 gms of protein and be only a little over half-way to his minimum protein goal and less than a third the way to his upper range of protein.

Let’s say he decided to eat 1/2 a large salmon i.e. 340 gm (12 oz) for supper, that would add 67 grams of protein.

Adding up all the protein so far, he would have only eaten 173 gms of protein, so he’d have to fry up 4 more eggs to make his 200 gm of protein to meet his minimum protein requirement.

This is what Dr. Naiman’s 120 gm of protein would look like, broken up over a day. Three eggs for breakfast would supply <20 gm of protein and eating 227 gm (8 oz) of beef at lunch would provide 50 gm of protein, so the person would need to eat another 227 gm (8 oz) of beef at supper just to make their 120 gm of protein for the day. Now, remember, this is for an individual whose ideal body weight is only 120 pounds!

This approach may be quite appealing to some, but is eating higher protein in the range of 120 gm per day) appropriate for most people?

The Recommended Daily Intake (RDA) for protein is only 56 gms per day – which represents the minimum requirement that individuals need for health and people in both Canada and the US are eating only 70 gms of protein per day (barely over the minimum requirement) but is this optimum?  Some very prestigious nutrition experts think not.  More on that in a series of upcoming articles.

2 – Low Carb High Fat

One of the popular proponents of a high fat approach is Dr. Jason Fung, a Toronto-area nephrologist (kidney specialist). His approach is reflected in the blogs he has been writing since 2013 as part of the Institute of Kidney Lifescience Technologies (www.kidneylifescience.ca), which have since  become the basis for his Intensive Dietary Management (IDM) Program, based out of Toronto[4].

From what I gleaned back from my early days reading all of his first two years of his blogs (Aug 2013- May 2015) and many since, Fung promotes a diet which is a maximum of 20-30 gm of net carbohydrate (gross carbohydrate content minus fiber) per day, a maximum of 75 gm of protein per day (~20 gm of protein at each meal), with the remainder of intake as a variety of fats. Fung does not promote the use of “fat bombs” popularized with the “Bulletproof Diet” written by layman “biohacker” Dave Asprey, but encourages the eating of fat that comes naturally in food; such as the skin on poultry, the visible fat on meat and the yolk of eggs plus a total of 70 gm of added fat per day for satiety (feeling full).

Dr. Fung’s recommendations seem to be roughly 5-10% net carbohydrate with about 75% fat and 20% protein.

Fundamental to Fung’s approach is the use of Intermittent Fasting to restore insulin sensitivity, which ultimately also has the effect of decreasing overall intake. This is how he defines fasting windows;

1. a 16-hour fast begins from the end of supper the previous night, until lunch the following day. That is, only breakfast isn’t eaten.
2. A 24-hour fast begins from the end of supper the previous night, until supper the following day (i.e. one meal).
3. A 36-hour fast begins from the end of supper the previous night and no breakfast, lunch or dinner is eaten the following day, with the fast broken at breakfast the next day.
4. A 42-hour fast is like the 36-hour fast, except people fast until lunch on the day following the fast.

If you are considering engaging in any intermittent fasting protocol, please discuss this with your doctor first. Dosages of medication for blood sugar and blood pressure very often need to be adjusted downwards with regular short fasts and this can only be done by your doctor.

It’s important to note that Fung’s “fasts” are not water-only fasts, but allow the drinking of protein-rich ‘bone broth*’ , as well as other beverages.

NOTE: An article on making a 18 hour bone broth along with nutritional analysis is located here.

3 – Low Carb Higher Protein Moderate Fat

Dr. Stephen Phinney MD, PhD, a medical doctor and Dr. Jeff Volek, RD, PhD a Registered Dietitian have decades of combined scientific and clinic  research  experience in the area of low carb diets and in 2011 published their expert guide titled The Art and Science of Low Carbohydrate Living [2]  documenting the clinical benefits of carbohydrate restriction.

They promote a low carbohydrate diet that is higher protein during the weight loss phase only, but the level of protein they recommend is nothing near the levels that Dr. Naiman and Dr. Kalayjian encourage, but still as I will outline below, it still requires a large quantity of protein foods to be eat daily.

In the induction and weight loss phase using Phinney and Volek’s approach, protein is ~30% of caloric intake but decreases to ~21% of caloric intake  following weight loss, during weight maintenance. Fat is 60% of calories  during the weight loss phase and 65-72% during weight maintenance. Carbohydrate intake is kept very low (7.5-10% of calories for men, 2.5-6.5% of calories for women) and this induces nutritional ketosis.

