This coming Monday will be 9 weeks since I started this journey. The weight loss has been slow yet steady. I’ve lost 9 pounds – 1 pound per week.
I’ve lost 4 inches off my waist. I can’t tell you how amazing it is to take jeans out of the dryer and put them on easily!
When I look in the mirror, I am starting to recognize the image that looks back. “She” had a neck and a chin – and “her” face is oval, not round. I know that person!
My blood pressure remains very stable (stage 1 hypertension) – down from the wildly erratic fluctuations between stage 2 hypertension, right up to a hypertensive emergency. It was that which started me on the journey, but what keeps me on it, is how I feel. I feel amazing.
My blood sugar is continuing to fall gradually, and for the last 2 weeks I’ve been in mild ketosis and am now “fat adapted”.
I no longer wake up with stiff, swollen fingers and for the first time in years, I fall asleep easily. Yes, I wake up several times to use the washroom, but I can certainly live with that.
This update, I am not going to post any statistics, no graphs, no fat percentages – in fact, I haven’t even taken it since last time. I’m not obsessing over every pound, every inch, or every percent. I’m just doing what I know to do and letting the results come as they come.
Two weeks after I started (March 16, 2017), I posted a video of me walking at the local track. It wasn’t “pretty” but it was real. The reason I posted it was because I believe it removes the barrier that somehow because I’m a Dietitian with a post-grad degree that I can’t really understand what it is like for my clients. I do.
I have to get healthy and make lifestyle changes, the same way as everybody else…one day at a time.
So instead of statistics, and charts and graphs, I am going to post the two videos. They’ve not been edited in any way – they are as-shot.
Want to know more?
Please send me a note using the “Contact Us” form above, and I’d be happy to get back to you.
Long before the ‘hybrid car” there was the human body – a hybrid ‘machine’ perfectly designed to use either carbohydrates orfat for energy. Like a hybrid car, we can run on one fuel source or the other at any one time.
If we are eating a largely carbohydrate based diet, we will be in ‘carbohydrate mode‘ by default. Carb-based foods will be broken down by our bodies to simple sugars and the glucose used to maintain our blood sugar levels. Our liver and muscle glycogen will be topped up, then the rest will be shuttled off to the liver where it will be converted into LDL cholesterol and triglycerides and stored in fat cells.
Historically, in times of plenty, we’d store up glycogen and fat and in lean times, we’d use up our glycogen and thenswitch fuel sources to be in “fat-burning mode” — accessing our own fat stores, for energy.
The problem is now that we rarely, if ever access our stored fat because we keep eating a carb-based diet. So we keep getting fatter and fatter.
GLUCOSE OR FAT AS FUEL
When we are in “carb burning mode”, the carbs we eat are broken down by different enzymes in our digestive system to their simplest sugar form (monosaccharides) such as glucose, fructose and galactose.
Glucose is the sugar in our blood, so starchy foods such as bread and pasta and potatoes are broken down quickly so they are available to maintain our blood sugar levels.
Monosaccharides are the building blocks of more complex sugars such as disaccharides, including sucrose (table sugar) and lactose (the sugar found in milk), as well as polysaccharides (such as cellulose and starch). When we drink milk for example, the galactose found in it is broken down into lactose and glucose. When we eat something sweetened with ‘sugar’ (sucrose), it is quickly broken down to glucose and fructose.
Any glucose that is needed to maintain our blood sugar level is used immediately for that purpose and the remainder is used to “top up” our glycogenstores in our muscle and liver. There are only ~ 2000 calories of glycogen – enough energy to last most people one day, so when our glycogen stores are full, excess energy from what we eat is converted to fat in the liver and stored in adipocytes (fat cells).
One problem is that our diets are high in fructose – naturally found in fruit but also as high fructose corn syrup in many processed foods. Fructose can’t be used “as is”, so it is brought to the liver. If our blood sugar is low, it will be used to make glucose for the blood (via gluconeogenesis) otherwise it will be converted into LDL cholesterol and triglycerides and stored as fat.
Feasting and Fasting
When we don’t eat for a while, such as would have occurred when our ancestors were hunter-gatherers, we’d use up our glycogen stores hunting for an animal to eat, or gathering other edible foods and if we weren’t successful at finding food to eat, then our bodies would access our fat stores, for energy. This is known as lipolysis. This process is regulated mainly by a hormone called glucagon, but other hormone such as epinephrine (the “fright and flight” hormone), cortisol (the “stress hormone”) as well as a few others (ACTH, growth hormone, and thyroxine) also play a role.
In times of plenty, we’d store up glycogen and fat and in lean times, we’d use up our glycogen, switch into “fat-burning mode” and then rely on our stored fat for energy.
The problem for most of us in North America and Europe is that we have access to food in our homes, in stores and at fast food restaurants 24/7. We can’t go for a walk without passing places selling or serving food and if the weather is bad or we are too tired, food is just a phone call or web-click away. So we just keep storing up our fat for ‘lean times’ that never come.
In addition, irrespective of our cultural background, our eating style is carb based; pasta, pizza, sushi, curry and rice or naan, potato, pita – you name it. Every meal has bread or cereal grains, pasta, rice or potatoes – and even what we consider “healthy foods” such as fruit and milk have the same number of carbs per serving as bread, cereal, pasta, rice and potatoes. That wasn’t always so. Our indigenous cultural foods were very different.
Compounding that, many “low-fat” products have added sugar (sucrose) in order to compensate for changes in taste from reducing naturally occurring fat, which then adds to excess carb intake. Sucrose (ordinary table sugar) is made up of half fructose, so a diet high in sugar adds even more fructose transport to the liver, for conversion to cholesterol and fat.
The vilification of fat
In 1977, both the Canadian and US food guides changed in response to the promoted belief that eating diets high in saturated fat led to heart disease. Multiple studies and reanalysis of the data of older studies indicates that saturated fat is not the problem, but that diets high in carbohydrate combined with chronic inflammation and stress, is.
In 2016, it came to light that the sugar industry funded the research in the 1960’s that downplayed the risks of sugar in the diet as being related to heart diseaseand highlighted the hazards of fat instead – with the results having been published in the New England Journal of Medicine in 1967 with no disclosure of the sugar industry funding*. The publication suggested that cutting fat out of the American diet was the best way to address coronary heart disease, and which resulted in the average American and Canadian as inadvertent subjects in an public health experiment gone terribly wrong. Overweight and obesity has risen exponentially and with that Diabetes, hypertension (high blood pressure) and high cholesterol.
