Food for Thought (blog)

EpiPen Recall (excludes Canada)

Mylan pharmaceutical­ has issued a major recall on thousands of EpiPens, which are emergency medications for adverse allergic reactions. At present this recall does NOT apply in Canada.

The recall was issued Monday, March 20 2017 on its selection of EpiPen 300 microgram Injection Syringe Auto­Injectors after the company discovered that the affected devices could “contain a defective part” that resulted in the pens failing to activate. The failure of the auto­injector to activate may result in patients not receiving the required dose of adrenaline resulting I worsening symptoms of anaphylaxis or anaphylactic reactions,” the statement read.

EpiPens that fail to activate or that require excessive force to activate pose a very serious, life-­threatening issue to those suffering from serious allergies. Serious food allergies can lead to anaphylaxis a severe, potentially life­-threatening allergic reaction that can occur within seconds or minutes of exposure to something you’re allergic to. The first line of treatment prescribed for an attack is epinephrine.Two reports worldwide were confirmed at the time of the announcement.

According to a release from Alphapharm, the recall extended to 80,000 pens worldwide.

The following batch numbers were confirmed as follows: 5FA665, 5FA6651, 5FA6652, 5FA6653, all listed with an expiration date of April /17. At present this recall does NOT apply in Canada.

Alphapharm recommended that anyone with an EpiPen, check the yellow box and/or label on the EpiPen itself to confirm the batch number and expiration date. If boxes feature the “Apr 17” expiration date AND/OR one of the aforementioned batch numbers, the company recommended that consumers replace the pens immediately, by returning them to a pharmacist.

Pharmacists are required to replace all potentially defective EpiPens with new ones or an EpiPen 300pug – for free.

 

A Dietitian’s Journey – three weeks in

INTRO: Three weeks ago, the pain of changing was less than the pain of remaining the same and so I changed. At that time, my blood pressure had hit dangerously high levels and I didn’t even know what my blood sugar levels were, as I hadn’t checked them in ages. I didn’t want to know. Despite being a Dietitian, I was in classic denial. March 1st, I began eating low carb high fat (LCHF) and doing short periods of intermittent- and alternate-day fasting (IF). Keep in mind, three weeks is an incredibly short period of time and I did not expect to see these kinds of results.  There was not only significant weight loss and loss of inches around the waist, but lower blood sugar and blood pressure, as well.

Today is three weeks since my journey began and here is an update on my progress – three weeks in.

Blood Sugar

In the first two weeks, my blood sugar decreased substantially even on the days I was not intermittent fasting – provided I ate very few carbs. When I was eating what most would consider “low carb”, my blood sugar would spike.

arrows indicated 2 periods of eating 10-15% carbs

It became clear that as long as I kept my net carbs (carbohydrate minus fiber) at or below 35 gm I did very well, but above that my body could not handle the sugar load. You can see this from the graph above.

The two periods where I was eating between 35-50 gm of carbohydrate per day (Saturdays) is indicated by the grey arrows, below the graph. That is when my blood glucose would spike.

As a Dietitian, I could see clearly that I was very insulin resistant –which is no surprise, considering I was diagnosed with Diabetes ~ 10 years ago. Despite my pancreas producing more and more insulin in response to eating carbs, the insulin was unable to take the glucose (sugar) from my blood in a reasonable amount of time, to store it in my liver.

[Note: As it turns out, between 65-75% of people with normal blood sugar are insulin resistant - that is, they have the same risk of hardening of the arteries and heart attack as those with Diabetes!  They just don't know it! That's is very sobering. More in an upcoming blog on Hyperinsulinemia and the research of Dr. Joseph Kraft which spanned decades.]

Since realizing how sensitive I was to more than the carbs naturally found in non-starchy vegetables and nuts and seeds, I cut out all other sources – including my beloved Hawaiian purple yam and homemade (baked) yam fries…for now, until my blood sugar levels are consistently in the non-diabetic range and my insulin levels, normalized. Even then, I know I will only be able to eat such things once in a while and in small servings, but that’s okay. As one of my sons would say “dying is bad“.

A week ago, I began tracking my carbs (easy to do and requiring no apps – not even a pencil). I kept them at or below 35 gm per day and as you can see from the graph below, there has been linear decrease in my blood glucose levels at all times of the day – including first thing in the morning, after lunch, after dinner and before bed. It’s only been three weeks!

Week three – March 15 – Mar 21

Interestingly, the little ‘spike’ yesterday was in the early morning after – I hadn’t eaten for 12 hours!

My body was breaking down the fat I have stored and was converting it into glucose for my blood – a process known as gluconeogenesis. This is a ‘good’ thing. My body was doing exactly what it was designed to do;

(1) store excess glucose as fat, in times of plenty,

(2) break down stored fat for glucose, in lean times.

The issue is, there have been no “lean times”.

This is the problem for most of us here in Canada and the US. Even those of less means have access to food in our homes, in stores and at fast food restaurants 24/7.  We can’t go for a walk in most cities without passing places selling or serving food. We don’t even have to go out to “gather” food.  It’s a phone call or web-click away.

There are three main contributors to the “Obesity Epidemic” as far as I can see;

1) irrespective of cultural background, our eating style is carb based; pasta, pizza, sushi, curry and rice or naan, steak and baked potato, hummus and pita, rice and stir-fried dishes. That wasn’t always so. Our indigenous cultural foods were very different.

2) Every meal has bread or cereal grains, pasta, rice or potatoes – and even what we consider “healthy foods” such as fruit and milk have the same number of carbs per serving as bread, cereal, pasta, rice and potatoes. Further, “low fat” options often have higher sugar levels – of which half of that, is fructose (which can’t be used “as-is” and must be processed by the liver).

3) Every meal is followed by another meal – and if we can’t wait, a snack, too. We eat every 2-3 hours.

Eating carb-based foods every 2 or 3 hours all day, every day is quite literally killing us. Even those with seemingly “normal” blood sugar levels have hyperinsulinemia.

Blood Pressure

Week One

The first week my blood pressure was divided up between

50% Stage 1 hypertension

~30% Sage 2 Hypertension

hypertensive emergency (not good!)

<15% pre-hypertension

It was all over the place (very hard on the heart) and the systolic pressure (the first number in a blood pressure) was very high.

After the issue with my eyes (which was non-diet or lifestyle-related) having hypertension (high blood pressure) put me at risk for blindness. I took this very seriously!


Week Two

The second week my blood pressure dropped to;

>80% Stage 1 Hypertension

<20% pre-hypertension 

This can largely be explained by the fact that the first thing that happens when we reduce insulin levels (a response to eating low carb) is something called naturesis. That is simply a medical term meaning our kidneys get rid of the excess salt by making us pee a lot. This period usually lasts ~4-10 days following going low carb.


Week Three

This week my blood pressure was;

~85% Stage 1 Hypertension

~15% pre-hypertension 

Yes, it was a tiny bit higher, but very stable.