The amount of mathematical calculations required for the average individual to follow Phinney and Volek’s method is, at the very least, daunting. The amount of fat in grams and carbohydrate in grams needs to be calculated initially during induction and recalculated for weight loss, then recalculated again during pre-maintenance and maintenance.  In addition, as the person’s weight decreases, the number of grams of fat and carbohydrate also needs to be recalculated. The amount of protein that must be eaten on an ongoing basis is another challenge to their approach.

Human Protein Tolerance

Ironically, even though Phinney and Volek encourage eating more protein than fat during weight loss, they write about “human protein tolerance”, including the “lethargy and malaise” that occurs when more protein than fat is eaten on a regular basis, along with the feeling of being “sick to the stomach” [3, pg. 210]. They also point out that there seems to be a physiological upper limit of protein intake of 20-25 gms per meal, after which skeletal muscle is no longer synthesized with additional intake.

Another reason Phinney and Volek recommend avoiding eating too much protein is that it lowers ketone production;

“it [protein] has a moderate insulin stimulating effect that reduces ketone production. While this effect is much less gram-for-gram- than carbohydrate, higher protein intakes reduce one’s keto-adaptation and thus the metabolic benefits of the diet.”

Phinney SD, Volek JS, The Art and Science of Low Carbohydrate Living: An Expert Guide, Beyond Obesity, 2011, page 210.

This Dietitian’s Approach

For the first few years of my low carb practice, my starting approach (for those without hereditary cholesterol or triglyceride issues) was closer to Dr. Fung’s approach than to either of the others, with several modifications. One of those modifications is around the types of fat that are central in the diet. Like Fung, I encourage people to eat fat that naturally comes with food (egg yolk, for example) but I don’t encourage the amount of saturated fat that many of his blogs reflect. I encourage my clients to consider rich sources of monounsaturated fats such as avocado, nuts and seeds and their oils as their primary fat source with omega-3 poly-unsaturated fat from fatty fish such as salmon, tuna, mackerel and sardine, a close second.

Another modification that I have made is that I encourage my clients to eat some cheese as it supplies a good source of calcium, that doesn’t have the anti-nutrients such as oxalates and phytates that are found in many calcium-rich vegetables.

As I continue to read though the literature on the topic, I am tending to a higher protein and lower fat ratio with 1 g – 1.5 g per kg of ideal body weight, the carbs that come naturally with plenty of non-starchy vegetables and the fat that is found naturally in the lean fish, poultry and meat, with minimal added fat if someone is trying to lose weight. Based on a 2000 calorie per day diet, this would be closer to 30% protein, 60-65% fat, with 5-10% net carbs. Everybody’s needs are different, so what is best for one person may not be best for another. I also tend to think more protein during the weight loss phase such as Phinney and Volek suggest makes sense, with adjusting the amount of protein intake downward (to ~21-23% of caloric intake, based on 2000 calories per day) after weight loss has occurred. Sometimes which approach a person will take depends on factors such as food preferences, cooking skill and lifestyle factors and these need to be factored into people’s decisions.

Some people, when they eat considerably more protein than fat feel nauseated.  This finding of feeling “sick to the stomach” was referred to by Phinney and Volek and came from a study of prolonged meat diets in the early 1930’s.  It is also supported from the traditional indigenous diets of the Inuit which Phinney and Volek pointed out “keep their protein intake moderate to avoid the lethargy and malaise that would occur if they ate more protein than fat” [3].

There is no one “right” way to eat a low carb diet.  What is appropriate for each individual depends on their clinical factors, as well as their personal preferences. There is no “one-size-fits-all” low carb approach.

Keep in mind that no Meal Plan is ‘carved in stone’.  Sometimes a client may start out with a higher fat approach but as they get closer to their goal weight, may reduce the amount of fat intake, so that they can take off the remainder of the weight. The flip side is true as well.  Sometimes people start out with a higher protein intake and then as they reach their goal weight, they drop their protein intake down and increase their added monounsaturated fats.

In any case, I make the process easy.

After conducting a thorough assessment, I do the math required to design their Meal Plan, calculating their protein requirement based on their physiological needs and preferences and then distribute their fat and carbohydrate intake around that.

Have questions?