*(Kearns CE, Schmidt LA, Glantz SA. Sugar Industry and Coronary Heart Disease Research A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016;176(11):1680-1685. doi:10.1001/jamainternmed. 2016. 5394).
Over the last 40 years the promotion of “low fat eating” by governments and the food industry has resulted in carbohydrate-intake skyrocketing. Every high-carb meal is followed by another high-carb meal, and if we can’t wait, a snack, too. We eat every 2-3 hours, and eating carb-based foods every 2 or 3 hours all day, every day is quite literally killing us.
How do we get fat out of “storage”?
The “key” to unlocking our fat stores, is decreasing overall intake of carbohydrates by decreasing the amount of carbohydrates we eat, both by eating much less of it and on occasion, by delaying the amount of time between meals.
Decreasing carb intake lowers insulin, the fat-storage hormone. At first our bodies access liver and muscle glycogen for energy, but since that is only about a one day’s supply, our bodies then turn to our own fat stores as a supply of energy.
By eating a diet rich in fat and keeping protein at the level needed by the body but not in excess, dietary protein is not used to synthesize glucose, but fat is.
An added bonus is that since insulin also plays a role in appetite, as insulin falls, appetite decreases.
This delicious low carb high fat Matcha Smoothie can help you lose weight & abdominal fat. The science behind it, the recipe & the nutritional info in this article.
Green tea is the unfermented leaves of the Camellia sinensis plantand contains a number of biologically active compounds called catechins of which epigallocatechin gallate (EGCG) makes up ~ 30% of the solids in green tea [Kim et al]. Studies have found that green tea catechins, especially EGCG play a significant role in both weight loss and lowerbody fat composition.
Population studies and several randomized controlled studies (where one group is “treated” and the other group is not) have shown that waist circumference is smaller and levels of body fat is lessthe more green tea consumed [Phung et al]. The anti-obesity effects of green tea are usually attributed to the presence of catechins [Naigle].
Several large-scale population studies have linked increased green tea consumption with significant reductions in metabolic syndrome – a cluster of clinical symptoms which include insulin resistance or hyperinsulinemia (high levels of circulating insulin), Type 2 Diabetes, hypertension or high blood pressure, cardiovascular disease including coronary heart disease and atherosclerosis.
It is thought that epigallocatechingallate (EGCG), the most abundant catechin in green tea, mimics the actions of insulin. This has positive health implications for people with insulin resistance or Type 2 Diabetes [Kao et al].
EGCG also lowers blood pressure almost as effectively as the ACE-inhibitor drug, Enalapril, having significant implications for people with hypertension (high blood pressure) and cardiovascular disease[Kim et al].
Research indicates that drinking 8-10 cups of green tea per day is enough to increase blood levels of EGCG into a measurably significant range [Kim et al].
The most effective way to reduce the symptoms associated with metabolic syndrome is through a low carb high healthy fat diet, however the addition of green tea as a beverage – especially as matcha green tea powder, may provide a means to preferentially target abdominal weight loss.
GREEN TEA CATECHINS
Catechins make up ~ 30% of green tea’s dry weight (of which 60–80% are catechins) and oolong and black tea (which are produced from partially fermented or completely fermented tea leaves) contains approximately half the catechin content of green tea.
Matcha,a powdered green tea used in the Japanese tea ceremony and popular in cold green tea beverages contains 137 times greater concentration of EGCG than China Green Tip tea (Mao Jian) [Weiss et al].
GREEN TEA CATECHIN CONTENT OF BREWED GREEN TEA VS MATCHA POWDER
A typical cup (250 ml) of brewed green tea contains 50–100 mg catechins and 30–40 mg caffeine, with the amount of tea leaves, water temperature and brewing time all affecting the green tea catechin content in each cup.
A gram (~1/3 tsp) of matcha powder contains 105 mg of catechins – of which 61 mg are EGCGs and contains 35 mg of caffeine. Most matcha drinks made at local tea and coffee houses are made and served cold and contain ~1 tsp of matcha powder which contains ~315 mg of catechins – of which ~183 mg are EGCs.
WEIGHT LOSS EFFECT OF GREEN TEA CATECHINS
A 2009 meta-analysis (combining the data from all studies) of 11 green tea catechin studies found that subjects consuming between 270 to 1200 mg green tea catechins / day (1 – 4 tsp of matcha powder per day) lost an average of 1.31 kg (~ 3 lbs) over 12 weeks with no other dietary or activity changes [Hursel].
Body composition EFFECT OF GREEN TEA CATECHINS
The effect of green tea catechins on body composition is significant – even when the weight loss between “treated” and “untreated” groups is small (~5 lbs in 12 weeks).
Even with such small amounts of weight loss;
– the total amount of abdominal fat decreased 25 times more with green tea catechin consumption than without it (−7.7 vs. −0.3%)
–total amount of subcutaneous abdominal fat (the fat just below the skin of the abdomen) decreases almost 8 times morewith green tea catechin consumption than without it(−6.2 vs. 0.8%).
HOW DO GREEN TEA CATECHINS WORK?
The mechanisms by which green tea catechins reduce body weight and reduce the amount of total body fat and in particular reduce the amount of abdominal fat are still being investigated. It is currently thought that green tea catechins;
– increased thermogenesis; i.e. increased heat production which would result in increased energy expenditure (or calorie burning)
– increase fat oxidation i.e. using body fat as energy. For those on a low fat high fat diet, this is good!
– decrease appetite
– down-regulation of enzymes involved in liver fat metabolism (fat storage)
WARNING TO PREGNANT WOMEN
While EGCG has also been found to be similar in its effect to etoposide anddoxorubicin, a potent anti-cancer drug used in chemotherapy [Bandele et al], high intake of polyphenolic compounds during pregnancy is suspected to increase risk of neonatal leukemia. Bioflavonoid supplements (including green tea catechins) should not be used by pregnant women [Paolini et al].
