This morning, as I was getting ready to go out for my walk, I noticed something on the floor. As I started to bend down to pick it up, I realized it was my own toes! There they were – peeking out from under my shrinking abdomen! It shouldn’t be that the sight of one’s own toes while standing elicits such a surprised reaction, but it did.
As usual, I went walking this morning – something that has become a routine, since I fractured a rib 5 weeks ago (washing a bathtub, of all things!). It was supposed to reduce the associated muscle pain (which it did) and after a few weeks, I realized I was really enjoying this “me” time, walking around a local lake. This week, I started Nordic walking (using Trek poles) and have really enjoyed the full-body exercise. Even the drizzle wasn’t going to stop me today. After all, that’s what rain shells are for. In fact, the one I grabbed this morning was the one I bought two years ago online, but that was too small, but today I put it on and zipped it right up. Finally, my body is changing! After 4 months of seeing very slow progress, the progress is becoming more and more evident.
Three weeks ago, at the encouragement of a local area physician whose practice focuses on low carb eating, I decided to take some body measurements, to track my progress. I measured mid arm circumference (between the point of my elbow and the pointy part of my shoulder blade), the my midpoint on my neck, my chest (where a brassiere would sit), my thigh (midway between my knee and my hip, at the widest part) and my abdomen at my umbilicus (or belly button) – which I have been tracking from the beginning.
[I don’t bother tracking my “waist” because this is smaller than the umbilicus, and what I want to assess is abdominal fat, which is better measured at the belly button.]
In the last three weeks, I’ve lost:
1/2 inch off my mid-arm
2 inches off my neck (yes I checked and rechecked this one!)
1 inch off my chest
1 inch off my umbilicus circumference
and gained 1/2 inch (of muscle) on my thighs.
Also during the last 3 weeks, I’ve lost 2 1/2 pounds and my fat percent has dropped 1.2%.
And today, I saw my toes!!
Yes, I have a long way to go, but I am not focusing on the destination but on the journey.
I am enjoying eating real food and not feeling uncomfortably full afterwards (something absent since I gave up eat carb-based foods!).
I enjoy being able to delay the time between meals (intermittent fasting) without feeling hungry, tired, grumpy or deprived). Since I’m a Dietitian, I talk or write about food all day during the work week and most days I eat only supper. Today I was hungry, so I ate a meal at 11am – but I still had a 16 hour ‘fast’ from supper last night until I ate today, where I hadn’t eaten anything. This time is so important, to enable my insulin levels to fall, and lower my insulin resistance that had been created by me previously eating 3 meals and 2-3 snacks per day, all centered around complex carbs – for years.
I like the feeling of being active; having gone from being totally sedentary (inactive) to being moderately active (45 minutes 5 days / week). I don’t exercise in order to lose weight, but because it is good for my heart and brain and it lowers my stress level (lowering cortisol). This in turn is good for my blood pressure and for overall health. I enjoy doing it early in the morning and enjoying the feeling of well-being and satisfaction all day long.
For the first time in many years, I don’t eat because I am craving something, I eat because I am hungry! In fact, I don’t crave anything! I eat a small amount of dark chocolate each day (for health, of course) and even while intermittent fasting, I can walk through a bakery section of a store and not be the slightest bit interested in any of it. My body is happily burning my own fat (which I have plenty of!) so I’m good. I’m always drinking sparkling water (which I make at home) and usually finish 2 litres (a little less than 2 quarts) by the time I return from my morning Nordic walk.
I am sleeping so much better than I have in many years and have discontinued the prescription that I would keep on hand for the frequent nights I was unable to fall asleep. I still wake up sometimes because of my healing fractured rib (if I roll over) but other than that I wake up rested. What a thought – waking up rested AND seeing my toes! I can get used to this.
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It’s been 4 months since I began my own weight-loss journey, following a low carb high healthy fat diet and I’ve been to the lab and had my blood tests. Here is an update on my progress to date.
Fasting blood sugar
When I began this journey at the beginning of March, my fasting blood glucose was averaging 12 mmol/L – and this was when I was eating the ‘standard recommended diet’ for someone with Type 2 Diabetes. My diet was high in complex carbs, and low in saturated fat. Also, as has been traditionally recommended for someone with Type 2 Diabetes, I ate 3 meals per day and made sure to have 2 – 3 snacks per day (each with complex carbs and some protein).
Now, four months into eating low carb high fat, my fasting blood sugar is averaging 8.5 mmol/L. It is significantly better, but not what I had hoped which was to be at or below 6.0 mmol/L (below the Diabetic cutoff range) in this time. There were factors that I was not considering.
Firstly, my blood sugar has been persistently high in the morning since I have been in nutritional ketosis – significantly higher than 2 hours after a meal. At first, I couldn’t figure out why. I’d been tracking my blood glucose at various times of the day; fasting, before I eat, 2 hours after I eat, before bed etc., but regardless what I ate the night before, it was highest in the morning. It was then that I began to suspect that the effect of the hormone cortisol might be a factor.
Cortisol is our “fright and flight” hormone and under stressful conditions, such as being chased by someone or something, cortisol provides the body with an immediate source of glucoseby breaking down our glycogen stores in our muscle and liver (a process called glycogenolysis) and uses them to manufacture glucose in the liver (a process known as gluconeogenesis).