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

To our good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

References

1. Mark’s Daily Apple, How to Eat Enough Protein, April 3, 2008 URL: www.marksdailyapple.com

2 – How Much Fat for a Ketogenic Diet; maintenance versus fat loss, https://www.dietdoctor.com/much-fat-eat-ketogenic-diet

3. Volek JS, Phinney SD, The Art and Science of Low Carbohydrate Living: An Expert Guide, Beyond Obesity, 2011

4. Fung, Jason,  Institute of Kidney Lifescience Technologies (www.kidneylifescience.ca) & Intensive Dietary Management (IDM) Program (www.intensivedietarymanagement.com)

 

 

 

INTRODUCTION – In Part I of this two-part series, I explained how the current dietary recommendations and popular beliefs about weight gain have inadvertently contributed to many of the health problems we now face.  If you haven’t yet read the first part, you can read it here and then follow the link back to continue reading this article.

In this post, I point to some previously written articles posted on this site to explain what a Low Carb High Fat style of eating is and how it serves as a solution to the problems outlined in the previous article.

Part II – Understanding Low Carb High Fat – the solution

What exactly is a Low Carb High Fat Diet?  This article explains the fundamental information people want to know about which food categories they can eat, such as  non-starchy vegetables, plant fat, low sugar fruit, meat fish poultry and seafood, animal fat and unsweetened beverages).

There is also a simple illustration of the food categories in a low carb lifestyle, indicating the types of food in each category. This dispels the myth that eating LCHF is in anyway a ‘restricted diet’.

This post also explains what macronutrients are and what the ratios of protein, fat and carbohydrate are on a LCHF diet. It is a basic primer about the Low Carb High Fat lifestyle.

People sometimes refer to a “low carb diet” as if it were a single entity, but there are many types of low carb diets ranging from moderate low carb (130 g carbs) to ketogenic diets (5-10% net carbs). Even amongst low carb or ketogenic diets, there are low carb high fat diets,  low carb high protein diets as well as Low Carb High Protein in weight loss and High Carb High fat in maintenance.

This article titled American Diabetes Association Approves Low Carb Diets for Weight Loss explains the basics of a moderate low carb diets (130 g carbs) which is approved by the American Diabetic Association as a weight-loss option for Diabetics.

Many people believe that saturated fat is ”bad” for them but few realize that our bodies actually manufacture it. This article titled The ”Skinny” on Fats explains the principles of fats while explaining the chemistry in simple terms that those with a non-science background can understand.  These ‘basics’ enable people to understand the controversy around saturated fat and to be able to talk about them with family members, friends, and their healthcare professionals.

People are used to thinking about food in terms of its ability to provide energy for their body but many don’t realize that their bodies can be fuelled by either carbohydrates or fat.  This article titled Humans — the perfect hybrid machine explains how in times past it was perfectly normal for us to experience a cycle of “feasting” and “fasting” – running on our own fat stores during the times between eating and how currently, we rarely are able to access our own fat stores, because of the constant supply of carbohydrate-rich food.

This article, titled Evidence for Remission of Type 2 Diabetes Symptoms using LCHF begins with a brief history of the Low Carb Diet and its role the primary approach to managing Diabetes prior to the discovery of insulin. It also talks about its role in managing seizure disorder and outlines how a Low Carb approach was central to the very first weight loss diet book written ~150 years ago.  It mentions the “Atkins Diet” which first came on the scene in the early 1970s and then introduces the research of Stephen Phinney (a medical doctor and PhD research scientist) and Jeff Volek, a Registered Dietitian with PhD whose work centers on using a low carb diet as a therapeutic tool for managing insulin resistance.  It presents the findings of Phinney and Volek’s most recent study which demonstrates that after 6 months following a low carb diet >75% of people in this study had HbA1c that was no longer in the Diabetic range (6.5%). It provides some evidence that yes, the symptoms of Type 2 Diabetes can to go into remission by following a Low Carb lifestyle.

Finally, the last article titled Are Low Carbohydrate Diets Safe and Effective provides compelling evidence from a two-year study which found that compared to a Mediterranean Diet and Low Fat diet, weight loss was greatest in those that followed a Low Carb diet. Of significance, subjects in in the LCHF group in this study also had lower fasting plasma glucose, lower HbA1C, significantly lower triglycerides, significantly higher HDL and lower C-reactive protein .

More Info

Want to know how I can help you adopt a low carb lifestyle?

I provide LCHF in-person services to those in the Greater Vancouver BC area and LCHF Distance Consultation services to those living elsewhere in the province, or from other provinces and territories in Canada. Please have a look at the “My Services” tab above for a list of the LCHF services that I provide.