Betterbydesign’s low carb Green Tea Matcha Smoothie Recipe
Total carbs: 2.5 gm per serving – contains ~315 mg catechins
1 tsp matcha (green tea) powder * (1 tsp = 2 gm)
12 cubes ice, crushed
1/2 cup (125 ml) coconut milk
optional: 1/2 tsp Silan (Middle Eastern date syrup) – will add an additional 3.5 g carbs to the recipe
Place 1 tsp matcha powder in a small stainless steel sieve and gently press through the sieve into a small bowl with the back of a small spoon
Put the sieved matcha powder into a ceramic or glass bowl (not metal, as the tannins in the tea will react and give the beverage and “off” metalic taste)
With a bamboo whisk (available at Japanese and Korean grocery stores) or a plain spoon, whisk 3 Tbsp boiled and cooled water into the matcha powder, until all the lumps are gone and the mixture is smooth
Place a whole tray of ice cubes (12) into a blender
Pour matcha and water mixture over ice in the glass
Pour coconut milk on top of ice and matcha
Pulse until desired texture is achieved*
*I blend mine just fine enough to be able to drink it through a straw.
Bandele, OJ, Osheroff, N. Epigallocatechin gallate, a major constituent of green tea, poisons human type II topoisomerases”.Chem Res Toxicol 21 (4): 936–43, April 2008.
Hursel R, Viechtbauer W, Westerterp-Plantenga MS. The effects of green tea on weight loss and weight maintenance: a meta-analysis. Int J Obes (Lond) 2009;33:956–61.
Kao YH, Chang MJ, Chen CL, Tea, Obesity, and Diabetes, Molecular Nutrition & Food Research, 50 (2): 188–210, February 2006
Kim JA, Formoso G, Li Y, Potenza MA, Marasciulo FL, Montagnani M, Quon MJ., Epigallocatechin gallate, a green tea polyphenol, mediates NO-dependent vasodilation using signaling pathways in vascular endothelium requiring reactive oxygen species and Fyn, J Biol Chem. 2007 May 4;282(18):13736-45. Epub 2007 Mar 15.
Nagle DG, Ferreira D, Zhou YD. Epigallocatechin-3-gallate (EGCG): chemical and biomedical perspective. Phytochemistry 2006;67:1849–55.
Park JH, Jin JY, Baek WK, Park SH, Sung HY, Kim YK, et al. Ambivalent role of gallated catechins in glucose tolerance in humans: a novel insight into nonabsorbable gallated catechin-derived inhibitors of glucose absorption. J Phyisiol Pharmacol 2009;60:101–9.
Phung OJ, Baker WL, Matthews LJ, Lanosa M, Thorne A, Coleman CI. Effect of green tea catechins with or without caffeine on anthropometric measures: a systematic review and meta-analysis. Am J Clin Nutr 2010;91:73–81.
Paolini, M, Sapone, A, Valgimigli, L, “Avoidance of bioflavonoid supplements during pregnancy: a pathway to infant leukemia?”. Mutat Res 527 (1–2): 99–101. (Jun 2003)
Rains, TM, Agarwal S, Maki KC, “Antiobesity effects of green tea catechins; a mechanistic review” J or Nutr Biochem 22(2011):1-7
Weiss, DJ, Anderton CR, Determination of catechins in matcha green tea by micellar electrokinetic chromatography, Journal of Chromatography A, Vol 1011(1–2):173-180, September 2003
It has been a little over seven weeks since I started eating a low carb high healthy fat diet, so here’s an update on my progress.
In 7 weeks (1 March – 16 April), I’ve lost 7 lbs – which works out to a pound per week, which is quite a reasonable weight loss for someone who was not obese. Most of my weight loss was in the first few weeks, which according to Phinney and Volek (The Art and Science of Low Carbohydrate Living) is quite common for numerous reasons, not the least of which is that our bodies excrete sodium as our insulin levels fall and as a result we lose excess water.
But as mentioned in the previous article, a scale is not an effective measure of short-term changes as the average adult’s weight can fluctuate by as much as 4 1/2 pounds per day, due to water alone.
From 1 March – 16 April, I lost 3 inches off my waist. That is alot, but is it significant?
Since it is unknown how much of that decrease was due to water excretion and how much due to fat loss, the decrease in my waist circumference does not provide much information in the short-term.
BODY FAT PERCENT
Based on a Body Fat Analysis, my body fat percentage is down from 40.2% to 37.4% – a decrease of ~ 2.8% but as mentioned in the previous article, Body Fat Analyzers use electrical impedance to determine fat percentage, and this measurement is affected by a number of conditions, including environmental (room) temperature, a person’s hydration status, as well as emotional stress.
Since hydration status can fluctuate by ~4 pounds per day, a body fat analyzer is no more accurate a short-term measure than a standard bathroom scale.
As a result of the limitations of a scale, tape measure and body fat analyzer to capture short-term weight loss, I was left with two ways to assess my progress:
(1) people’s observations of me having lost “so much weight”
(2) how my clothes fit.
Over the last number of weeks, I have had quite a number of people remark about my ‘significant weight loss’, but given that I (seemingly) lost a nominal amount, this surprised me. Over the same period, I’ve been comfortably wearing clothes I could not even get into previously. Surprisingly, it was an inadvertent ‘before’ and ‘after’ photo that provided the most accurate measure of the effect low-carb eating has had on my body weight.
In filing a photo that was taken last week, I found another picture that was taken just before I started eating low carb – where I happened to be wearing the exact same outfit.
The difference was evident.
They say the “camera never lies“.
In retrospect, I would have deliberately taken ‘before’ pictures.
Prior to coming face-to-face with my own denial, I was wriggling into most clothes – particularly pants. I had set aside some clothes because I simply could not get into them. Wash day always raised the uncertainty as to whether I would be able to get my clean clothes on after they came out of the dryer.
Now there are no clothes that I own that I can’t wear. That does not mean they all look great (by no means!), but I can easily close buttons, zippers and actually sit in them! Some clothes that I fit ‘before’ are now beginning to feel loose.
OTHER MEASURES OF LOW CARB SUCCESS
Fasting Blood Glucose
Five weeks ago my monthly average fasting blood glucose was 8.8 mmol/L. Two weeks ago, it was ~8.6 mmol/L. Now it is 8.0 mmol/L. The last time I had it taken by the lab (a year and a half ago), it was 9.7 mmol/L!
I am aiming for a fasting blood glucose of 5.0 mmol/L by November of this year.
Post Prandial blood glucose (2 hours after a meal)
My blood sugar 2 hours after lunch has dropped from 7.4 mmol/L to 7.0 mmol/Land after dinner, it has dropped from 7.7 mmol/L to 7.3 mmol/L. This is well below the target of < 10.0 mmol/L for a Type 2 Diabetic.