The first two weeks I ate very low sodium as I usually did, but this week I actually had to start adding salt into my diet as my kidneys had expelled all the excess sodium it was retaining and my sodium levels were too low.  I felt a bit lethargic and light-headed.  The reading I’ve been doing in the literature and the Conference Proceedings I’ve been watching from some of the world’s leading physicians that treat diseases (such as Diabetes, hypertension / high blood pressure, dyslipidemia / high cholesterol as well as Alzheimer’s and some cancers) using a low carb high fat diet, mentioned this need for increasing sodium after the first 10 days.

A pleasant surprise was seeing my diastolic pressure (the second number in blood pressure) hit normal levels several times.

One of the roles of insulin (besides taking the glucose in our blood and storing it in our livers as glycogen or fat) is to signal the kidney to retain salt.  That makes us bloated and causes our blood pressure to go up.

Being Diabetic or insulin resistant (65-75% of people aged 3- 90 years, according to Dr. Joseph Kraft’s robust studies) causes people to retain sodium and raises their blood pressure.  Hypertension (high blood pressure) is called “the silent killer” – but much of this is entirely diet related.  It is not too much salt, but too many carbs and too little green leafy veggies that are rich in potassium.

Anthropometrics

Weight

The first week and a half, my weight dropped 4 pounds — likely much of it was water, from my kidneys expelling the excess sodium.  My weight didn’t budge for most of the last week and a half, but I didn’t let that discourage me.  My body was now burning fat and not carbs and the weight loss necessarily had to follow.

It is now the end of the 3rd week, and I have lost 6 pounds all together.  That is quite a bit, considering I am not obese, but overweight.

Waist Circumference

In the first two weeks, I lost 1 inch off my waist and this week, another 1/2 inch came off.  That is a very good thing – but for a different reason than I thought.

As Dietitians, we were taught that BMI (weight-to-height ratio) and waist-to-hip ratio allows us to factor in the greatest risk of cardiovascular events (heart attacks, strokes) but current research is showing that there is a much better predictor years of life lost (YLL) due to overweight, and that is the waist-to-height ratio.

Years of Life Lost (YLL) compared to Waist to Height Ration (WHtR)

Most of us have heard that where we carry our fat is even more important than how much of it we actually have. This is true.

Carrying it around the abdomen (belly fat, what Dietitians and Doctors call “central adiposity“) is a greater predictor of cardiovascular risk than BMI (weight to height ratio). Simply put, being an “apple” as opposed to a “pear” is not good.

But what should our waist circumference be?

A meta-analysis from 2012 pooled data from multiple studies which in total looked at more than 300, 000 adults in several ethnic groups, found that Waist to Heigh Ratop (WHTR) was a far better predictor than BMI or Waist Circumference of cardiovasular or metabolic risk factors in both sexes.

Ashwell M, Gunn P, Gibson S (2012) Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 13: 275–286

The least amount of years of life lost is associated with a Waist to Height Ratio of 0.5 (mine was not anywhere near that!).

That is, take your height and divide it by 2.

NOTE: Measure your waist at the navel, with the front and back of a flexible seamstress-type tape measure at the same height, and your belly fully relaxed.  This is not the time to suck it in!If you measure your height in inches, measure your waist in inches and if you measure your height in cm then measure your waist in cm.

If the result of your Waist to Height ratio is greater than 0.5, then welcome to the club.  The question is, what to do about it?

That’s where I can help.

Practicing what I preach,

Joy

A Dietitian’s Journey – the road to better health

A Dietitian’s Journey – the road to better health

In the previous article titled “A Dietitian’s Journey – the beginning“, I shared about why I am following a low carb high healthy fat diet and why I am using intermittent fasting (http://www.bbdnutrition.com/2017/03/14/a-dietitians-journey/in my pursuit of improved health.  In this post, I talk about the smaller third.

In future posts, I will explain the science of why I am doing this, in simple terms that everyone can understand, because as a Registered Dietitian, I believe that best clinical practice necessarily has to be based on evidence as available in the scientific literature. Why I am doing this is because quite literally, my life depends on it.

This “journey” as I have called it, is my road to better health – to optimal health.

As a Registered Dietitian in private practice, I’ve spent the last decade helping people in the Lower Mainland of Vancouver learn how to eat healthier, lose weight, lower their blood sugar and blood pressure and have cholesterol that is in the healthy range.  While I had lost 50 pounds myself a few years ago, little by little over the last 2 years, I’d put 1/2 of it back and along with the higher weight, came higher blood sugar levels, followed by high blood pressure.

My “fat picture” – prior to losing 50 lbs.

I had two choices; (1) go on medication or (2) change my lifestyle.  I chose the latter. March 1 2017 was the beginning of the journey, on the road to better health.

But what was the “road”?

Over the last 2 years, I had done a fair amount of reading with regards to the physiology of why diets high in carbs underlie the “obesity epidemic” (see previous post: http://www.bbdnutrition.com/2017/03/14/a-dietitians-journey/).  I understood how excess carbs that were not needed for energy were converted to fat and stored in the liver.  I also understood how and why this excess fat in the liver negatively impacted cholesterol levels – that it wasn’t eating fat that gave people high cholesterol (except for a very small minority with genetic conditions) but eating too many carbs.

Day in, day out in my private practice I’d explain to people how eating “plenty of fruit and vegetables” was making things worse for them because the bulk of their vegetables were high carb ones and fruit was eaten with- and between meals.

I knew that eating low fat, small portions, and exercising a lot was not only not going to be sustainable, it was not going to accomplish my goal.

So, I decided to “practice what I preach”; eat low carb, high, healthy fats (LCHF), use intermittent fasting (IF) and eventually, incorporate short periods of high intensity interval training (HIIT). I knew that while what I ate and when and how long I didn’t eat was the most important component of my “journey”, I had to get moving.

Since I am not yet “fat adapted” – that is, my body hasn’t yet switched over to using my own fat stores as a fuel source, I knew that I needed to postpone the high intensity interval training and just start with walking.

Yesterday, I set an appointment with myself to do just that, and while I was 3 hours later than I planned to be today, my ipod wasn’t charged and it was 5° C and pouring rain, I went to the track and did what I said I would do.

Here’s a clip from my first workout:

A Dietitian’s Journey – the beginning

A Dietitian’s Journey – the road to better health

Two years ago, my Endocrinologist gave me the choice between a low-carb-high-healthy-fat diet with occasional periods of fasting or taking medication for Diabetes, high cholesterol & blood pressure. Two weeks ago, I made my choice.


As a Dietitian, I’ve heard of many different types of diets; some good and others not-so-much and I’ve also heard people tell of their success and failures with each of them. I’ve heard of the pounds lost and amount-and-then-some gained back and the feeling that somewhere along the line these people feel as though have failed. But did they?  Was it really a lack of will-power or was something else going on?