All hormones have a natural cycle of rising and falling throughout the day and this is known as a hormone’s circadian rhythm and over the course of the night, cortisol production begins to climb around midnight and reaches and is highest level between 6 am to 8 am. When I began to track my blood sugar from 10 pm until 8 am, I noticed that it would start going up in the wee hours of the morning and keep rising until 6:30 or 7 am, am when I would take it. It was then that it became evident that my fasting blood sugarwas rising with cortisol.
When we sleep, our body breaks down the glycogen stored in our muscle and liver and converts it to glucose for our blood – an entirely normal process. Since I am following a low carb high fat diet andhave been in nutritional ketosis for while,my body uses ketones as its primary fuel source and make all the glucose it needs for my blood from the protein and fat in my diet. When it runs out of that, it burns my stored fat for fuel – which is exactly what I want it to do! Since I’d been keeping my carbohydrate intake ~50 gm per day, when cortisol levels would rise over night, my body would break down my glycogen first, then my own fat stores to make glucose for my blood, which I suspect is the origin of my high fasting blood glucose. That, combined with my liver still being insulin resistant, the glucose has no where to go.
This made sense to me and explained why my fasting blood glucose remained high, despite no carb creep (more carbs than planned for).
Since I’m keeping myself in nutritional ketosis, I’m not concerned about my fasting blood glucose remaining higher, although I may try distributing my carbs differently – with fewer at night. Since my goal is lower insulin resistance, I am going to continue to focus on that. High blood sugar is a symptom. The problem is insulin resistance.
My blood glucose2 hours after meals has been getting better. It is now averaging around 6.0 mmol/L(sometimes hovering around 5.5 mmol/L) which is much better than 7.2 – 8.6 mmol/L which is what it was at the beginning of March. My goal is to see it consistently below 5.0 mmol/L after meals by mid-November.
HbA1C – glycosolated Hemoglobin
Glycosolated hemoglobin (HbA1C) is the hemoglobin in our red blood cells that gets sugar molecules attached to it proportional to the amount of sugar in our blood. It is used to measure the three-month average plasma glucose concentration, based on the fact that the lifespan of a red blood cell is four months (120 days). The advantage of this test, is that one does not need to be fasting to have it.
HbA1C is most strongly correlated with fasting blood glucose (as opposed to pre-meal blood sugar or to 2 hour post-meal blood sugar) and since my fasting blood glucose has been consistently high, my HbA1C results naturally reflected this. Lab tests indicate it is 7.5%, which is above the upper cutoff for Type 2 Diabetics of 7.0% – and higher than what I was aiming for, which was below 6.0%, the Diabetic range cutoff. However, since neither fasting blood glucose nor HbA1C measure what I am trying to change (which is insulin sensitivity), I’ve decided that in November, I will pay to have my fasting insulin re-assessed. After all, the goal is to lower insulin – which underlies the high blood sugar!
I knew that I needed to get my cortisol levels down, as cortisol drives appetite, which drives eating which in turn, causes insulin to be released. More insulin means my body will be focused on fat storage, not fat burning which is the opposite of what I want. Since my goal is lowering insulin resistance, lowering cortisol makes sense. Since I can’t change cortisol’s natural circadian rhythm, I had to focus on lowering the whole curve! Lowering stress wasn’t going to happen sitting at my desk working. I had to get moving. More on that, below.
As mentioned in my last update, a month ago I asked to be started on a very low dose of Ramipril (Altace), as my blood pressure had begun to creep up again. When I saw 160/90 mmHg two days in a row, I went to see my doctor. He wasn’t there, but the locum agreed with my assessment that it was wise to protect my heart, brain and kidneys while I continued to make the dietary and lifestyle changes. She asked me to delay getting my blood work for a few weeks, to assess my electrolytes (sodium and potassium) level which can be affected by the medication.
Even two years ago, my potassium was at the high end of normal – and this was when I was dutifully eating a diet high in complex carbs and low in saturated fat, as I ate a diet high in potassium-rich foods.
This time my potassium was at the upper normal limit, so I’m tracking my intake of it and keeping it approximately 1/3 to 1/2 of what it was previously.
Taking the blood pressure medication is a temporary measure that I decided on in order to offer some protection against heart attack, stroke and kidney damage until I lose more weight, and my blood pressure stays down on its own.
Thankfully, my overall kidney function is now better than it was 2 years ago, although I did need to make a few dietary changes to be sure that I avoid getting kidney stones (something that runs in my family). When I started exercising regularly a month ago, I didn’t adequately increase my water intake – which I’ve since corrected. I had also added a calcium supplement when I stopped drinking milk in March and which was binding with certain food components in the veggies and nuts I was eating. This was probably what was resulting in calcium-oxalate being detectable in my urine. I’m no longer taking the calcium supplement and have added more hard cheese into my diet, instead.
My LDL was at the high-end cutoff two years ago, but after 4 months on a low carb high healthy fat diet, it is approaching what is considered by the existing / popular standards of “optimal LDL” for someone who is high risk (family history of cardiovascular disease). My LDL is 2.60 mmol/L (1.14 mg/dl), my triglycerides(TG) were 0.64 mmol/L and my HDLwas1.97 mmol/L.
Using more significant measures, my TG:HDL ratio is now 0.32 (with <0.87 considered ideal). According to several studies (that I will go into more detail in an upcoming article), a very low TG:HDL ratio is associated with lots of large, fluffy LDL – the kind associated the lowest risk of cardiovascular disease (CVD) such as heart attack and stroke. It is the higher density, small LDL particles that are associated with CVD.