I am aiming for a 2 hour post-prandial blood glucose of between 5.0 – 6.00 mmol/L by November of this year.
For those that have been following my journey over the last 7 weeks, you may recall that it was a ridiculously high blood pressure that was the impetus to change the way I ate.
I’ve gone from ~30% Stage 2 Hypertension, 50% Stage 1 hypertension 15% pre-hypertension and the rest a hypertensive emergency (yikes!) to 80-85% Stage 1 Hypertension and 15-20% pre-hypertension.
This last week (week 7) my blood pressure has been 100% Stage 1 Hypertension, which one would think at first glance was a “setback”, but I don’t view it that way. Firstly, blood pressure that fluctuates a lot is much harder on the heart than blood pressure that is stable.
Secondly, the last two weeks I have been supplementing sodium to eliminate the headaches I had been getting and the periodic arrhythmia (irregular heart beats) that I started to get.
Phinney and Volek (The Art and Science of Low Carbohydrate Living) explain that if one is eating less than 60 gms of carbs per day, that 2-3 grams of sodium should be added to the diet (provided the person is not taking any diuretics or other blood pressure medication). A half a teaspoon of table or sea salt provides 1000 mg or 1 gram of sodium.
Failing to supplement sodium in a low-carb diet can result in really bad headaches and if sodium remains low, potassium will also be excreted to keep a necessary sodium-potassium balance. The drop in potassium can result in irregular heart beat, a condition known as arrhythmia.
Currently, I seem to do best on 1 to 1 1/2 tsp of sea salt, which provides 2 – 2.5 grams sodium. Of course, once the weather starts getting warmer or my exercise starts becoming more strenuous, I will need to increase that.
The ‘side effect’ of keeping my sodium levels constant is that my blood pressure has stabilized – and this is a good thing. Now I can watch it fall over time, without the wild fluctuations I had been experiencing when I was eating a high carb diet.
OTHER MEASURES – FASTING INSULIN, AM-CORTISOL AND C-PEPTIDE
A year and a half ago, I asked my GP to assess my Fasting Insulin and Fasting Cortisol and he would not as he said he was unable to provide interpretive information. Instead, he referred me to an Endocrinologist.
The Endocrinologist assessed my Fasting Insulin (August 2015) and it was 49 pmol/L (20-180 pmol/L) – but she would not provide me with interpretative information, either. So I had this number, that meant nothing to me at the time.
I did some ‘digging’ in the literature and found a 2009 study from the European Journal of Endocrinology [European Journal of Endocrinology (2009) 161 223–230] which reported that Fasting Insulin was a strong and independent contributor to cardiovascular risk and atherosclerosis and that women with Fasting Insulin in the lower quartile (25 pmol/L) had significantly lower risk of systemic atherosclerosis, than those in the higher quartile (44 pmol/L). Now my Fasting Insulin result had some meaning – and it wasn’t good! My fasting insulin was above the higher quartile (49 pmol/L).
Mygoal is to lower my fasting insulin to at or below 25 pmol/L by November of this year- and the way to lower insulin is by (1) eating a low-carb diet and through(2) intermittent fasting which is what I have been doing.
Now I have even more motivation to stick with this long-term.
My journey is more about health and reduced cardiovascular risk than it is about looking good. Looking better is a great side benefit.
Elevated C-peptide (not the same as C-Reactive Protein) is reported to be associated with the higher level of heart disease, including myocardial infarction and coronary artery disease – even in those whose fasting glucose is not impaired (Diab Vasc Dis Res. 2015 May;12(3):199-207).
Since my C-Peptide was 569 pmol/L (325-1090 pmol/L) a year and a half ago, my goal is to bring that number much closer to the lower end of the range (~350 pmol/L). I will be researching in the literature to determine what factors affect C-Peptide the most.
Cortisol, the so-called “stress hormone” is highest between 6 and 8 AM and it gradually falls during the day, reaching its lowest point around noon. A year and a half ago, my AM Cortisol was 451 nmol/L (140-690 nmol/L) and since cortisol is the hormone that is responsible for mobilizing glucose as part of the “fright and flight response”, it may contribute to my fasting blood glucose being so high.
My goal will be to look into ways to lower my AM Cortisol levels through diet, exercise and stress management.
This is a “journey”; one which is as much about the process of getting to my destination as the destination itself.
It is about having a healthy relationship with food and about eating when I’m hungry; not because “it is time to eat”.
It is about the process of enabling insulin levels to fallsimply by delaying when I eat and what I eat.
It is about addressing my body’s inability to process carbohydrates – no differently than I would address an inability to tolerate lactose or inablity to tolerate gluten. Instead of lactose intolerance or Celiac disease, I have carbohydrate intolerance and as a Dietitian, the path forward is clear. I limit carbs to those contained in non-starchy vegetables, nuts and seeds and use healthy fats as my predominant fuel source. This allows my insulin levels to fall, lowering insulin resistance and enables me to access my own (abundant) fat stores for energy.
For the first time in years, I am sleeping well and the inflammation in my joints that plagued me for years, is largely gone. Just as a newly-diagnosed Celiac feels well for the first time once they eliminate gluten from their diet, so too do I feel so much better without eating carbs, as carbs.
Have questions about how I can help you?
Feel free to send me a note using the form on the “Contact Us” tab, above.
People who are eating differently in an effort to lose weight often hop on the scale daily to see how they’re doing. What they fail to consider is that an average adult’s body weight can fluctuate by as much as 4 1/2 pounds per day — solely as a result of changes in the amount of water they are retaining or excreting.
The Limitations of Using a Scale to Determine Fat Loss
An 80 kgperson has, on average 48 liters of water in their body. The problem with using body weight as an assessor of fat loss is that the human body does not precisely regulate body water content.
Above 49 liters of water, the kidneys of an 80 kg person will clear the excess water by causing the person to urinate more and below 47 liters of water, the 80 kg person will feel thirsty and increase their fluid intake. People’s “weight” is affected by this change in body water content of ~2 liters per day — which weighs approximately 2 kg or 4.4 pounds! Put another way, each day our “weight” can fluctuate by this amount solely due to the difference in retained or excreted water.