In past blogs, I have talked about the changes to Canada’s Food Guide, which paralleled changes to the US Food Pyramid, both which began in 1977.  Both countries made dietary recommendations that focused on low-fat, high carb diets; all with the promise of lower rates of heart disease, but what we got instead was what some have called the “Diabetes Epidemic“.

What effect have these dietary recommendations had on obesity statistics?

In 1978, only 15% of children and adolescents in Canada were overweight or obese but by 2007, that rate doubled to 29% ! By 2011, obesity prevalence alone was 15.1% for boys aged 5 to 17 years, and 8.0% for girls of the same age.

What about adults?

In the period of 1970-72, the prevalence of obesity* in Canadian adults increased from 10% to 26% in 2009-11.

Obesity is defined as having a body mass index (BMI) ≥ 30 kg/m 2

Based on waist circumference 37% of adults and 13% of youth are abdominally obese – and this kind of fat, which lies around and between our organs increases risk of heart attack and stroke far more than fat under the skin (sub-cutaneous fat).

As of 2013, there were approximately 7 million obese adults and 600 000 obese school-aged children in Canada!  Not just “overweight”, but OBESE!

These statistics and a discussion with a friend who is a physician resulted in me beginning to question whether this dramatic increase in obesity and overweight after 1977 was correlated to the changes in the dietary recommendations of Canada’s Food Guide and the US Food Pyramid toward lower fat, higher carbohydrate diets.

I began to question whether the ‘standard’ three-meals-and-two-or-three snacks per day, with 45-65% of calories coming from carbohydrate really was best. And so began the process of me changing not only what I believed, but what I practiced.

A Dietitian’s Journey – the beginning

I remember back at McGill, when I was doing my undergrad training as a Dietitian, one of my professors saying that most people chose Dietetics because they came from a background of disordered eating or diet-related health issues.  True to form, most of my extended family were obese and most had Diabetes, high blood pressure and high cholesterol and were on a whole host of medications for each.

Fast-forward 20 years (and several children later) and despite losing 35 of the 60 pounds I had to lose, I became Diabetic. More recently, I’ve had high blood pressure.

Unable to answer my questions regarding addressing both of these through a low-carb-high-healthy-fat eating plan, my GP referred me to an Endocrinologist. After a thorough physical examination and a whole host of blood work, she asked me about how I planned to address this, given that I am a Dietitian.  Hesitantly, I told her that I planned to eat a high healthy-fat diet and low carb diet with a medium amount of protein and use intermittent fasting to lower insulin resistance. She asked me what percent of “net-carbs” (total carbs minus fiber) I was aiming for and what percentage of protein and what my fat sources would be, and I told her.  I was waiting for an extremely negative reaction, but instead was completely taken aback by her reply. She said that from she’s been reading in the literature, my plan was not only evidenced-based, but that if I didn’t don’t lose the rest of the weight and eat this way, that I will end up on both medication for my blood sugar, and cholesterol and likely for my blood pressure, too.  

I began to implement the dietary and lifestyle changes and was seeing my “numbers” coming down, but like many people, life happened and I didn’t follow through. The weight crept up and presumably so did my blood sugar and pressure, but I had stopped monitoring those ages ago. But it was a problem with my eyes — one whose cause was unrelated to being Diabetic or having high blood pressure that was a game-changer for me. Having these conditions put me at higher risk of losing my vision and this was simply not something I was willing to risk.

Two weeks ago, I arrived at a fork-in-the-road. One direction was the same as most of my family took; with medication for blood sugar, blood pressure and cholesterol. The other was the road that I am taking; the one less traveled, but very well-researched, and with the encouragement of my Endocrinologist – a low-carb-high-healthy-fat way of eating, with days of fasting in the day but eating supper, and periods of days of eating and then not eating.

Not “starving”, but “intermittent fasting”. The difference?

Starving results in the body lowering its metabolism to spare calories and intermittent fasting and alternate-day fasting results in the body raising its metabolism and burning stored fat.

The expected outcome?

The first goal begins with lowering insulin resistance; which is the underlying cause of Type 2 Diabetes, and with lower insulin resistance follows lower blood sugar levels – both fasting blood sugar and A1C (3 month average).

A change in diet and strategic use of fasting, lowers insulin and cortisol levels which in turn, lower triglycerides (TG). TG are largely a byproduct of a high-carb diet (especially affected by fructose), so lowering these results in lower TG and in turn, lower levels of LDL (bad cholesterol) and higher levels of HDL (good cholesterol).  Lower insulin and cortisol as well as less abdominal fat, results in lower, more normalized blood pressure.

Will it work?  The research seems to indicate it will and over the weeks to come, I will posting the results of some of that research so that the context of what I’m doing can be understood.  After all, I am a Dietitian and a scientist — it has to be evidenced-based.

The First Two Weeks – off to a good start

Blood Sugar

Of course this is an incredibly small period of time to look at, but in the first two weeks since I started my low-carb-high-healthy-fat eating with intermittent- and alternate-day fasting , my blood sugar has decreased substantially even on the days I was eating, provided I was eating very few carbs.

arrows indicated 2 periods of eating 10-15% carbs

Blood Pressure

My blood pressure went from 50% Stage 1 hypertension with 1 hypertensive emergency (scary!) and ~30% Stage 2 Hypertension the first week:

…to approximately 80% Stage 1 Hypertension and almost 20% Prehypertension the second week.

That is a significant change!

My weight is only down ~ 4 pounds, but I’ve lost 1 inch off my waist.

I am not hungry on my intermittent-fast days …and keep in mind, I talk about food all day long with my clients. If I am not talking about food, I am working on meal plans and writing about food!  If I was hungry, this would be torture, but it’s not. In fact, the last time I ate was last night at supper and I feel fine. I should have had a coffee though (as I get caffeine headaches if I don’t).  I’ll make one soon.

I’ve only taken one alternative-day fast so far and it went fine.  I drank “bone-broth” (I’ll explain in coming blogs!) and had my morning coffee with a little cream, no milk because of the carbs. I don’t really like cream, but it was okay.  Bone broth is interesting — a bit like chicken broth, but different.

One side-bonus that I never expected, is that I am sleeping better than I have in years.  Crazy good sleep and waking up rested.  What a great added bonus.

I have a long way to go to get to my goals (plural) because I’ve set the bar very high…and why not? If the literature indicates that this works, then I want;

(1) blood sugar in the non-diabetic range

(2) normal blood pressure

(3) normal / ideal cholesterol levels

(4) a waist circumference in the “at or below” recommended values of the Heart and Stroke Foundation

Will I meet all these goals?  Who knows?! But I won’t know if I don’t try and the alternative of a life of medication for blood sugar, blood pressure and eventually cholesterol too does not appeal to me!

So join me in my journey – a journey of change, of good health and on a road less traveled.

Joy

Lactose Intolerance

INTRODUCTION:

Lactose is the sugar found in milk and milk products. It is also added to some processed and prepared foods such as salad dressings. An enzyme called lactase is needed for your body to break down (digest) lactose.