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

To our good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

 

 

 

INTRODUCTION – If you are one of those that is considering adopting a low carb high fat lifestyle and want to understand the reasons behind ‘why’, this post is for you. It will guide you through a handful of previously written articles on this site so that you’ll understand how the current dietary recommendations and popular beliefs about weight gain have inadvertently contributed to many of the health problems we now face.

As in anything, before considering a solution to a problem, we first need to understand the problem.

Part I – Understanding Low Carb High Fat – the problem

In 1977, the US and Canada changed their Dietary Recommendations  encouraging us to eat 45-65% of daily calories as carbohydrate and to limit all kinds of fat to 20-35%. Of relevance, in the early 1970s, prior to these changes only ~8% of men and ~12% of women were obese – and now almost 22% of men and 19% of women are obese.

The article titled Obesity Rates in Canada and Changes to Canada’s Food Guide will walk you through the changing recommendations of Canada’s Food Guide (CFG) over the years, as well as the corresponding and  simultaneous increase in the rates of overweight and obesity.

Unfortunately the dietary changes of 1977 have given us 40 years of data showing ever-increasing rates of obesity, overweight and Diabetes. It is quite literally an “epidemiological* experiment gone wrong”.  This article titled Canada’s Food Guide — an Epidemiological Experiment Gone Terribly Wrong will help you understand some of the shortcomings of the guide, as it stands now.

*Epidemiology is the study and analysis of the patterns, causes, and effects of health and disease in populations.

We’ve been told for years that the problem is that we “just need to eat less and exercise more“.  If it were really that simple then 4.7 million adults in Canada wouldn’t be classified as obese and more than 40% of men and 27% of women classified as overweight.  This article titled Why do we Gain Weight — the Myth of ”Calories in, Calories out” will explain why this model doesn’t work.

We’ve also been told that people are overweight because “they lack self control” but this article titled Weight Gain as a Hormone Imbalance not a Calorie Imbalance explains how body weight is regulated automatically under the influence of hormones – hormones that signal us to eat and indicate when we are satiated. These hormones also signal our bodies to increase energy expenditure and when calories are restricted, they will slow energy expenditure. It’s not a matter of people “trying harder” but eating in such a way as to regulate these hormones.

In Part II titled Understanding Low Carb High Fat – the solution, I explain what a Low Carb High Fat style of eating is and how it serves as a solution to the health problems we now face.

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

INTRODUCTION: In a recent article, I established that low carbohydrate diets are not new and that recently published six-month results of a non-randomized, parallel arm, outpatient intervention demonstrated it was so effective at improving blood sugar control in Type 2 Diabetes, that at the end of six months >75% of people had HbA1c that was no longer in the Diabetic range (6.5%).

But what about the long term safety and effectiveness of low carb diets?

To date, there have been 3 long-term clinical trials (2 years) published over the past 10 years that included a low-carbohydrate treatment group and in this series of three articles, I will look at the methodology and findings of each.

Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

The first study published in 2008, with research conducted between July 2005 and June 2007 was a 2-year Dietary Intervention Randomized Controlled Trial (DIRECT) to compare the effectiveness and safety of (1) a low-fat calorie-restricted diet, (2) a Mediterranean calorie-restricted diet and (3) a low-carbohydrate non—calorie-restricted diet.

The criteria for recruitment to the study was age between 40 and 65 years and a body-mass index (BMI) – which is the weight in kilograms divided by the square of the height in meters of at least 27, or the presence of Type 2 Diabetes (according to the American Diabetes Association criteria) or coronary heart disease regardless of age and BMI.

Subjects were randomly assigned within strata i.e. gender, age (below or above the median), BMI (below or above the median), history of coronary heart disease (yes or no), history of Type 2 Diabetes (yes or no), and current use of statins (none, <1 year, or ≥1 year).

Subjects in each of the 3 diet groups were assigned to subgroups of ~18 participants (total of 6 subgroups in each group) and each diet group was assigned a Registered Dietitian that met with their groups in weeks 1, 3, 5, and 7 and after that at 6-week intervals, for a total of 18 sessions of 90 minutes each.

Low Fat Diet— Participants were counseled to consume low-fat grains, vegetables, fruits, and legumes and to limit added fats, sweets, and high-fat snacks. For the low-fat, restricted-calorie diet they were instructed to consume up to 30% of calories from fat, 10% from saturated fat and up to 300 mg cholesterol/day, with 1500 kcal for women and 1800 kcal/day for men.