A month ago, I began walking every morning during the weekdays. I had just fractured a rib (slipping washing a bathtub!) and read that walking was good to reduce pain. Since reducing pain was high up on my “to do” list, I started with walking 1 km each morning during the week, before I began my office hours. I gradually increased it to 2 km. The last week and a half it has been 3 km.
At the beginning of last week, I saw a fellow who was in very good shape using Nordic walking poles,so I asked him why he used them. He explained that as he digs the poles into the dirt on the path and pushes himself off of them, it gives him a good upper body as well as the lower body workout that comes from walking briskly. I decided to get myself some.
I researched what height they needed to be and decided whether I would get adjustable height ones or not, and purchased them on Friday and over the weekend, I read about how to use them properly. It seemed as thought it would be pretty intuitive for me, given that I have (and use) a Nordic Track ski machine when the weather is not conducive to going out to exercise.
I was skeptical that using them could actually increase the calories I burned by 30%, for the same distance walked until I tried them this morning.
I am no longer skeptical!
I was very well aware of how much better a workout I had gotten after 2 km, but did another 1 km anyways. I can’t wait to go again tomorrow.
Getting Even More Serious
A month ago my weight was still ‘stuck’ at its 6 pound weight loss, so I decided to reduce my carbs from ~50 gms/day to +/- 35 gm/day and to monitor my intake of nuts and dark chocolate, which could easily cause me to exceed my carb ceiling.
Monday – Friday I wasn’t hungry in the morning, because I would eat a very satisfying meal the night before (with adequate protein and lots of healthy fats and low carb veggies), so I was and am quite content to have only a coffee and cream for breakfast, and then go for my walk.
When I come home, most days I’m really not hungry, because my body had finally figured out how to burn my own fat stores for energy!
At first when I started exercising (nothing crazy…I was just walking briskly!) and intermittent fasting, my blood sugar would get quite low in the late afternoon (+/- 4.0 mmol/L), so at that point I would eat something like a piece of cheese, as I prepared dinner.
Here is a graph showing my blood glucose since I started walking and intermittent fasting;
In the last 3 weeks, my weight has dropped another 4 pounds, making it a total weight loss of 10 pounds, in all so far. I expect as I continue to walk 4 days a week and intermittent fast most weekdays and limit my carbs, that the weight and inches will continue to come off.
I am not suffering in any way!
As a Dietitian, I talk about or write about food all day long and I’m intermittent fasting and feel just fine! I’m not hungry. As I jokingly posted last week;
“My body has finally figured out how to make glucose from my fat on a low carb high fat diet. I may potentially have found the source of immortality.
I still have at least another 30 pounds to go to get to the “goal weight” that I set at the beginning of this journey, and am now aiming to lose another 40-45 pounds instead in order to reach my ideal (healthiest) waist to height ratio. I clearly won’t accomplish this by mid-November, but if I reach close to my initial goal weight, I will be quite content.
They say a picture speaks a thousand words, so below are two photos. The one on the left, with the blue shirt is me at the beginning of this journey. The one on the right, with the burgundy shirt is me now. I am starting to see a face I recognize.
Want to know how I can help you reach your own nutrition goals? Please send me a note using the “Contact Us” form above, letting me know how I can help.
The hormone insulin (involved in storing fat) and leptin (involved in burning fat) work very differently in lean people than in overweight people. This is why excess fat such as is found in “bullet proof coffee” or “fat bombs” results in overweight (or obese) people that follow a Low Carb High Fat diet gaining weight—whereas lean people will simply burn it off. This article explains the role of these hormones and how they impact lean people and overweight people very differently.
When we eat, the hormone insulin is released which signals our body to do two things; (1) it tells our cells to uptake energy (in the form of glucose) and (2) to store excess energy as fat. Insulin is the major driver of weight gain. If we are lean, when we eat more than usual and increase our body fat stores, the body responds by increasing secretion of a hormone called leptin. Leptin acts as a negative feedback loop on the hypothalamus area of our brain, reducing our hunger, causing us to eat less and preventing us from gaining too much fat.
The problem occurs when we become insulin resistant.
When we eat a diet that is high in carbs and we eat every few hours(3 meals plus snacks), insulin is released each time we eat (in order to cause our cells to take in energy and store the excess as fat). If we continue to eat this way, over time our body is inundated with insulin, so it sends signals to down-regulate the insulin receptors, making our cells less sensitive to insulin signals. This is called insulin resistance. When we are insulin resistant, our body releases more and more insulin to deal with the same amount of glucose in the blood.
Consistently having high levels of insulin, will also keep stimulating the release of leptin, which normally results in us becoming less hungry and eating less. However, when we are insulin resistant, we keep producing more and more insulin, which results in us producing more and more leptin. Over time, this consistently high leptin level will result in the same type of down-regulation of hormonal receptors that occurred with insulin, resulting in leptin resistance.
Leptin resistance interferes with the negative feed back loop on our hypothalamus which normally reduces our hunger, causing us to eat less. When we are leptin resistance, even when we’ve eaten a great deal of food, we don’t feel satiated — even when our abdomens are straining from feeling full. As a result, we just keep eating, as if there is no “off” switch.
It is this leptin resistance that results in obesity.
Obese people aren’t obese because they lack will-power, but because their body is responding to signals from very powerful hormones produced in response to the types of foods they eat.