Primary lactose intolerance occurs when your body does not have enough lactase – which can occur because your body does not make it. Certain ethnic populations have a higher likelihood of having primary lactose intolerance. In North America, adults lactose intolerance has been reported at 90% of Asians, 80% of First Nations, 75% of Blacks, 50% of Hispanics, and 21% of Caucasians 1. As high as 60-80% of Ashkenazi Jews (Jews of Eastern European background) have primary lactose intolerance 2

Secondary lactose intolerance occurs as a result of something else such as in inflammatory bowel disease, such as Crohn’s or Colitis. Celiac disease (antibody mediated gluten intolerance) or those with Celiac disease who have not been strictly following a gluten-free diet may also have secondary lactose intolerance. In these cases, the villi of the intestine (little hair-like projections that increase the surface area of the intestine) which contain the lactase needed to break down the lactose become damaged, resulting in lactose intolerance.  For those with inflammatory bowel disease or Celiac disease, once their disease is better managed,  the villi in their intestines heal, making them able to digest lactose again. Even a bout of stomach flu can result in temporary lactose intolerance.

Congenital Lactose Intolerance – In rare cases, lactose intolerance is cause by a defective gene that is passed from the parents to a child, resulting in the complete absence of lactase in the child. This is referred to as congenital lactose intolerance.

milk-splash

Symptoms

In those without lactose deficiency, the body breaks down the lactose taken in through the diet into smaller parts for digestion and absorption. Without the lactase enzyme, or enough of this enzyme, the lactose passes into your large intestine undigested, and there it is fermented by bacteria which may result in symptoms such as:

  • bloating
  • gas
  • cramping
  • nausea
  • diarrhea
  • weight loss (in children)

The severity of these symptoms depends on the amount of lactose eaten and the amount of lactase enzyme that the body produces. Most people with lactose intolerance can tolerate some lactose in their diet.

How Is Lactose Intolerance Diagnosed?
Lactose Intolerance Test

This blood test measures your body’s reaction to a liquid that contains high lactose levels.

Hydrogen Breath Test

This test measures the amount of hydrogen in your breath after consuming a drink high in lactose. If your body is unable to digest the lactose, the bacteria in your intestine will break it down instead. The process by which bacteria break down sugars like lactose is called fermentation. Fermentation releases hydrogen and other gases. These gases are absorbed and eventually exhaled. If you aren’t fully digesting lactose, the hydrogen breath test will show a higher than normal amount of hydrogen in your breath.

Stool Acidity Test

This test is more often done in infants and children. It measures the amount of lactic acid in a stool sample. Lactic acid accumulates when bacteria in the intestine ferment the undigested lactose.

Managing Lactose Intolerance

Those with lactose intolerance benefit from reducing the amount of lactose in their diet.

While you expect to find lactose in milk products, it is often added as an ingredient to foods and beverages you might not think have lactose. Be sure to read the ingredient list on product label to find out if the product contains an ingredient that contains lactose – such as:

  • milk
  • milk solids
  • whey
  • lactose
  • curds
  • cheese flavour
  • malted milk
  • non-fat milk solids
  • buttermilk
  • cream
  • non-fat milk powder

chip-dip

Prepared foods may also contain lactose, including:

  • store bought gravy or sauce mixes
  • vegetable or chip dips
  • soups
  • chips or snack crackers (e.g. cheese or ranch flavoured)
  • sugar substitutes made with lactose (e.g. Equal®)
  • artificial whipped toppings
  • powdered meal replacement supplements
  • hot chocolate mixes
  • cream-based liqueurs

Note: Products that contain lactic acid, lactalbumin, lactate and casein do not contain lactose.

Limiting, Rather than Avoiding Lactose

Some people are able to tolerate certain lactose-containing foods while other people with lactose intolerance cannot.

Limit your intake of foods that cause you discomfort.

cheddar
hard cheddar

Once your symptoms have improved significantly, try adding in small amounts (60-125mL or 1/2 cup) of lower lactose foods such as:

  • hard, aged cheese (cheddar, Swiss, Parmesan)
  • yogurt
  • chocolate milk
  • pudding
  • sour cream
  • cottage cheese

If these amounts cause you discomfort, then try eat less.

Greek yogurt
Lactose Free & Lactose Reduced

In Canada, “lactose-free” means that there is no detectable lactose in the food.  “Lactose-reduced” means that at least 25% of the lactose in the product has been removed.

Calcium and Vitamin D

Many foods that contain lactose are also important sources of calcium and vitamin D, so if you avoid lactose-containing foods, be sure to include other sources of these nutrients, such as the following lactose-free or lactose-reduced products, preferably fortified with calcium, such as:

  • lactose-hydrolyzed milk (e.g. Lactaid®, Lacteeze®)
  • soy beverage
  • rice beverage
  • casein or soy-based products in place of cheese
  • yogurts with live bacterial cultures or lactose-reduced yogurts
Calcium & Vitamin D

It is important that if you are lactose intolerant to be sure to get enough Calcium and Vitamin D.

Calcium is a mineral that helps you build and maintain strong bones and teeth, and is also used in other parts of your body – to help your muscles work and is involved in maintaining your heartbeat. Adequate calcium intake throughout your life can help to prevent osteoporosis, a disorder that causes thinning of the bones until they are weak and fracture easily or break. Women are at greater risk of developing osteoporosis than men, particularly after menopause, because estrogen levels which act to maintain bone are reduced.

Lactose-free sources of vitamin D include fish, liver and egg yolks.

Remember…

Being lactose intolerant does not mean you can’t ever have dairy – hard cheese and yogurt are naturally low in lactose and reduced lactose milk can be purchased at most grocery stores. Some people may not have any symptoms at all from regular milk or cream, provided they only have a small amount. If 1/2 cup (125ml) causes you discomfort, then try 1/4 cup.

Finally, remember that Calcium and Vitamin D can be found in other foods besides dairy, such as canned sockeye salmon. Don’t forget that the bones are the best sources, so mash them finely and eat them along with the rest.

best-canned-salmon

 


References

  1. Scrimshaw NS, Murray EB. The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Am J Clin Nutr. 1988;48(4 Suppl):1079. Available at: http://www.ncbi.nlm.nih.gov/pubmed?term=3140651. Accessed on March, 6, 2015.
  2. Heyman, MB. Lactose intolerance in infants, children, and adolescents. Pediatrics 2006;118(3):1279-1286. Available at: http://pediatrics.aappublications.org/content/118/3/1279. full Accessed on February 23, 2015.

 

 

Important Public Health Notice – Outbreak of Cyclospora

The Public Health Agency of Canada is advising Canadians to check where their produce comes from after an outbreak of Cyclospora was reported in four provinces –  Quebec, Ontario, Alberta and British Columbia between May and July.