Mediterranean Diet— The moderate-fat, calorie-restricted diet is rich in vegetables and low in meat, with poultry and fish replacing beef and lamb. Subjects were instructed to consume 35% of calories from fat; the main sources of added fat were from 30-45 grams of olive oil and a handful of nuts (5-7, less than 20 grams) per day. Subjects were instructed to restrict energy to 1500 kcal for women and 1800 kcal/day for men.

Low Carbohydrate Diet- This low-carb, non-calorie restricted diet was modeled after the Dr. Atkins Diet and aimed to provide 20 g/day of carbohydrates during the induction phase (first 2 months), and returned to this level of carb restriction after each religious holiday. At other times participants were instructed to increase carbs gradually up to maximum of 120 g/day to maintain the weight loss. Total calories, protein and fat intake from any source (except trans fats) were not limited.

Adherence to the diets was evaluated by a validated food-frequency questionnaire (127 food items with portion-size pictures) at baseline and at 6, 12, and 24 months of follow-up, and the questionnaires were self-administered electronically. A validated questionnaire was also used to assess physical activity.

Weight – The participants were weighed without shoes to the nearest 0.1 kg every month.

Blood Samples – Blood samples were obtained by at 8 a.m. after a 12-hour fast at baseline and at 6, 12, and 24 months.

Results – Dietary Intake, Energy Expenditure, and Urinary Ketones

At baseline, there were no significant differences in the composition of the diets consumed by participants assigned to the low-fat, Mediterranean, and low-carbohydrate diets.

Daily energy intake as assessed by the food-frequency questionnaire, decreased significantly at 6, 12, and 24 months in all diet groups as compared with baseline and there were no significant differences among the groups in the amount of decrease.

The low-carbohydrate group had a lower intake of carbohydrates and higher intakes of protein, total fat, saturated fat, and total cholesterol  than the other groups.

The Mediterranean-diet group had a higher ratio of monounsaturated to saturated fat than the other groups, and a higher intake of dietary fiber than the low-carbohydrate group.

The low-fat group had a lower intake of saturated fat than the low-carbohydrate group.

Physical Activity – The amount of physical activity increased significantly from baseline in all groups, with no significant difference among groups in the amount of increase.

Urinary Ketone Production – The proportion of participants with detectable urinary ketones at 24 months was higher in the low-carbohydrate group (8.3%) than in the low-fat group (4.8%) or the Mediterranean-diet group (2.8%).

Note: of interest, participants in all groups produce urinary ketones.

Weight Loss

A phase of maximum weight loss occurred from 1 to 6 months and a maintenance phase from 7 to 24 months.

All groups lost weight, but the reductions were greater in the low-carbohydrate and the Mediterranean-diet groups than in the low-fat group.

The overall weight changes among the 322 participants at 24 months were −4.7 (10.3 lbs) ±6.5 kg (± 14.3 lbs) for the low-carbohydrate group, âˆ’4.4 (9.68 lbs) ±6.0 kg (± 13.2 lbs) for the Mediterranean-diet group and
−2.9 (6.38 lbs) ±4.2 kg (± 9.24 lbs) for the low-fat group.

Lipid Profiles

Changes in lipid profiles during the weight-loss and maintenance phases are as followed;

HDL cholesterol increased during the weight-loss and maintenance phases in all groups, with the greatest increase in the low-carbohydrate group (0.22 mmol per liter (8.4 mg per deciliter) compared to the low-fat group which increased by 0.16 mmol per liter (6.3 mg per deciliter).

Triglyceride levels decreased significantly in the low-carbohydrate group 0.27 mmol per liter (23.7 mg per deciliter) as compared with the low-fat group 0.03 mmol per liter (2.7 mg per deciliter).

Of significance, LDL cholesterol levels did not change significantly within any of the groups, and there were no significant differences between the groups in the amount of change.

Overall, the ratio of total cholesterol to HDL cholesterol decreased during both the weight-loss and the maintenance phases. The low-carbohydrate group had the greatest improvement, with a relative decrease of 20% as compared with a decrease of 12% in the low-fat group.

High-Sensitivity C-Reactive Protein, High-Molecular-Weight Adiponectin, and Leptin

The level of high-sensitivity C-reactive protein (an assessor of inflammation often used to may be used to evaluate risk of cardiovascular disease.) decreased significantly in the low-carbohydrate group (29%), and also in the Mediterranean-diet group (21%) during both the weight-loss and the maintenance phases, with no significant differences among the groups in the amount of decrease.

The level of high-molecular-weight adiponectin (which regulates glucose levels, as well as fatty acid breakdown) increased significantly in all diet groups, with no significant differences among the groups in the amount of increase.