Since there is no way to measure this daily change in water weight in non-clinical settings, the standard scale is a very imprecise way to measure fat loss over the short-term.
Many people know that carrying excess weight around the middle increases one’s risk of cardiovascular disease, including heart attack so they measure their waist circumference frequently. Even if waist circumference is measured halfway between the lower rib and the top of the hip bone, with a fully relaxed abdomen, their are limitations to using this as a short term measure of weight loss.
The Limitations of Using a Tape Measure to Determine Fat Loss
Since the average person’s body weight fluctuates by as much as ~4 1/2 pounds per day due only to changes in body water, a tape measure fails to capture decreases in waist circumference stemming from the kidneys excreting water.
That said, waist circumference is helpful as a long-term indicator of weight loss, just not a short-term one.
Body Fat Percent
Some people have bathroom scales that have body fat analyzers built in and think that what it is measuring is the amount of fat they are carrying, however a number of factors can influence this reading.
The Limitations of Using a Body Fat Analyzer to Determine Fat Loss
Body Fat Analyzers use electrical impedance to determine fat percentage, and this measurement is affected by a number of conditions, including environmental (room) temperature, a person’s hydration status, as well as emotional stress. Since hydration status can fluctuate by ~4 pounds per day, a body fat analyzer is no more accurate as a short-term measure than a standard bathroom scale, without it.
HOW TO Assess short-term weight loss
How one’s own clothes fit and comparative ‘before’ and ‘after’ photos are a much better short-term assessor of fat loss than a scale, a tape measure and a body fat analyzer. Since body water fluctuates considerably on a low carb high fat diet due to changes in sodium levels, I recommend that people eating a low carb high fat diet weigh themselves once every two weeks on the same day of the week, at the same time of day and measure their waist circumference at the same time. If they have a scale that assesses body fat percent once every two weeks is sufficient for taking these measurements.
None of these will provide much information on actual fat loss over the short term…so why rely on them for that, but they will be helpful measurement over the longer term.
Sodium and Body Water Content
As mentioned in a previous article, by eating only when hungry and only until no longer hungry, insulinlevels have the opportunity to fall to baseline – something they do naturally after not eating for 12 hours.
On days where the time until eating is extended by a few hours (i.e. “intermittent fasting”), insulin levels stay low for an even longer period of time. In response, our kidneys excrete sodium in a process called naturesis.
Failing to supplement sodium while eating low-carb high fat can result in intense headaches – and if sodium remains low, potassium will also be excreted to keep the necessary sodium-potassium balance. This drop in potassium often results in irregular heart beats, known as arrhythmia.
Phinney and Volek (The Art and Science of Low Carbohydrate Living) recommend that if one is eating less than 60 gms of carbs per day, that 2-3 grams of sodium should be added to the diet (provided the person is not taking any diuretics or other blood pressure medication).
A half a teaspoon of table salt or sea salt provides 1000 mg or 1 gramof sodium.
Since hopping on the scale daily or even several times a week won’t provide any useful information, nor will measuring our waist circumference or using a body fat analyzer too often – why do it? Part of ‘getting healthy’ ought to include having a healthy body self image – something that won’t be nurtured by obsessing about such “numbers”.
Short-term measures of success
Short-term success is best measured visually – with comparative photos taken from the same distance away, from the same relative height and wearing the same clothing.
How one’s clothes are fitting is another way.
A person who is insulin resistant or Type 2 Diabetic should be seeing both their fasting blood glucose and post-prandial (2 hours after a meal) glucose levels gradually coming down. If they aren’t then they should schedule an appointment with their Dietitian to find out why that is.
Medium-term measures of success
Medium-term measures of success in eating low carb high fat can be measured both subjectively and objectively.Subjective measures include weighing oneself and taking one’s own waist circumference once every two weeks. Objective measures include having your Dietitian weigh you on a clinical scale, having her assess your waist circumference and body fat percentage using both a device that measures electrical impedance, as well as using good old-fashioned calipers, that measure subcutaneous (under the skin) fat, in 3 or four specific locations on the body.
A person with highblood pressure should be seeing both systolic (the first number) and diastolic (the second number) blood pressure coming down and Type 2 Diabetics or those with insulin resistance should be continuing to observe lower fasting blood glucose and post-prandial (2 hours after a meal) glucose levels.
Longer-term measures of success
After 6 or 8 months eating low carb high fat, both subjective and objective measures should be continuing to lower in a reasonably linear fashion. Of course there will be times where a ‘plateau’ is reached, but if that lasts more than two or three weeks, then its important to check in with your Dietitian to make sure the amount of carbs you think you are eating is what your Dietitian has been determined as being best for you.
A Type 2 Diabetic should be seeing both their fasting blood glucose and post-prandial (2 hours after a meal) glucose levels approaching more normal levels and both Type 2 Diabetics and those with insulin resistance (“pre-diabetes”) should have their HbA1C assessed at a lab every three months, as this provides insights into one’s 3-month average blood glucose level. Fasting blood glucose providesa ‘snap-shot’ of blood sugar in the morning after not eating, and should be done twice a year by a lab, especially if one is Diabetic. Comparing lab test results to previous lab test results is an objective indicator of the effect that eating low-carb high fat is having on specific markers and provides an opportunity to determine if the amount of carbs being eaten may still be too high.
The most accurate assessor is a 2 hour glucose tolerance test, however few doctors will requisition this after one is diagnosed as Type 2 Diabetic.
Finally, every year or so, it is helpful for those who have been diagnosed as Diabetic to have their fasting insulin, C-Protein and AM Cortisol levels assessed and compared to previous results. For these, your doctor may refer you to an Endocrinologist.
Remember, achieving health is a journey and takes time and like most journeys, it is best not done alone.
Have questions about how I can help or about the services I provide?
Please send me a note using the form on the “Contact Us” tab, above.
Prior to the domestication of animals and the development of agriculture, the human diet centered around the ‘hunt’. They ate when they caught something, and didn’t eat until again until they either caught something else, or were successful in finding edible vegetation, berries or nuts. “Feasting” and “fasting” were normal events in the rhythm of life, and our bodies were designed to function using our fat stores for energy, as evidenced by our continued existence.