The Canadian Food Inspection Agency said it is still looking into a food source linked to the outbreak, however it is known that it is usually associated with fresh producePast outbreaks in both Canada and the US have been linked to:

prepackaged salad mix

basil

cilantro

raspberries

blackberries

mesclun lettuce

snap peas

snow peas

snap peas  blackberries and raspberriesspring greens  cilantro and basil

What is Cyclospora?

According to the US Center for Disease Control and Prevention (CDC), Cyclospora is a parasite that causes an infection affecting the small intestines and which can lead to “watery diarrhea, with frequent, sometimes explosive, bowel movements.”

Symptoms

People infected with Cyclospora  experience a wide range of symptoms and some don’t get sick at all. Others feel as though they have a bad case of stomach flu. There are some that get seriously ill.

Most people develop the following symptoms within one week after being infected with Cyclospora:

  • watery diarrhea
  • abdominal bloating and gas
  • fatigue (tiredness)
  • stomach cramps
  • loss of appetite
  • weight loss
  • mild fever
  • nausea

It may take 7 – 14 days (a week to 2 weeks) after eating contaminated produce or drinking contaminated water for symptoms to appear.

If left untreated, you may have the symptoms for a few days up to a few months.

Most people have symptoms for 6 to 7 weeks.

Sometimes, symptoms may go away and then return.

If you become ill, drink plenty of water or fluids to prevent dehydration from diarrhea. If you have signs of illness and have reason to believe you have cyclosporiasis, call your health care provider.

How is Cyclospora Spread?

The Cyclospora parasite is spread by people ingesting food contaminated with feces and this most likely occurs when farm workers either (1) defecate in the fields and the produce that is growing becomes contaminated and/or (2) farm workers not washing their hands after a bowel movement and then going to pick produce, contaminating it.

Reducing Risk of Getting Ill

It is very important to note that washing contaminated produce may not get rid of the parasite. The best way to reduce risk is to cook all produce from Tropical and Subtropical countries where Cyclospora is found, including:

  • Peru
  • Cuba
  • India
  • Nepal
  • Mexico ***
  • Guatemala
  • Southeast Asia
  • Dominican Republic
***For those in British Columbia, remember that some of our imported produce comes from the US, but much of it, particularly from the fall onward, comes from Mexico.

If you’ve been considering “buying local“, now is a good time. Cyclospora is not commonly found on produce from Canada, the United States and European countries.

Planning to Travel to a Tropical or Sub-Tropical Destination?

People traveling to tropical or subtropical regions of the world need to be especially careful about eating fresh produce or drinking untreated water as that may put them at increased risk for infection from this parasite.

Most people recover fully, however, it may take several weeks before an ill person’s intestinal problems completely disappear.

 

http://www.phac-aspc.gc.ca/phn-asp/2016/cyclospora-eng.php

Staying Hydrated in Hot Weather – more than ‘8 glasses’

We’ve all heard that we need to drink 8 glasses of water a day, but is that true? How we know if we are properly hydrated? And does it have to be water, or can we drink something else?

The Myth of ‘8 Glasses’

While we’ve all heard we need to drink ‘8 glasses of water’ everyday, our water needs really depend on many factors, including our health, how active we are, and whether it’s hot or humid outside.

Why Water is Important

By weight, our body is about 60 % water and every system in our bodies depends on water to function properly. For example, water flushes toxins out of our kidneys and livers, carries nutrients to our cells and serves to keep the tissue in our ear, nose and throat tissues moist.

Lack of water can lead to dehydration; which results when we don’t have enough water to carry out normal functions. Even mild dehydration can drain our energy and make us tired. Severe dehydration can be very serious; resulting in hospitalization and in some cases, even death.

So How Much Water Do We Need?

Every day, we lose water as we exhale, perspire, and of course pass urine and have yes, we even lose water in our bowel movements. For our body to function properly, we need to replenish this water by consuming drinks and even foods that contain water.

So how much water does the average, healthy adult living in a temperate climate such as southern Canada or the northern USA, need?

The Adequate Intake (AI) of water for an adult man is roughly 3 liters (13 cups) and the AI for women is 2.2 liters (9 cups) of total beverages a day.

If we are sick and have a fever or it is hot and humid out, we need to drink even more. We also need to take in more fluid if we exercise strenuously and sweat, even more so if we work out when its hot.

A quick look at your lips in a mirror will let you know if you need to drink more! If you see vertical lines or crevices, you are already dehydrated.  If they are very deep and wrinkled — even more so! Cracked or peeling?  It’s not looking good.

Here are some indications of how much additional water (above the Adequate Intake mentioned just above) that you need to take in for different reasons;

Exercise; When we exercise, we need to take in an extra 400 to 600 milliliters (about 1.5 to 2.5 cups) of water for short workouts but intense exercise lasting more than an hour (for example, running a marathon) means we need to take in that much more to drink. During long workouts, it’s best to drink something that contains a little bit of sodium, as this will help replace sodium lost in sweat and reduce the chances of developing low sodium levels, which in itself, can be life-threatening. It’s also important to keep replacing fluids after you’re finished exercising.

Environment; Hot or humid weather can make us sweat and means we need to take in additional fluid. In the winter, overly heated indoor air can also cause us to lose moisture and being at high altitudes (greater than 8,200 feet / 2,500 meters may cause more rapid breathing and increased urination, which means we need to take in even more fluid.

Illnesses or health conditions; When we have fever, or are ill with vomiting or diarrhea, our body loses even more fluids. In these cases, we need to drink more water and sometimes it is helpful to drink oral rehydration solutions, such as Gatorade or Powerade. The reason homemade chicken soup works well is it often has sodium (salt) in it as well as sweet root vegetables such as carrots, onions and parsnips or parsley root. We also need to increase our fluid intake when we have bladder or urinary tract infections.There are also certain health conditions that require people to limit their intake of fluid, including heart failure and some types of kidney, liver and adrenal diseases.

Pregnancy or breast-feeding; Women who are pregnant or breast-feeding need additional fluids to stay hydrated. Pregnant women should aim to drink 2.3 liters (10 cups) of fluids daily and women who are breast-feeding should drink 3.1 liters (13 cups) of fluids per day.

Beyond the tap: Other sources of water

Although it’s a great idea to keep water within reach at all times, you don’t need to rely only on what you drink to meet your fluid needs. What you eat also provides a significant portion of your fluid needs. On average, food such as fruit and many vegetables such as cucumbers and tomatoes provides about 20% of total water intake.

In addition, beverages such as milk, juice and soup are mostly of water.

Remember though, while beer, wine and caffeinated beverages such as coffee, tea or cola or root beer contribute to fluid intake, they increase fluid loss. Water really is your best bet because it’s calorie-free, inexpensive and readily available.

Staying Properly Hydrated

Another way (in addition to the ‘lip-test’ above) to tell if you are drinking enough is by making sure you are urinating enough.

In general, we should produce about 1.5 liters (6.3 cups) or more of colorless or very light coloured urine a day, so if we aren’t, we should “up” our fluid intake.