Difference between a High Carb Diet and a High Fat Diet
When people consume diets high in carbs it stimulates insulin to be released. In response to all the insulin, energy that is not immediately needed for activity is stored as glycogen in the liver and muscle cells, and the remainder is shipped off to our adipose cells (fat cells), to be stored as fat. When eating a high carb diet, getting excess calories into fat cells is easy, getting the fat out of fat cells, not so much.
When people eat a diet high in fat and low in carbs, the fat is absorbed in the intestines as chylomicrons and is shuttled through the lymphatic system to the thoracic duct, going directly into the blood circulation. From there, the fat is either burned for energy or goes into our fat cells, to be stored. It is important to note that the fat does NOT go to the portal circulation of the liver and as a result, fat needs no help frominsulinto be absorbed.
That’s good, but if excess fat gets stored in fat cells, doesn’t eating fat make one fat?
Not for lean people, because lean people are leptin sensitive and obese people are leptin resistant. When overweight or obese people eat excess fat, it is a different matter.
Lean People versus Obese People
If a lean person eats a diet high in fat and low in carbs, the excess fat will be stored in fat cells, but insulin does not go up. So a lean person does not become insulin resistant, as described above. As their fat mass goes up, leptin also goes up. Since the lean person is sensitive to leptin, the negative feedback loop acts on the brain causing them to stop eating, allowing their body weight to go back down. Even if a lean person deliberately eats more and more fat when they aren’t hungry, what happens is their body’s metabolism goes up, and they burn off the extra calories.
If an overweight or obese person eats a diet high in fat andlow in carbs with moderate amounts of protein, insulin levels don’t go up — which is good of course, however from years of eating high carb low fat diets and from eating a carb rich foods every few hours, overweight and obese people are insulin resistant. This means that their blood glucose levels remain high for long periods after they’ve eaten and as importantly, it also means that they are also leptin resistant. In this case, if they eat too much fat – such as drinking “bullet-proof coffee” or having “fat bombs”, they will respond (as the lean person does) by making more leptin, but the problem is, they are not sensitive to leptin! Their brain doesn’t respond to the signals from leptin, so when an obese or overweight person eats excess fat, beyond that which is naturally found in a low carb high fat foods, their appetite doesn’t drop – nor does their metabolism go up to burn off the excess fat being stored in fat cells. They simply get fatter.
For those that are overweight or obese and insulin resistant, it is important to keep in mind that with insulin resistance comes leptin resistance. Leptin resistance by definition means that the signals to stop eating don’t work. The “off switch” is defective. As well, the body doesn’t respond to signals from leptin to up-regulate metabolism, so when an overweight or obese person on a low carb diet eats too much fat, they gain weight.
Since increasing carbs is not an option and increasing protein results in glucose being synthesized from the excess (gluconeogenesis), the way to lower insulin resistance (and thus leptin resistance) is by extending the amount of time between meals. This is known as intermittent fasting – a topic that will be covered in a future article.
Want to know how I can help you get started on a low carb high healthy fat diet? Please drop me a note using the “Contact Us” form, located on the tab above.
Ebbeling CB, Swain JF, Feldman HA, et al. Effects of Dietary Composition During Weight Loss Maintenance: A Controlled Feeding Study. JAMA : The journal of the American Medical Association. 2012;307(24):2627-2634. doi:10.1001/jama.2012.6607.
Feinman RD, Fine EJ (2003) Thermodynamics and metabolic advantage of weight loss diets. Metabolic Syndrome and Related Disorders, 1:209-219.
INTRO: After a seeming endless 6 week plateau with my weight barely budging, I decided to do some serious intermittent fasting and lower my carbs and bingo – my weight is dropping nicely! Not only that, my fasting blood sugar is the best it has been since I was diagnosed as Diabetic ~10 years ago. Here’s an update.
Yesterday was my third day of intermittent fasting (IF) this week – where I didn’t eat anything after supper at night, until supper the next day. This is my second week of doing intermittent fasting Monday to Friday and eating a regular, low carb high healthy fat supper at night.
Here’s an example of what I ate on one night, to give you an idea. It was some Thai chicken thighs that had been marinated in coconut milk, red curry paste and curry and grilled on the barbecue, along with a huge mixed green salad, with some shaved Parmesan, raspberries, pepitas (pumpkin seeds) and homemade raspberry vinaigrette (great thing to do with over ripe berries!) that was made with Dijon mustard, wine vinegar and extra virgin olive oil. To start with, I also ate about a cup of snap peas with ~ 1 1/2 Tbsp of taramasalata (Greek carp roe spread) that didn’t have any of the usual bread in the recipe.
Keeping in mind that I am only a “sample set of 1”, here are my results;
Last week, which was my first week of regular IF, my fasting blood sugar,which had been stuck at the high to mid- 6 mmol/L (117 mg/dL) range for weeks, dropped to the mid- 5 mmol/L range (~99 mg/dL) for several days in row.
Yesterday, which was my third day of IF this week, my blood sugar just before dinner was the lowest it has been since I was diagnosed as Type 2 Diabetic ~10 years ago.
While I felt totally fine and had been working a full clinical day, I knew it was time to eat something! I ate about 10 salted almonds and went about preparing dinner.
I should add, that last week I also started walking daily ~ 2-3 km (1 1/4 -2 miles) around a local man-made lake (I posted a video below, so you can see it). The first two days I could only go once around, as I had fractured a rib last Friday and it was still quite painful. I starting walking daily because it was supposed to be good to alleviate the muscle pain accompanying my injury and I found it helped a lot, so I kept doing it each morning. Then I realized how great it felt to be walking in such a beautiful place, so now it has become a morning routine.