Circulating leptin, which reflects body-fat mass, decreased significantly in all diet groups, with no significant differences among the groups in the amount of decrease.

Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin

Fasting Blood Glucose

Among the 36 participants with Type 2 Diabetes, those in the Mediterranean diet group and low carb diet group had a decrease in fasting plasma glucose levels of 2.1 mmol/L (32.8 mg per deciliter) and 0.1 mmol/L (1.2 mg/dl) respectively, whereas those in the low-fat group had an increase 0.7 mmol/L (12.1 mg/dl).

There was no significant change in fasting plasma glucose level among the participants without Type 2 Diabetes.

Fasting Insulin

Insulin levels decreased significantly in participants with Type 2 Diabetes and without Type 2 Diabetes in all diet groups, with no significant differences among groups in the amount of decrease.

HOMA-IR

Not surprisingly, since HOMA-IR is determined from fasting blood glucose and fasting insulin, among subjects with Type 2 Diabetes the decrease in HOMA-IR at 24 months was significantly greater in those assigned to the Mediterranean diet (-2.3) and low carbohydrate diet (-1.0) than in those assigned to the low-fat diet (-0.3).

Glycated Hemoglobin (HbA1C)

Among the participants with with Type 2 Diabetes HbA1C at 24 months decreased most noticeably in the low-carbohydrate group (0.9 ±0.8%), and moderately in the Mediterranean-diet group (0.5 ±1.1%) and low-fat group (0.4 ±1.3%). The changes were significant only in the low-carbohydrate group.

DISCUSSION

In this 2-year dietary-intervention study, the low-carbohydrate diets was found to be both an effective and safe alternative to the low-fat diet for weight loss.

In addition to producing weight loss in moderately obese subjects, the low-carbohydrate demonstrated some marked beneficial metabolic effects including;

• lower fasting plasma glucose: 0.1 mmol/L (1.2 mg/dl)
• lower HbA1C: -0.9 ±0.8%
• significantly lower triglycerides: -0.27 mmol per liter (23.7 mg per deciliter)
• significantly higher HDL: +0.22 mmol per liter (8.4 mg per deciliter)
• lower C-reactive protein: -29%

These results suggest that a low carbohydrate, non-calorie restricted diet that provides 20 g of carbs per day during the induction phase of 2 months, with slightly higher amounts of carbohydrates with the addition of nuts, low-carb vegetables and small amounts of fruit until goal weight is achieved (~30-50 g carbs) is both safe and effective over a two-year period.

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References

Astrup A et al, Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008 Nov 13;359(20):2169-70.

free pdf available here: www.nejm.org/doi/full/10.1056/nejmoa0708681

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first. If you are taking medication to lower blood sugar or blood pressure, you should be monitored by your physician while following a low carb diet, as medication dosages will need to be adjusted – often soon after beginning.

For the umpteenth time in as many weeks, I had a client tell me that they were told that “low carb eating is not sustainable” – and this was in the same breath as the decision to increase the second of two medications they are prescribed for Type 2 Diabetes.

What frustrates me is that their physician did not even want this person to try a lower carbohydrate approach.

The client was reminded soberly that “Diabetes is a chronic progressive disease” and that it is “expected” that over time the dosage of both of those medications will increase until they can’t be any more, and that they will eventually be insulin-dependent. I think that for many, this becomes a self-fulfilling statement and believing it to be ‘inevitable’, people are resigned that there is ‘nothing they can do’.

But is this true? Does it have to be a chronic, progressive disease?

Medical professionals across Canada, the United States, Australia and Europe have clinical experience demonstrating that the symptoms of Type 2 Diabetes can be put into remission and that most are able to the majority of their patients off many, if not all of their medications by following a low carbohydrate diet.

What about the claim that “low carb eating is not sustainable“?

Certainly, people who adopt a low carb lifestyle eat differently than they did before – but so do people who choose to be vegetarians. How often are those who choose not to eat meat for ethical or moral reasons told that “a vegetarian diet is not sustainable“? I don’t know of any.

Following a low carb lifestyle is no more or less sustainable than choosing not to eat meat.

For heaven’s sake, for the last 40 years people have been advised to eat a low-fat diet and I don’t recall anyone being told that “a low fat diet is not sustainable“.