To make sure you are drinking enough, here are a few tips

• Drink a glass of water (250 ml / 8 oz) or other calorie-free or low-calorie beverage after each meal and between meals.

• Drink water before, during and after exercise.

Is it possible to drink too much water?

Although it is not common, it is possible to drink too much water and when your kidneys are unable to excrete it, the electrolyte (mineral) content of our blood becomes diluted, resulting in low sodium levels in the blood. This is called hyponatremia and is a very serious condition. Endurance athletes, such as marathon runners who drink large amounts of water, are at higher risk of hyponatremia.

Flavoured Water

Sometimes we just want to drink something other than water, so rather than turning to commercial flavoured water, why not make your own? Here is a recipe for a wonderful refreshing drink that is commonly drunk throughout the Middle East, where it can be very hot and humid. It’s called “Lemonana“.

“Limonana” is a combination of the word for lemon (limon) and mint (nana) in Hebrew and is a lovely refreshing combination of these two ingredients, plus a touch of sweetness. Add a splash of rose water (available in Middle Eastern grocers) for a touch of Middle Eastern flavour!

LIMONANA

Limonana 2

 

 

 

 

 

 

 

 

Ingredients

4 medium-sized lemons, washed and sliced thinly
2 lg sprigs of fresh mint leaves, washed and torn
3 Tbsp berry sugar
2 litres ice water or 2 cups ice cubes plus water
(optional) 1 tsp rose water [available in Middle Eastern groceries]

How to make

Dissolve berry sugar in 1/2 cup boiling water in the bottom of a 2 litre glass pitcher, stirring until clear.

Slice the lemons thinly and add to the pitcher.

Toss the torn mint leaves in.

Fill pitcher with 2 trays of ice cubes and cold filtered water.

Add the rose water, if you have it (or leave it out).

Pour into glasses and enjoy!

If you follow the above Limonana recipe, the result should look like the photo above.

Do Saturated Fats Really Increase the Risk of Heart Attack and Stroke?

For the last 35+ years, the Canadian and American Dietary Recommendations have been telling us to eat less fat overall (not more than 20-35% of daily calories) and in particular, to eat much less saturated fat. Saturated fat is naturally found  in red meat, dairy products and certain oils, such as coconut oil and palm oil. For years, a debate has raged over whether saturated fat contributes to poor heart health.

Neither the American and Canadian Dietary Recommendations have set a Daily Recommended Intake (DRI) for saturated fat, but both recommend that saturated fat intake remain as low as possibledue to its positive relationship with coronary heart disease risk“.

The American Heart Association warned that saturated fat can raise the risk of cardiovascular disease and urged people to limit consumption of dairy, red meat and fried, processed food and until recently, the Heart and Stroke Foundation of Canada was recommending the same as Health Canada (limit overall fat to 20-35% of daily calories, keeping saturated fat to <5% of daily calories).

In September 2015, the Heart and Stroke Foundation released on new position statement titled “Saturated Fat, Heart Disease and Stroke“, which takes a closer look at how dietary choices affect heart disease risk, encouraging Canadians to stop focusing on one particular aspect of food such as fat, sodium, calories, sugar – and instead focus on eating unprocessed, whole foods. 

With respect to “low fat foods”, the Heart and Stroke Foundation clarified that

confusion around fats and their impact on our health has led to a proliferation of processed foods labelled “low fat”. While these products may indeed be lower in fat than some others, that doesn’t necessarily make them healthy. In fact, these foods are often highly processed and loaded with calories, sodium and refined carbohydrates, including sugar. The focus on “low fat” has not benefitted Canadians’ diets.”

A recent research paper published in August 2015 in the British Medical Journal and whose lead research is Dr. Russell de Souza, a nutrition epidemiologist at McMaster University in Hamilton, Ontario found that saturated fat is not linked to stroke, type 2 diabetes, heart disease or death. did find a clear relationship between trans fats (often found in processed or fried foods) and poor heart health.

The Heart and Stroke Foundation has concluded that

“Research provides a mixed picture of the association between saturated fat, heart disease and stroke. Early studies found an association existed, while more recent studies have found no such association. These mixed findings have been the focus of recent scientific debate, and show us that saturated fats are complex.”

Saturated fats are found in meat, butter, cheese, tropical oils (such as coconut) and many processed foods. Most of the saturated fat in the average North American diet doesn’t come from whole foods like beef or coconuts; instead it comes from processed foods such as pizza, cakes, cookies, donuts and ice cream.

The Heart and Stroke Foundation repeated the same findings as Dr. deSouza’s August 2015 study and that is;

The one constant that is not in dispute is the harm of artificially produced trans fat on heart health. This fat raises LDL (bad) cholesterol, lowers HDL (good) cholesterol, and should be avoided. Trans fats have been linked with up to a 10-fold higher risk of heart disease.

Something many people don’t realize is that;

Trans fats are still widespread in our food supply, despite a voluntary reduction by food companies directed by Health Canada.

Their finally recommendations are;

“Reduce your intake [of trans fats] by avoiding foods that contain partially hydrogenated oil, hard margarine or shortening, and cutting back on commercial baked goods, which have the most trans fat.

Heart disease prevention comes from whole food-based diets, filled with vegetables, fruit, whole grains, lean protein (including lower fat dairy and alternatives), fish, legumes, nuts and seedsand fat is naturally found in this diet! Eating this way means not having to worry about any one nutrient in isolation. It’s the big picture that matters most.”

A few thoughts on the Heart and Stroke Foundation’s new position statement;

There are many recent studies that seem to indicate that saturated fat consumption is not the issue when it comes to heart risk — and that saturated fat may actually be protective against heart risk and there are many studies showing the benefits of consuming MCT oil and that it reduces “abdominal fat”, which in turn is associated with lower cardiovascular risks.  I think it is erroneous to say that high fat consumption in general is a risk to heart health — when one can consume very high amounts of monounsaturated fats such as olive oil or avocado oil and omega 3 polyunsaturated fats in fatty fish such as salmon, mackerel and tuna and have no increased risk of cardiovascular disease related to fat consumption. I also think saying that “saturated fat” is  “bad” or “dangerous”, when an oil such as coconut oil, which is 50 % saturate fat which is an MCT oil, is misleading.

Looking at the epidemiological data from the last 35 years, we can see what has happened to obesity rates and diabetes rates since both the American and Canadian governments have been encouraging us to eat “low fat” everything. Lower fat has not translated to improved health outcomes.

If we cannot say that naturally occurring fats such as olive, avocado and coconut oil result in an increased rate of heart attack and stroke then why vilify fat.

If the real issue is synthetic “trans fats” and processed omega-6 polyunsaturates (associated with increased inflammation) then I believe as health-care professions, we should be focusing on those.

Certainly, as a Dietitian, I cannot in good conscience encourage people to eat a low fat diet, when doing so leads to them eating “low fat” manufactured products that have increased sugar.