My blood pressure is doing amazing now.
It had stalled between Stage 1 hypertension and pre-hypertension for about a month, but when it creeped back up to Stage 2 hypertension for two days in a row, I decided to go see my doctor and get prescription for a ‘baby-dose’ of Ramipril (2.5 mg).
There is a strong family risk of heart attack and stroke, and a blood pressure that hit 160/90 was not something to fool around with.
I plan to staying on the meds until I lose another 20 pounds, or until my blood pressure becomes too low – whichever comes first.
Look at my blood pressure now.
The only day that was high (Stage 1) was last Friday, before I started on the lowest dose of Ramipril.
The rest of the time I am in pre-hypertension and one day was totally normal! I am looking forward to seeing the continueddietary changes, bring it down even further.
As I planned to do 3 monthsafter I started eating low carb, I have a requisition for blood work and an appointment for mid-July to have that done. I will be getting my HbA1C checked and my cholesterol, along with some liver and kidney function tests as well as electrolytes (important on this hypertensive medication).
One of the other dietary changes that I made, besides the intermittent fasting, was that I cut my carbs considerably. I was not doing well on 50 gm of carb per day, my weight loss had been stalled, my blood pressure as well and it had been a month of no significant progress, even though I was in low stage ketosis. I cut my carbs down to 35 gms per day (sometimes a little less), but making sure to have lots of non-starchy vegetables and protein and of course, plenty of healthy fats in the form of olive oil, coconut milk and nuts.
In short, I feel amazing.
The weight is dropping, the inches are dropping, my blood sugar is approaching more normal values and my blood pressure is being kept in check, while I continue this process of eating low carb high healthy fat and daily walks. I’m not hungry during the day even though I am not eating, because my body is happily accessing my own fat stores for energy. I think the limiting factor at this point is that my body is not quite used to synthesizing the enzymes needed for it to make glucose from my stored fat (a process called gluconeogenesis), so I will be monitoring my blood sugar closely, to make sure it doesn’t get too low.
I want to encourage you, that if your weight is staying stable for longer than you’d like, I’ve posted some things on the blog that would be helpful (located under the Food For Thought tab). One article is on tracking carbs, and the next one is on where calories factor in.
If your weight has plateaued, and you’ve been eating low carb high fat and your not losing weight as you’d like to, these two articles should help.
If you’d like to learn more about how I can help you accomplish your own weight loss or insulin-resistance lowering goals, please send me a note using the “Contact Us” form above.
Keep in mind that for the month of July only, I am offering a substantial savings on taking both an assessment package and a weight management package, so please visit the front page to find out more about the Canada Day special.
I have found that people wanting to lose weight simply don’t want to weigh or measure food or count calories – and who can blame them! I design Meal Plans for my clients so they don’t need to. As I will explain in this article, with a Standard Meal Plan(based on a traditional macronutrient distribution), carbohydrate, protein and fat are all laid out, based on the food exchanges. With a Low Carb High Healthy Fat Meal Plan or a Hybrid Meal Plan, carbohydrate percent, protein- and fat percent are also laid out, but for those seeking to lower insulin resistance or lose weight or both, tracking carb intake is important. In this article, I’ll explain tracking carbs.
Firstly, what is a Meal Plan?
What is a Meal Plan?
A Meal Plan isn’t a “menu” that tells you what foods you have to eat, but indicates how many servings of each category of food you should aim to eat at each meal. I explain more about what a food category is, below.
The first step in designing a person’s Meal Plan after I’ve done their assessment, is to determine their overall caloric needs based on age, gender, activity level, desired weight loss (or gain), as well as any special considerations such as growth, weight loss, pregnancy or lactation, etc.
More about calories in the next article, but suffice to say here, calories are generally not the focus in Low Carb High Healthy Fat eating, carbsare.
The next step is to set the macronutrient distribution (% of calories from carbohydrate, protein and fat) of the Meal Plan according to what would best suit the person’s clinical needs, goals and lifestyle. This is something I discuss with people during the assessment, and which is ultimately up to them. The Standard macronutrient distribution is ~45-65% carbohydrate, ~15-20% protein and ~30% fat. Generally speaking, unless there is a compelling clinical reason for using a Standard Meal Plan, I encourage people to consider the benefits of lower carb high healthy fat eating.
The Low Carb High Healthy Fat macronutrient distribution is ~5-10% carbohydrate, ~20% protein and ~65-70% healthy fat, with the Hybrid macronutrient distribution falling somewhere in between.
In the final step, I design a person’s Meal Plan based on the foods that they’ve told me they like, avoiding those they don’t, and factoring in the time of day they either need to (for scheduling reasons) or prefer to eat. Then we meet for me to go over their Meal Plan with them, and for me to teach them how to easily and accurately estimate their portion sizes, using visual measures. More on visual measures, below.
The only thing left for them to decide is what they want to eat!
Food Categories – Standard Meal Plan
In a Standard Meal Plan or Hybrid, categories include Starchy Vegetables and Grains, Fruit, Non-Starchy vegetables, Meat, Poultry, Meat and Egg or Cheese, and Legumes (pulses). These categories are based on how many grams of carbs are contained in the foods in make up that category.