From hunter-gatherers to farmers
After the Ice Age, those that survived were left with an increasingly unpredictable climate, decreases in big-game species that were hunters’ first-choice prey, and increasing human population in the available habitats for hunting and gathering. To decrease the risk of unpredictable variation in food supply, people broadened their diets to second- and third-choice foods, which included more small game, plusplant foodswhich required much preparation, such as grinding, leaching and soaking. As I will demonstrate below, these plant foods, including grains were very different in carbohydrate and protein composition than they are today.
The domestication of animals and plant cultivation of ~ 13,000 years ago, forms a significant turning point in the human diet.
Humans began to transport some wild plants, including grains from their natural habitat to more productive selected habitats, and so began intentional cultivation, or farming. With the development of agriculture and the domestication of animals – the plants and animals themselves began to change.
This is important.
The fruit of today bear little resemblance to their ancient predecessors. The grains of today don’t either. For example, wild wheat and wild barley bear their seeds on top of a stalk, and sheds its seed spontaneously – enabling it to germinate where it falls.
Once people began bringing some wild wheatorbarley seeds back with them in order to intentionally plant them, some seeds would accidentally spill along the way, germinating in new places. Over time, some seed would cross-pollinate with wild grain, while others would undergo spontaneous mutations, leading to wheat and barley varieties with non-self-shattering heads. Eventually, these non-shattering grains were selected for by humans for cultivating, leading to a very different type of grain than the wild species – and one with very different nutritional content than their wild predecessors.
Similarly, domesticated animals were selected based on traits that were considered desirable to people – chickens were selected to be larger, wild cattle to be smaller, and sheep to lose their bristly outer hairs and not to shed their soft inner wool. Eventually, the land where hunter-gatherers lived was overrun and replaced by people who had become agricultural – and who were ever-expanding the amount of land they required for raising animals, as well as for growing crops.
At Tell Abu Hureyra, in the Euphrates valley of modern Syria are the remains of a civilization that lived between 13,000 and 9,000 years ago, spanning the Epipaleolithic and Neolithic periods. This site is significant because the inhabitants of Abu Hureyra started out as hunter-gatherers, but gradually moved to agriculture, making them the earliest known farmers in the world. Meals consisting of the meat of gazelle, wild goat and game birds were supplemented with wild-growing Einkorn wheat-porridge, as well as berries, nuts or fruit, if in season. Tools such as sickles and mortars for harvesting and grinding grain, as well as pits for storing it have been found at Tell Abu Hureya and remains of harvested Einkorn wheat (which was ground by hand and eaten as porridge) have been found at Tell Aswad, Jericho, Nahal Hemar, Navali Cori and other archeological sites.
The diet of man forever changed at that point.
As previously mentioned, plants underwent change as a result of both natural cross-pollination as both underwent change as a result of intentional manipulation by man. This occurred everywhere that man settled – from the lush valleys of the Middle East*, to Africa and Asia.
[*yes, the Fertile Crescent of the Middle East was lush and green, then.]
The grain we know today as “wheat” and “rice” is nothing like their wild ancient predecessors. Likewise with fruit. The fruit of today has been bred to be sweet – not so with the wild cultivar. A brief history of wheat will help illustrate this type of change.
Evolution of Wheat – but one example
The first wild grass that was cultivated was Einkorn wheat. As cultivation techniques improved, Einkorn eventually became an essential component of the diet – reducing the need for hunting and gathering. Einkorn wheat contained only 14 chromosomes.
Shortly after the cultivation of the first Einkorn, the Emmer variety of wheat (Triticum turgidum) appeared in the Middle East; a natural offspring of Einkorn and an unrelated wild grass, called ‘goatgrass’ (Aegilops speltoids.
Emmer wheat is what is referred to in the Hebrew Bible (Exodus 9, Exodus 32, Isaiah 28, Isaiah 25) as Kes-emmet (כֻּסֶּמֶת) and both Eikorn wheat (חִטָּה) and “Emmet” (ֻּסֶּמֶת), translated in English as ‘spelt’, are referred to together as distinct species (e.g. Exodus 9:32). It was the ancient Egyptians that are credited with the addition of wild strains of yeast in order to make bread rise – which gives an added dimension to the story of Passover, where the Jews left slavery in Egypt in “great haste”, “not having time to let their bread rise”.
Since plants do not combine genes but add (or sum) them which provides evidence of what cross-bred with what. Goatgrass added its genetic code to that of Einkorn , so Emmer wheat had 28 chromosomes.
Emmer wheat then naturally cross-bred with another wild grass called Triticum taushii, giving rise to the original cultivar of Triticum aestivum, the predecessor of modern wheat, which has 42 chromosomes. This was a higher yielding wheat variety which had many desirable baking properties that Eikorn and Emmer lacked. This new strain remained largely unchanged until the mid-eighteenth century when Carolus Linneaus, who invented the Linnean system of categorizing species, counted only 5 species.
Today, Eikorn, Emmer and the original cultivated strains of Triticum aestivum have been replaced by almost25,000 strains of modern human-bred wheat strains that are hundreds, if not thousands of genes apart from the original Eikorn and Emmer wheat species.
Our food is not the food of our ancestors.
Modern Triticum aestivum is on average 70% carbohydrate by weight and only 10% protein. Emmer wheat, on the other hand was 57% carbohydrate and 28% protein – and was suitable to supplement the protein of a meal.
Paleo Diet compared with the Low Carb High Healthy Fat diet
The premise of Paleo eating to eat like our Paleolithic ancestors did is understandable, however the foods that exist now are nothing like the foods our ancient ancestors ate.Fruit, for example is considered “paleo” -but the carb content of paleo fruit was substantially less than that of today.
In a low carb high healthy fat way of eating, carbs are not avoided. It is the foods that are high in carbs that are easily broken down to glucose and have little nutrient-density that are limited.
[It is hard to justify eating grain products made from varieties of wheat that were bred for no other reason than they could be grown in nutrient- poor soils in novel parts of the world.]
No justification is needed to eat carbs that come as part of fibre- and nutrient-rich non-starchy vegetables and to eat carbs found in nuts that are a good source of protein and monounsaturated fat.
A diet where 45 – 65% of calories are as carbohydrate is has us eating “carbs for carb’s sake”, but a low carb high healthy fat diet should not be about “fat for fat’s sake”.