I like to think of adopting a low carb lifestyle in terms of someone who has been diagnosed with a food allergy or food intolerance. Someone who’s been diagnosed as Celiac is intolerant to gluten and they make the choice to avoid gluten for health reasons. People with nut allergies also face food restrictions that guide their choices. Do we ever hear Celiacs being told that “eating a gluten restricted diet is not sustainable” or that “eating a nut-free diet is not sustainable“?

No.

People are advised by their doctors, or who have consulted with their doctors to follow these dietary restrictions for health reasons should not view this style of eating as any more or less restrictive or limiting than any other dietary restriction made for heath reasons.

Many people who adopt a low carb lifestyle do so to reduce the risks associated with health conditions such as Type 2 Diabetes, high blood pressure and high triglycerides / cholesterol. People who have seen friends or family members live through or die from complications from these conditions are likely to be highly motivated to make dietary changes and to stick with them. As with any other dietary restriction, a low carb lifestyle is a dietary choice and the willingness to continue with it is tied to the strength of the motivation to make that dietary change in the first place.

Note: The American Diabetes Association gives Type 2 Diabetics the option of following either a moderate low carb diet (130g carbohydrate) or a low calorie calorie restricted diet for up to a year, for weight loss. At the present time, Diabetes Canada does not yet approve this approach.

Once people start eating lower carb, how much better they feel provides the self-motivating to continue!  They report that they are no longer driven by food cravings, that they sleep better, have more energy and mental clarity and focus.  Many people with joint stiffness and pain find it improves considerably and of course, they lose weight naturally and almost effortlessly, without being hungry.

There is such a sharp contrast between how they feel after adopting a low carb lifestyle to how they felt before, that this serves to reinforce their initial reason for adopting this change. Why would they want to go back to feeling overstuffed, lethargic, hungry and tired? So they continue in their lower carb lifestyle.

What if when a person is faced with the preconceived conclusion that “low carb eating is not sustainable” they responded by suggesting adopting it for 3 months and re-running the blood work, along with the commitment to monitor their own blood glucose levels and blood pressure daily, and returning immediately if there are any issues? People could get “buy in” from their doctors in order to improve their own health using dietary changes – in much the same manner as dietary changes are used to manage other conditions. This is what I ask my clients to do before they begin a low carb diet; to discuss the approach with their doctors beforehand and have them follow them over time.

Maybe to change the ‘status quo’ is simply a matter of each of us advocating for change in managing our own “chronic, progressive diseases” – especially those that need not be either chronic, nor progressive.

 

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A low carb high fat (LCHF) diet is a way of eating that maximizes the body’s natural ability to access one’s own fat-stores for energy. Fat takes the place of carbohydrate as the preferred source of energy, so most of the body’s energy needs comes from a wide variety of healthy fats. All low carb high fat diets minimize carbohydrate-based food, have a moderate amount of protein and high amount of healthy fats, some versions (e.g. Phinney and Volek) have higher protein and lower fat during the weight loss phase.

When we eat this way, our body uses dietary fat that we eat and our own stored fat for energy and by keeping carb intake low, insulin levels are allowed to fall, which in time makes our cells more sensitive to it. As insulin levels fall, so does hunger – so we eat meals when hungry, until we are no longer hungry – but are no longer hungry every few hours.

The low carb high healthy fat diet

These are the categories and types of food that are available to enjoy on a low carb high healthy fat diet;

Macronutrients

The exact ratio of macronutrients in your diet (i.e. grams of carbs, fat and protein) will differ depending on your age, gender, activity level, current body composition as well as any health conditions or medication you may be taking – and of course, which style of low carb high fat diet you follow.

Here are some general guidelines to give you an idea;

Protein

A low carb high healthy fat diet does not have unlimited amounts of animal protein, although some variations of this style of eating do. As mentioned above, some versions of this eating style have higher amounts of protein than fat only during the weight loss phase.

Fat

One thing all low carb high fat diets have in common, is that they are lower in carbs than the conventional low fat calorie-restricted diet and high in fat.

During weight loss, some approaches have ~60% fat and higher amounts of protein, whereas others have 75-80% fat (e.g. Fung’s approach) and moderate amounts of protein.  But isn’t all this fat “bad” for us – especially saturated fat?

It’s important to keep in mind that only ~ 20% of the saturated fat in our body comes from diet, with the remainder being made by our body. If it were that ‘bad’ for us, why would our bodies naturally manufacture it?

How much saturated fat should we eat?

According to Phinney and Volek (The Art and Science of Low Carbohydrate Living), when someone is adapted to eating a low carb high healthy fat (i.e. are in “fat-burning mode”), saturated fats do not raise LDL cholesterol. That said, why eat only saturated fat? Eating a wide range of healthy fats from a variety of natural sources provides our bodies with all the essential fatty acids we can’t make, as well as provides us with foods that can reduce inflammation.