Take, for example, the Starchy Vegetable and Grain Category. This group includes all the standard “carbs” such as bread, pasta, rice and cereals as well as “starchy vegetables” such as peas, corn, potatoes, sweet potatoes / yams and winter squash (such as acorn or butternut squash). All foods in this category have 15 gm of carbs per serving (where a serving is 1/2 cup or the equivalent of 1 slice of bread).
So, 1 slice of bread has 15 gms of carb, 1/2 cup of peas has 15 gms of carb, 1/2 cup of rice has 15 gms of carb, 1/2 cup of oatmeal has 15 gms of carb, and 1/2 a hamburger bun has 15 gms of carb.
If a person’s Meal Plan indicates that they can have 2 servings from the Starchy Vegetable and Grain category, that could be 2 pieces of toast, or 1 cup of oatmeal, or 1 cup rice, etc. Their Meal Plan doesn’t tell them what food they have to eat, just how much from each category.
Here is an example of what a Standard Meal Plan looks like;
As you can see, all the calculations have been done.
In this example, this Meal Plan was for an 85 year old man who wanted to gain weight and was based on 45% of his calories coming from carbs, 21% from fat and 34% from fat.
Estimating Portion Sizes
When I’ve taught someone to accurately estimate their serving sizes using visual measures, the amount of macronutrients (carbs, protein, fat and calories) they will take in following their Meal Plan will be what was planned.
What are Visual Measures?
Visual measures are easy and accurate means to estimate serving sizes. For in-person clients, this might be based on the size of their hand or fingers, such as (depending on the size of a person’s hand) a 1/2 a cup (dry measure) may be the amount of something round (like frozen peas) that could be contained in their scooped hand, without rolling out. An ounce (by weight) might be the size of two specific fingers on their hand, or a Tbsp may be the amount of the last digit on their thumb. For Distance Consultation clients, the standard used in teaching visual measures are standard size items, such as the size of a golf ball or four dice stacked up.
Where tracking carbohydrates comes into play is with Low Carb High Healthy Fat Meal Plan or a Hybrid Meal Plan – especially when lowering insulin levels or losing weight is desired. Keeping track of carbohydrates on these kind of Meal Plans is nothing like needing to count calories! It is very easy.
On a Low Carb High Healthy Fat Meal Plans, the macronutrient distribution for carbs is set quite tightly. For men, total carbs would be somewhere between 80-100 grams and for women, it may be set as low as 35 gms carb or as high as 50 gms. It depends on their needs. Naturally, Hybrid Meal Plans will have higher total daily carbs.
Since there are no Starchy Vegetables and Grains and Milk on these Meal Plans (cheese is used, just not milk due to the carb content), the Food Categories on a Low Carb Meal Plan or Hybrid are different than on a Standard (or traditional) Meal Plan).
Food Categories in a Low Carb Meal Plan include Non-Starchy Vegetables, which exclude “Starchy Vegetables” such as peas, corn, potatoes, sweet potatoes / yams and winter squash – with some intake guidelines around root vegetables such as carrots, beets and parsnips. The Fruit category here is specified more narrowly than in a Standard Meal Plan – generally focused on berries and low sugar citrus such as lime and lemon, as well as tomatoes and cucumbers (yes, both are technically ‘fruit’).
Meat, Poultry, Meat and Egg or Cheese is pretty much the same as with a Standard Meal Plan, with an ounce of any of these protein foods being 1 serving and individuals being able to have several servings at each meal (based on their caloric needs, factoring in any weight loss). The fat contained in the Meat, Poultry, Meat and Egg or Cheese is already calculated when the Meal Plan is made, so “Fat” here means added fat. The Fat category includes everything from olive oil, avocado (both the fruit and the oil), coconut oil, butter, olives and nuts and seeds.
Foods in the Meat, Poultry, Meat and Egg or Cheese category have little or no carbs in them and Non-Starchy Vegetables are generally around 5 gm of carb per cup and berries, which are in the Fruit category are roughly 15 gm of carb for 1/2 a cup. A few berries on a salad isn’t usually a problem, but more than that can easily put us over our maximum amount of carbs for the day, which I call the “carb ceiling“.
Where it becomes particularly important to track carbohydrates when one is seeking weight loss is with foods such as nuts and seeds. It is very easy to eat a handful of nuts and end up exceeding one’s daily maximum number of carbs.
“Carb-creep” is when we eat more carbs than we think we are, which results in weight loss slowing, or even stopping. When one reaches a plateau where they haven’t lost any weight for longer than a week or two, then tracking carbs to see if there is carb creep is advised.
A man’s carb limit may be set to 80-100 gms per day and a woman’s may be as low as 35 gms or as high as 50 gms. That is not a lot and it is easy to inadvertently exceed this amount of carbs in the course of a day. A few splashes of milk in several cups of coffee, a handful of peanuts walking by the bowl near the photocopier and an ounce or two of 72% dark chocolate (for heart health, of course!) can quickly put us over our carb ceiling. This is where it’s important to evaluate food choices that may be putting your over your carb ceiling.
Want to know more about having a Meal Plan designed for you?
Please send me a note using the “Contact Us” form above and I will reply to you, usually by the next business day.
There are two words that I’ve noticed aren’t talked about much in low carb high fat (LCHF) circles; one is “calories” and the other is “exercise“. I think that’s because both have been tied to the old “calories in, calories out” model.
I think it’s important to reframe both of these within a LCHF context, because both have a role to play in us being successful in improving health as well as losing weight, even though the reasons for that are very different than in the “calories in, calories out” model.