 

 

References

  1. de Souza Russell J, Mente Andrew, Maroleanu Adriana, Cozma Adrian I, Ha Vanessa, Kishibe Teruko et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies BMJ 2015; 351
  2. Health Canada, Do Canadian Adults Meet their Nutrient Requirements Though Food Intake Alone? Cat. No.: H164-112/3-2012E-PDF, 2012
  3. Heart and Stroke Foundation of Canada, Position Statement “Saturated Fat, Heart Disease and Stroke, September 24, 2015
  4. Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington: The National Academies Press; 2006

 

The “Skinny” on Fats

INTRODUCTION:

Many people believe that saturated fat is “bad” for you but few people realize that our bodies actually manufacture it.  It’s true. In this article, I cover “just enough” chemistry (made very easy!!) for you to be able to understand the latest new findings. My next article will be on a change in the dietary recommendations of a key stakeholder in heart health in Canada, and what this change means.


If Saturated Fat was so Dangerous, Why Would our Body Actually Make it? 

There are two sources of fats (also called “lipids“); those we eat in our diets and those our body makes. The fats we eat are called “exogenous fats” (“exo” meaning ‘from outside’) and the type of fats that our body makes are called “endogenous fats” (“endo” meaning ‘from within’).

Exogenous Fats

The types of fat that our body takes in as exogenous lipids from what we eat include saturated fats, and different kinds of unsaturated fats — including polyunsaturated fats — both omega 3 and omega 6, as well as monounsaturated fats. You can look back to the preceding blog, if you aren’t clear on these.

Endogenous Fats

Our body actually makes fat in a process called lipogenesis. This is important because some of the LDL cholesterol and triglycerides (TG) that gets reported on blood test results is endogenous; that is, our bodies made it. So we have high LDL (“bad” cholesterol) or triglycerides it’s not all from the fat we eat!

[Not only do our bodies make saturated fat, but excess carbohydrates gets stored in our body first as triglyceride and then if it still isnt needed, it gets stored as LDL cholesterol in our liver.  So carbs can raise both triglycerides and LDL cholesterol.]

Below, I will present just enough chemistry to understand the different types of fat and more importantly, be able to read about them and understand.

The Saturated Fat Our Body Makes and What it is Used For

1. The first thing that you need to know is that palmitic acid is a long-chain saturated fat is made (synthesized) in the liver. Palmitic acid is a 16-carbon fatty acid and having so many carbons in its backbone, it is considered “long chain”). It has no double bonds, so all the carbons in the backbone have a hydrogen bound to it (more on that below), so palmitic acid is a saturated fat.  Palmitic acid is found naturally in foods such as butter, cheese, milk and meat — but it is also synthesized by our bodies!

Now the message of the media since the mid- to late-1970s is to eat low-fat dairy; including low fat milk, low-fat yogourt and low-fat cheese with the assumption that saturated fat is “bad” for us — but our bodies actually manufacture it!


2. The other thing that you need to know is that a triglyceride is made up of three fatty acids attached to a glycerol molecule. That’s easy to remember, because “tri” means “3”.

a) Glycerol acts as the support for the other fats and is made up of three carbon atoms, each with something called a “hydroxyl group” bound to it.

A hydroxyl group (written “-OH”) is an oxygen and a hydrogen molecule bound together.  That is, water (H2O) is just a hydrogen (H) molecule bound to a hydroxyl (-OH) group.

So, this is a glycerol molecule;

As you can see, each of the carbons in the chain have a hydroxyl (-OH) group bound to it. Easy, so far, right?

b) Fatty acids are long chains of carbon atoms (i.e. think of a freight train, where each rail car is a carbon atom) with a carboxylic acid (-COOH) group at one end (i.e. the caboose is a carboxylic group). At each of the carbons in the chain, there is the potential for a hydrogen atom (H) to bind there.

You may recall from our previous article that a saturated fat is one that has no double bonds in the carbon chain, so in that case, all the carbon atoms in the chain have a hydrogen attached.  It is having all the carbons “saturated” with hydrogen atoms, that make it a “saturated” fat!

The names given to fatty acids are based on the number of carbon atoms and the number of carbon-carbon double bonds in the chain.


Different Kinds of Oils 

Remember, a triglyceride is made up of three fatty acids attached to a glycerol molecule. So, for example, palmitic acid and stearic acid are both exactly the same, except one has 16 carbons (palmitic acid) and the other has 18 carbons (stearic acid) in its chain.

Palmitic acid, a saturated fat has 16 carbons.  That is, it is “saturated” with hydrogen atoms at each of its 16 carbons. It is all of this “saturation” that makes saturated fat solid at room temperature.

Stearic Acid, is also a saturated fat, but has 18 carbons, so each of its carbons has a hydrogen bound to it,

Using just these two saturated fatty acids (palmitic acid and stearic acid) we can combine them in different ratios to make entirely different oilsFor example, canola oil has a 4:2 ratio of palmitic acid to stearic acid and grapeseed oil has an 8:4 ratio of palmitic acid to stearic acid.

Furthermore, the same two fatty acids can be put together in the same ratio and be different fats. For example in a 7:2 ratio, it could be either almond oil or safflower oil — depending on how they are put together.

Palmitic acid, the saturated fat that our body makes is found in all kinds of “healthy” foods.


Lipogenesis – Our Bodies Making fat!

Lipogenesis is the process by which our bodies actually make fat and our bodies can make unsaturated fats or saturated fats.  

Unsaturated fatty acid lipogenesis

Our body can make a longer chain unsaturated fat from a shorter chain fatty acid (such as taking the linolenic acid from flax seed and adding carbons to the chain to make arachidonic acid). But there are limits.  Our bodies cannot take the linolenic acid from flax seed and make it into eicohexanoic acid or decahexanoic acid which are the healthy “omega 3 fats” fats found in  fish. So eating eggs made from chickens fed flax is not the same as eating fish.  We just can’t turn one into the other. Our body can make it longer, but not much longer.

Saturated fatty acid lipogenesis

As said above, our bodies synthesize palmitic acid, a 16 carbon saturated fat in our liver and then forms a triglyceride from three palmitic acid molecules attached to a glycerol molecule. These triglycerides are then transported around the body in something called a VLDL. More on that just below. 


Cholesterol – The Good the Bad and the Ugly

Most people know that HDL cholesterol is the so-called “good cholesterol” and LDL cholesterol is the “bad” cholesterol  — but where does LDL (“bad cholesterol”) come from? The first step when our body makes something called VLDL.

Very Low Density Lipoproteins (VLDL)

The body takes the triglycerides it manufactures in lipogenesis as well as takes in in the diet into Very-low-density lipoprotein (VLDL) cholesterol. These VLDLs move cholesterol, triglycerides and other lipids (fats) around the body.

VLDL is produced in the liver and include the triglycerides made with differing amounts of palmitic acid.  That is, our bodies MAKE palmitic acid in the liver and then combine the palmitic acid it makes in differing ratios, into triglycerides. It then takes the triglycerides, containing palmitic acid and protein and packages it into VLDLs. It then releases the VLDLs into the bloodstream, to supply body tissues with triglycerides.  About half of a VLDL cholesterol is made up of triglycerides, including those containing the palmitic acid it made!