Some people think they should eat large amounts of saturated fat “just because they can”, and I suppose that’s true. One can certainly eat a pound of bacon, but when compared with a fat marbled grain-fed steak or a Brome Lake- or wild duck, one is more nutrient-dense than the other. The yolks of free-range egg comes as part of a nutrient-dense package, which includes good quality protein, as well as other nutrients. A pound of bacon, does not. That doesn’t mean that eating bacon is “bad”, but in comparison to grilled salmon with a large serving of non-starchy vegetables bathed in cold-pressed olive- or avocado oil, it doesn’t quite measure up. It is not just about not being hungry, but about being healthy.
A Low-Carb-High-Healthy-Fat Diet is about “nutrient density” – not just “fat density”.
In a Low-Carb-High-Healthy-Fat Diet, carbs are not “bad” and fat is not “good”.
Carbs and fat that come in nutrient-dense food and in particular ratios are what we are striving for.
As well, protein quantity is based on physiological need and not unlimited (as excess in a low carb diet will be converted and stored as fat). The source of that protein ought to be considered, as well. For example, it is well documented that fatty fish such as salmon, mackerel and tuna are high in omega-3 fatty acids and are good for our brains and our hearts so for those that enjoy fish, eating it often is ideal.
The good thing about the Low-Carb-High-Healthy-Fat Diet is that it can be adapted to culture- or religious restrictions. Don’t eat pork? No problem. Don’t eat beef? Not an issue. Take fast days? That is easily worked-in.
Want to know more?
Feel free to send me a note using the form on the “Contact Us” tab, above. Remember, Nutrition is BetterByDesign.
To your health!
Binford LF. New Perspectives in Archaeology, 1968; 313–341
David, W. Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health Rodale Books, 2011; 15-32
Diamond J. Evolution, Consequences and Future of Plant and Animal Domestication. Nature, 2002; 418:700-7
Flannery KV. The Domestication of Plants and Animals, 1969;73–100
Hillman GC, Davies, MS. Measured Domestication Rates in Wild Wheats and Barley under Primitive Cultivation, and their Archaeological Implications. J. World Prehistory; 1990; 4:157–222
Raeker RO, Gaines CS, Finney PL, Donelson T. Granule size distribution and chemical composition of starches from 12 soft wheat cultivars. Cereal Chem 1998;75(5):721-8
Shewry PR. Wheat. J Exp Botany 2009;60(6):1537-53
Stiner MC, Munro ND, Surovell TA. The Tortoise and the Hare: small-game use, the broad-spectrum revolution, and Paleolithic demography. Curr. Anthropol. 41, 39–73 (2000).
Zohary D, Hopf M. Domestication of Plants in the Old World 3rd edn (Oxford Univ. Press, Oxford, 2000).
Two years ago, the paradigm from which I’ve understood nutrition shifted dramatically. That was when a friend, a retired physician, asked my professional opinion on the approach that Dr. Jason Fung was expressing in his blog, Intensive Dietary Management. I began to read it from the beginning and after almost 3 weeks of reading, I concluded that the physiology was what we learned in our undergraduate degrees – and promptly set aside when we specialized in our respective professions. As healthcare professionals, we talk about “evidenced based decisions” and at that point, I had to decide whether the evidence was sufficiently strong to change the way I thought and practiced. This was this Dietitian’s dichotomy.
Fast forward 2 years, and the learning-curve continues as I read through further studies and watch conference talks from some of the leading researchers and practitioners in the low carb high fat world.
Five weeks ago, I started practicing what I preached, and began eating what I call a “low carb high healthy fat” diet, myself.
So how’s that been going?
Well, I am definitely out of denial. I am overweight, insulin resistant, my LDL was too high and so was my blood pressure – and no matter how I looked at it last week, I had 30 more pounds to lose.
But here it is a week later, and I still have 30 pounds to lose. Am I discouraged or concerned? No. Here’s why;
Weight and Waist Circumference
I had to ask myself – or shall I say, ‘re-ask’ myself how do I measure success? If it is by the scale or a tape measure alone, then clearly I am ‘failing’. But am I?
My fat percentage is down from 40.2% to 39.8% – which means, despite NO CHANGE in my weight or my waist circumference, I’velost body fat.
How was that accomplished if I didn’t lose weight or “inches“?
This past week, I’ve been maintaining a higher level of ketones then I did last week, so my body has been breaking down triglycerides (fat!) in my liver and fat cells, to make ketones for my brain and to synthesize glucose for my blood.
Electrolytes and Water Balance
Something that has been slow for me to grasp hold of, is the need to addsalt to my food. I have been used to eating fresh foods with no added salt and preparing foods with the minimum of salt, but with insulin levels falling, so does the kidney’s retention of sodium.
By eating only when hungry and only until no longer hungry, my insulin levels have the opportunity to fall to baseline – something they do naturally after not eating for 12 hours. On days where I extend the time until I eat by a few hours (i.e. “intermittent fasting”), my insulin levels stay low for an even longer period of time. In response, my kidneys excrete sodium, in a process called naturesis.
The one thing that has to be monitored closely – even for people like myself who are not on any kind of medication for Diabetes or high blood pressure, is that my sodium levels don’t fall too low, as well as potassium, calcium and magnesium. Sodium and potassium and calcium and magnesium are used in pairs in a number of systems in the body and I’ve learned quickly how important these are. All the more important for anyone taking medication to lower blood sugar or blood pressure! After having one or two excruciating headaches from letting my sodium fall too low, I learned quickly that if I feels certain symptoms, I need to take some salt. As well, I’ve learned that people that let their potassium get to low sometimes experience heart palpitations – not a pleasant feeling. I already was supplementing Calcium and Magnesium (along with Vitamin D) prior to adopting a low carb high fat diet, but how to get adequate sodium and potassium?
It’s fairly difficult to meet the potassium Dietary Reference Intake on a regular diet, but even with a very high non-starchy vegetable intake, it is still hard. Many of the good sources of potassium, such as potato and yams are not part of the low carb high fat diet. I do eat a lot of mushrooms (high in potassium) but am severely allergic to avocado, one of the best sources, so I make what I call “keto-water”. Keto-water is club soda (I make mine at home with my Sodastream!) to which 1/8 tsp of half-sodium / half potassium salt has been added. I put a tiny twist of lime or lemon to round out the taste and also to add a source of Vitamin C to my diet and voila, “keto-water“!
Provided I drink two liters of “keto-water” per day, I feel great!
No doubt, drinking keto-water has resulted in my body retaining more water, along with the sodium (which is what it is supposed to do!) which would account for my loss of fat, with no change in my weight or waist circumference.