In the traditional high carb, low fat paradigm, restricting calories and increasing exercise are seen as the foundation of weight loss – based on the assumption that “calories out” is only the calories we burn in activity. As explained in this week’s blog on “Do Calories Matter When Eating Low Carb“, there are other demands on the energy we take it (calories) that are higher priority than exercise, such as regulating our body temperature and providing energy to keep our heart pumping.
In the low carb, high fat model, overall calories need to be understood within a diet that is 70% fat and <10% carbohydrate and exercise needs to be understood within the context of lowering stress levels (i.e. cortisol), as well as increasing metabolic rate so that fat stores continue to be burned long after activity ends.
Below is a very short video from my morning walk, with a few thoughts on “exercise”.
A new report released by the Canadian Cancer Society predicts that almost one in two Canadians will be diagnosed with cancer in their lifetime.
“One half” is a very sobering number!
Currently, cancer is the leading cause of death in Canada, accounting for almost 1/3 of all of all deaths (30%).
Heart disease is the second leading cause of death, accounting for 1/5 of all deaths (20%).
In an interview with Peter Goffin of the Toronto Star, Dr. Robert Nuttall, Assistant Director of Health Policy at the Canadian Cancer Society attributed this alarming new statistic that 1/2 will get cancer in their lifetime to the “aging population” – not “lifestyle factors“.
“The important thing to remember here is that the biggest driver behind this is the aging population. “Canadians continue to live longer, and cancer is primarily a disease that affects older Canadians.”
Japan has the oldest population in the world, with ~1/3 of people aged over 60.
What do their statistics show?
According to the Institute for Health Metrics and Evaluation, Japan’s leading causes of death (2015) were:
cerebrovascular disease (stroke)
cardiovascular disease (heart disease)
lower respiratory infection
Lung cancer was 5th, followed by stomach cancer (6th) and colorectal cancer (7th). In Japan, a country with the oldest population in the world, cancer of any kind wasn’t even in the top four!
Are half of us really going to get cancer because of the “aging population” or is it because of “lifestyle factors“?
Looking at the top 4 Causes of Cancer in Canada:
Lung cancer is the number one form of cancer and the Canadian Cancer Society indicates that more than 85% of lung cancer cases in Canada are related to smoking tobacco.
Colorectal cancer is the second leading cause of cancer and the Canadian Cancer Society indicates that risk factors for colorectal cancer include (a) diet , (b) being overweight, (c) physical inactivity and (d) smoking.
Breast cancer (in both men and women) is the third leading cause of cancer. Apart for personal and family history of breast cancer and other genetic factors, the Canadian Cancer Society list the following known risk factors: (a) exposure to ionizing radiation, (b) use of oral contraceptives (c) alcohol and (d) being obese.
Prostrate cancer which only affects men, is the fourth leading cause of cancer and the only known risk according to the Canadian Cancer Society is family history.
Major Risk Factors for the top 4 Causes of Cancer
Here are the major risk factors for the top four leading causes of cancer in Canada;
exposure to ionizing radiation (x-rays)
use of oral contraceptives
Except for use of x-rays, all of these are lifestyle factors!
Diet, being overweight and being inactive are three things that can be changed easily and sustainably!
A low carb approach can be particularly helpful, as it can not only address being overweight, but new studies have found that a number of cancer cells feed exclusively on glucose. It is thought that a ketogenic lifestyle may play a role in reducing the glucose available for some types of cancer.
We being told that ‘the biggest driver behind the projection that half of us will get cancer in our lifetime is the aging population‘ – when it would seem that the underlying risk factors of these cancers are lifestyle factors.
In fact, the Canadian Cancer Society says themselves that half of the cases are preventable;
“We already know a lot about how to prevent cancer. If we, as a society, put everything we know into practice through healthy lifestyle choices and policies that protect the public, we could prevent about half of all cancers.”
We will all age and this is not preventable, but by addressing lifestyle factors includingsmoking, diet, overweight and physical inactivityand others, we should be able to prevent almost 1/2 of all cancers.
Have questions on how I can teach you how to eat healthier and work with you to help you tackle being overweight and inactive, then please send me a note using the “Contact Us” form on this web page.
Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-type/lung/risks/?region=on#ixzz4kZ5AnNz6
Canadian Cancer Society, http://www.cancer.ca/en/about-us/for-media/media-releases/ontario/2011/not-enough-canadians-being-screened-for-colorectal-cancer-leading-to-many-unnecessary-deaths/?region=on#ixzz4kZ5vSGSS
Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-type/breast/risks/?region=on#ixzz4kZ8RvXbm
Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-type/prostate/risks/?region=on#ixzz4kZ9J6o64
Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-101/cancer-research/prevention/?region=on#ixzz4kZ9jQJwt
Institute for Health Metrics and Evaluation, http://www.healthdata.org/japan
The Toronto Star, Peter Goffin (Staff Reporter), Tue June 20 2017, https://www.thestar.com/news/gta/2017/06/20/half-of-all-canadians-will-get-cancer-in-their-lifetime.html
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 childrenin the world (~10%) along with India.
In 2015, China along with the UShad 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.
Cereals – in the form of rice, corn, bread, noodles, crackers and tubers make up the base of the Pagoda
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.
Meat, Poultry, Fish & Seafood and Eggs form the third level, and it is recommended that should be ‘eaten regularly’, but ‘in small quantities’.
Milk & Dairy and Bean & Bean Products – form the fourth level.