High levels of VLDL cholesterol have been associated with the development of plaque deposits on artery walls, which narrow the passage and restrict blood flow.

VLDL cholesterol on blood test results aren’t measured, but estimated as a percentage of the triglyceride value.

What is LDL cholesterol?

When VLDL cholesterol reach fat cells (called “adipose tissue”), the triglyceride is stripped out and absorbed into fat cells. That means that VLDLs shrink.

Once a VLDL has lost a large amount of triglyceride it becomes a new, smaller, lipoprotein, which is called Low Density Lipoprotein, or LDL — the so-called ‘bad cholesterol’. LDL contains mostly cholesterol and some protein. Some LDLs are removed from the circulation by cells around the body that need the cholesterol contained in them and the rest is taken out of the circulation by the liver.

Here is the key point: the only source of LDL is VLDL. 

Saturated Fat — not dangerous and can be beneficial 

The media keeps telling us that “saturated fat is bad” and that it is even “dangerous” — but if it was so dangerous, why would our bodies actually manufacture it?  Our bodies manufacture palmitic acid, a saturated fat, then synthesize triglycerides from it which it sends all around our bodies, supplying our bodies with saturated fat!

Furthermore, there are some saturated fatty acids, called Medium Chain Triglycerides (MCTs) that are metabolized entirely differently than the longer chain saturated fatty acids and have beneficial properties.  These MCT oils go straight to the liver by the portal circulation and don’t need to be digested.

People who consume fats high in MCT oil, such as coconut oil which is almost half (44-55%) Lauric acid, an MCT have been found to have lower amounts of “belly fat” than those that do not consume these saturated fats.  Studies have found lower rates of “visceral adiposity” or “belly fat” in those that consume these fats, and correspondingly , lower lowering waist circumference.

Since carrying fat around the abdomen (the so-called “apple shaped” people) is considered to be a risk-factor to heart disease and studies have found that those who eat a diet high in MCT saturated fats have less fat around their middles and a smaller waist circumference, can we categorically say that saturated fat is really “bad” or “dangerous” to heart health. In fact, in our next article, we will outline the beginning of a change in the recommendations concerning saturated fat consumption.

Some thoughts…

Saturated fat and its consumption needs to be put into context; one context would be looking at the risks of a high carbohydrate diet compared with a high saturated fat diet, for example.  As covered in previous blogs, prior to 1977, when the dietary recommendations in Canada and the US changed to favour a diet low in saturated fat and high in carbohydrates, the rate of Diabetes was 1/10th what it is now and obesity rates in adults, especially men were too. Childhood obesity was almost unheard of prior to 1977.

Another context would be to differentiate between saturate fats.  That is, to look at which saturated fats.  Numerous studies demonstrate the benefits of MCT oils in increasing metabolism, lowering body fat, especially “visceral adiposity”.

Another context would be to determine how much of the “high cholesterol” (i.e. high LDL cholesterol) came from VLDL that was endogenously produced, versus eaten (exogenous).

Many studies have found that people are less hungry (have increased “satiety”) when they consume higher fat dairy products (which are rich in saturated fat), and as a result consume less calories overall than those that do not eat higher fat dairy products. So, we need to know which fats, and in particular which saturated fats are associated with this increased satiety?

It is my opinion that “vilifying” fat — labelling it as ‘unhealthy’ and the current government dietary recommendations and the media ads encouraging us to eat “low fat” everything, is creating a much bigger problem than the fat itself.  When manufacturers take out fat, they have to ‘replace” it with something and that ‘something’ is often sugar (simple carbohydrates).  Is increasing the carbohydrate content ‘safer’ than the naturally occurring fat that was found in the milk or yogourt or cheese, in the first place?

Recent studies seem to indicate that saturated fat consumption is not the issue when it comes to heart risk — and that saturated fat may actually be protective against heart risk. Certainly there are many studies showing the benefits of consuming MCT oil for reducing “belly fat”, which reduces heart risk — so can we say that something like coconut oil, used in moderation is “bad” or “dangerous”.

Looking at the epidemiological data from the last 35 years, we can see what has happened to obesity rates and diabetes rates since both the American and Canadian governments have been encouraging us to eat “low fat” everything.

Are naturally occurring fats really the issue — or are synthetic “trans fats” and excess carbohydrate?

At this point in time, I am persuaded by the many studies I have read, that naturally occurring fats, including saturated fat are not “bad” or “dangerous” when consumed as part of a whole-foods diet.

Stay Tuned

Stay tuned for our next article on some changes in recommendations concerning saturated fat consumption, which demonstrates the tide of medical opinion on saturated fats, is beginning to  change.

 

Carbs or Fat – which one should we eat less of?

lipids-and-fats-11-638

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

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

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

Obesity became an epidemic.

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

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

Diabetes rates almost doubled.

In the 1970s, the rate of Type 2 Diabetes in women was 2.6% and 3.4 % in men, in the 1980s that number rose to 3.8% for women and 4.5% for men.  In the 1990s the rate was almost double what it was in 19704.7% for women and 7.5% for men.

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

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

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

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


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

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

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

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

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


1. What are the different type of fats.

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

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

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

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

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

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

  • fatty acids are molecules made up of a carbon backbone.  Think of it like a train with cars connected together.  Actually think of it more like “fuselage” of a plane (which will become clear as to why, below). The body is made up of carbons all in a row.
  • if there are no double bonds in the carbon chain, it is a saturated fatty acids because something can bond at every carbon along the carbon chain.  Think of those molecules that bond to a carbon as “wings” sticking off the fuselage.
  • if there is one double bond in the carbon chain, it is an unsaturated fatty acid. It is “unsaturated” because no other compound can bond where the double bond is. So it can have “wings” every where else along the carbon chain (which makes it unsaturated) but not at the place where the one double bond is.
  • if the carbon chain has more than one double bond, it is called a polyunsaturated  fatty acids (PUFAs).
  • there can be a double bonds off one of the carbons in the carbon backbone chain.
  • where the double bond off the carbon backbone is located determines whether it is an omega-3 polyunsaturated fatty acid or an omega-6 polyunsaturated fatty acid.
  • all omega-3 fats have their first double bond in the same place on the carbon chain (away from what is called the ‘carboxyl’ end).  All omega-3 fats have their first double bond starting at the 3rd carbon (away from what is called the ‘carboxyl end’).
  • all omega 6 fats have their first double bond starting at the 6th carbon (away from the carboxyl end)

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

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

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

Spoiler alert!  

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

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

Meanwhile, remember that most people’s extended benefit coverage rolls over a the end of the year; which is coming up in only 5 weeks and most plans cover visits to a Registered Dietitian.

If you want to maximize your 2015 benefits, be sure to contact us now.

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