Beyond saturated fat that is found in the diet’s protein sources (meat, fish, egg, cheese and poultry), I recommend that people look mainly to mono-unsaturated plant-based fats such as those found in avocado, olive,  and avocado oil along with saturated fat and medium chain triglycerides from coconut oil (processed through the lymphatic system rather than the liver), modest amounts of  omega 6 fats from nuts and seeds, as well as plenty of omega 3 fats found in fatty fish.

It’s important to note that nuts and seeds such as almonds, walnuts, pumpkin and sunflower seeds, pistachios are a source of carbs (ranging from ~1.5—4 grams net carbs per ounce (30g)), so it’s important to use these in moderation, such as a few as a topping for a salad. In addition, nuts are high in omega-6 fats which are pro-inflammatory as they compete for binding-sites with omega-3 fats such as those found in fish.

Chia and flax seed are approximately 1—2 grams net carbs per 2 Tbsp (50 ml) and are excellent sources of both soluble and insoluble fiber.

All fats on the meal plan are healthy – which is why I call this approach “low carb high healthy fat”, but for a small percentage of people for whom high LDL cholesterol continues to be a concern, eating less saturated fat may be beneficial. Each person’s needs and familial risks are different, so no one low carb high healthy fat Meal Plan is the same.

Carbohydrate

Carbs are a healthy part of the low carb high fat diet, but the quantity of carb is minimized.

There are naturally-occurring carbs in non-starchy vegetables and low-sugar fruit (such as lemon, lime, eggplant, cucumber and tomatoes) as well as berries, as well as those found in nuts and seeds, as mentioned above.

Some versions of a low carb diet do not include nuts, seeds or berries during weight loss.

When starting a Low Carb High Healthy Fat Diet

Although not everyone does, some people experience some of the following symptoms, which usually subside within a couple of weeks. For each, I have offered some suggestions to minimize them:

• headaches: often a result of eating too little salt. As insulin levels fall, so sodium is excreted by the kidney in urine. The drop in sodium results in the headache.  Taking 1-3 gms of salt per day (I prefer sea salt) will alleviate this. If you are taking medication for high blood pressure, be sure to check with your doctor before making any changes to your diet.  “Bone broth” is another way to restore electrolytes that are lost as insulin levels fall. Be sure you’re drinking plenty of water and also consuming enough salt/sodium.
• sleep disruption: often a result of needing to urinate more, but sometimes experienced when people of switching from being in “carb-burning mode” to being in “fat burning mode”. Some people find taking some magnesium (with calcium) before bed helpful.
• digestive changes: some people find they get slightly looser stools or get slightly more constipated when starting.  I can help troubleshoot this with you to get things back on track.
• aches and pains: some people feel a little achy and almost flu-like for a few days when they are switching fuel sources.  Some people call this the “keto-flu”.  Making sure to have a balanced amount of sodium/potassium and calcium/magnesium as well as taking extra omega 3 fatty acids is helpful.

My role as a Dietitian

As a Dietitian, I make sure that you understand the effect that following a low carb high healthy fat diet can have on your body.  If you are taking medication for high blood pressure  (hypertension) or to lower blood sugar, I’ll ask you check with your doctor before starting, as blood sugar and blood pressure medications may need to be adjusted lower, as insulin levels fall.

If you aren’t taking any medication, I’ll help you transition into understanding that fat in and by itself is not ‘bad’ and that eating good quality healthy fats, nutrient-dense carbohydrate-containing foods and high quality animal protein is part of a healthy diet that will enable you to feel better, lose weight and lower insulin resistance.

I’ll design your Meal Plan so that it is adequate in macronutrients (protein, carbohydrate and fat) as well as micronutrients (vitamins and minerals – especially Calcium, Magnesium, Potassium, B-Vitamins, Vitamin A, Vitamin D, Vitamin K and Vitamin C) and sufficient in soluble and insoluble fiber  – suitable for your age, gender and activity level, and that factor in any diagnosed medical conditions you may have.

I’ll make sure that you are eating sufficient food in each of the food categories to meet your dietary needs, while adjusting for weight loss, if that is also a goal – so that you can just focus on eating healthy, ‘real food’.

Have questions? Feel free to send me a note using the form on the Contact Me tab, above.

To your health!

Joy

you can follow me at:

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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.