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, strokewas 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 UShad the highest number of obese adults (>35%) in the world.
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.
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
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;
exercise more (150 minutes/week plus 6000 steps/day)
eat less fat and animal protein and
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?
How I can help you
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.
In the last few years, we’ve heard the term “obesity epidemic“, but a new study published this past Monday, June 12, 2017 in the New England Journal of Medicine seems to indicate that it is now an “obesity pandemic“.
Researchers analyzed data from 68.5 million adults and children in 195 countries to assess (1) the prevalence of overweight and obesity in 2015 and (2) the trends in the prevalence of overweight and obesity between 1980 and 2015.
The “short story” is that a 1/3 of people worldwide are now overweight or obese — put another way, two billion people globallyare overweight or obese and are at increased risk of morbidity (chronic diseases) and morbidity (death), as a result.
Epidemiological studies (studies of different populations from around the world) have identified high BMI as a risk factor for cardiovascular disease, type 2 Diabetes, hypertension, chronic kidney disease and many types of cancer.
Furthermore, overweight children are at higher risk for the early onset of diseases such as type 2 Diabetes, hypertension and chronic kidney disease.
Body Mass Index (BMI) is the weight in kilograms divided by the square of the height in meters
Obesity is defined as having a Body Mass Index (BMI) > 30 kg/(m)2Overweight is defined as having a BMI between 25 and 29.9 kg/(m)2
Data showed that in 2015, there were 603.7 million obese adults worldwide and107.7 million obese children.
The prevalence of obesity has more than doubled in 70 countries since 1980, and there has been a triplingof obesity in youth and young adults in developing, middle class countries such as China, Brazil, and Indonesia.
Worldwide, the prevalence of obesity is now 5% in children and 12% in adults — findings that mirror global trends in type 2 Diabetes.
Most alarming was that in 2015;
high BMI accounted for four million deaths globally
almost 40% of deaths resulting from high BMI occurred in people who were overweight, but notobese
more than 2/3 of deaths related to high BMI were due to cardiovascular disease
It is important to note that risk of outcomes related to obesity has not been found to be uniform across populations. For example, it has been reported that at any given level of BMI, Asians have been shown to have a higher absolute risk of Diabetes and hypertension, whereas African Americans have a lower risk of cardiovascular disease than other groups.
Addressing the Problem
To address the problem of overweight and obesity both here and around the world, requires correctly identifying its causeand for the last 40 years, excess dietary fat — especially saturated fat has been blamed as the villain and ostensibly responsible for the “obesity epidemic” and resulting “diabetes epidemic”.
But is it?
When one compares the Dietary Recommendations in both Canada and the United States since 1977 to rates of overweight and obesity in both of these countries, it seems apparent that it has been the promotion of diets high in carbohydrate that lies at the root.
In the next article, I’ll take a look at the Dietary Recommendations of the country with the highest rate of childhood obesity and adult obesity in 2015, as well as some of the highest rates of stroke and heart disease per capita, in the world.
How I can help
If you have eaten a ‘low fat diet’ and counted calories (or points) until you are blue in the face and are tired of doing the same thing over and over again, expecting a different outcome, why not drop me a note using the “Contact Us” form, above. I’d be glad to explain how I can help you achieve a healthy body weight, while normalizing your blood sugar, blood pressure and cholesterol levels.
Today marks 3 months since I started my own weight-loss and getting-healthy journey and so I’m posting this short update.
While I’ve only lost 7 pounds, I’ve lost a remarkable 4 inches off my waist, which is greatly encouraging, as I still have another 6 inches to lose (based on my height-to-waist ratio). I know without a doubt that this is entirely ‘doable’!
I look in the mirror and recognize the person looking back. I recently bought new jeans that are a full size smaller and when the weather has been hot, I’ve not only worn shorts, but I’ve wore them out of the house.
My blood pressure is very stable and now fluctuates between stage 1 hypertension and pre-hypertension; a dramatic improvement from the wildly erratic fluctuations between stage 2 and stage 1 hypertension, with a hypertensive emergency thrown in for excitement. It was that crazy high blood pressure which started me on this journey, but what keeps me on it, is how I feel. I feel great!
My blood sugar has been great after meals, but recently has become quite a bit higher several hours after eating, even though I have not eaten or drunk anything except water. From the reading I’ve been doing in the literature, this has been reported in those who previously had what is called “dawn syndrome” (high morning fasting blood glucose – which I had) after they’ve adopted a low carb high fat diet. It seems that the second of the two stages of insulin release is suppressed in those such as myself, causing blood glucose to remain higher for a longer period of time. One way of addressing this is via exercise, so it seems I will be doing this more than once in a while to manage this.
This morning it was gorgeous out; clear sky, cool temperatures and the track was beckoning me, and so I went. I haven’t worked out more than 2 or 3 times a month since I began my journey, but despite that, I noticed a huge improvement in my fitness level today. I can only attribute that to the loss of fat around my middle. I did an extra two rounds on the track at a pretty decent clip, with a total distance of 3.2 km (2 miles). I could have done another round (maybe two) but thought I might be too stiff tomorrow, and since my goal is to do this more often to address my second stage insulin suppression, I decided to ‘call it a day’ after 3 km. As I was leaving the track, I decided to take a short video to post along with this 3-month update. Have a look at the video which is posted below, and compare it with the one from 3 months ago (http://tinyurl.com/yb3unuff). My progress is evident.
Want to know how I can help you accomplish your own health and fitness goals?
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