MY BLOOD SUGAR
Here is a snapshot of what has occurred with my blood glucose over the last 5 weeks.
My fasting blood glucose started off averaging 8.6and then went up, as I began to mobilize fat reserves to supply my blood glucose. Now, my average fasting blood glucose is 7.4 – with dips as low as 6.2 (this morning!) and higher levels in the low 8’s.
My postprandial (2 hours after a meal) blood glucose is great after lunch, a bit higher later in the day (I’m guessing due to the circadian rhythms of cortisol) but then drops nicely before bed. Keep in mind, these results have been realized in only 5 weeks of eating a low carb high healthy fat diet!
Now this is a beautiful thing! For those that have been following this journey over the last 5 weeks, you may recall that it was a crazy-high blood pressure that was my impetus to change the way I ate.
The first week my blood pressure was divided up between
50% Stage 1 hypertension
~30% Sage 2 Hypertension
1 hypertensive emergency (not good!)
The second week my blood pressure dropped to;
>80% Stage 1 Hypertension
This can largely be explained by naturesis (kidneys getting rid of the excess salt through the urine) in response to the insulin drop.
The third week my blood pressure was;
~85% Stage 1 Hypertension
Yes, it was a tiny bit higher, but very stable, with my diastolic pressure (the second number in blood pressure) hitting normal levels several times.
The 4th week my blood pressure was;
~81% Stage 1 Hypertension
It has been pretty steady the last 2-3 weeks but certainly down from what it was.
Week Five – this week
Look at this!
From 3 weeks in a row stalled at ~80% Stage 1 Hypertension and ~20% pre-hypertension, it is almost 60% / 40% now…and that is WITH taking sodium and potassium “keto-water”!
This is how I measure success.
Success is about achieving goals and my goals have been about lowering my insulin resistance and blood pressure and losing weight and inches in the process. Success is attained when you measure the appropriate outcomes.
Wonder how I might be able to help you accomplish your goals?
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Today it’s 4 weeks since I began “practicing what I preach” when it comes to a low carb high healthy fat diet and to be frank, the results have astounded me. Over the last two years, I’ve been reading through the literature on this topic and while I knew that eating this way could produce significant results – I had no idea that it would be possible to see blood sugar and blood pressure come down this much in this short a time, especially given how well, and much I eat. Then there is the weight and inches lost. This is a summary of my progress to date.
Out of Denial
Part of this ‘journey’ of getting healthy myself, has been to come out of denial.
When we ‘deny’ something, we say it is untrue – but it was not as though I was deliberately deceiving myself or anyone else about my health, I was simply omitting to find out the magnitude of reality.
In psychological terms, I was in denial.
Out of Diabetes Denial
In the first entry in this journal, I mentioned how I didn’t know how high my blood sugar was because I hadn’t measured it in ages. I hadn’t had my HbA1C measured in a year and a half. I didn’t want to know how bad it was. Despite being a Dietitian with a post graduate degree in Human Nutrition, I didn’t want to know how unhealthy I was.
Now, I have a date that I’m going to have my labs run, and that’s at the beginning of June 2017.
Because it will be 3 months since I began this journey and I want to know what my labs show as it takes that long for HbA1C to reflect the dietary change. It takes 3 months for the red blood cells in our bodies to turn over and HbA1C measures the amount of glucose bound to hemoglobin (glycated hemoglobin). Having my HbA1C measured in 3 months will show my average plasma glucose level since I started eating a low carb, high healthy fat diet.
Using good scientific methodology, I should have measured my fasting blood glucose and HbA1C at baseline – before I started to change what I am doing and then measure them again in 3 months. That way, I could calculate the magnitude of change.
There’s one small problem.
I have a long-standing physician who is my age and who would have without question, sent me home with prescription for a oral diabetes medicine – likely metformin once the results came in. I know that my blood sugar has been ~12 mmol/L because that’s what it would be this past month when I would eat more ~ 50 gm of carbs. Before I started this journey, I was eating significantly more carbs than that.
Furthermore, the previous three years, my fasting blood glucose was 7.9 mmol/L (Feb 2013), 9.1 mmol/L (Sept 2014) and 9.7 (Aug 2015). Extrapolating that data to the present date brings it pretty close to 12 mmol/L.
Note: I am not advocating for anyone not to take oral diabetes medication, if prescribed it. It was my choice, as an allied healthcare professional to take an alternate route before being prescribed medication.
out of Hypertension Denial
Without question, prior to a month ago, I would have been diagnosed with hypertension (high blood pressure) as the first week of this journey, my blood pressure was 1/3 of the time in Stage 2 Hypertension with one hypertensive emergency(i.e. higher than Stage 3 hypertension) and 50% of the time I was in Stage 1 hypertension, with the remaining ~ 15% in pre-hypertension.
The last time my GP measured my blood pressure was a year and a half ago (Aug 2015), I was straddling Stage 1 and Stage 2 hypertension.
It’s not rocket-science to figure out that had I gone to my doctor following my hypertensive emergency, I would have come home with a prescription for hydrochlorothiazide, a diuretic-based blood pressure medication.
Note: I’m not advocating for anyone to avoid taking anti-hypertensive medication, if prescribed it. As a healthcare professional, I chose a different route before being prescribed medication.
Instead, that ridiculously high blood pressure was the impetus for me to change. That day, I became my ‘first client’. That day, I began practicing what I preach. I began eating low carb, high healthy fat, myself.
out of Dyslipemia (Cholesterol) Denial
I have no idea what my lipids were when I started changing how I eat, but I know what they were for the last 3 consecutive years. My LDL cholesterol (so-called “bad cholesterol”) was hovering around 3.00 mmol/L, with the normal range for low risk individuals being 1.50-3.39 mmol/L. However due to having Diabetes as well as a family history of high cholesterol, I am high risk and my LDL levels need to be ≤ 2.00 mmol/L.
My HDL cholesterol (so-called “good cholesterol”) was high; ranging between 1.76 mmol/L three years ago, to 1.91 mmol/L two years ago, to 2.25 mmol/L – significantly above the 1.10 mmol/L cutoff, however my GP did not consider that protective. As he told me, he only looks at LDL as the determination for putting someone on lipid lowering medication (statins). Assuming my HDL continued to be around the 2.00 mmol/L mark, more than likely had I had lab tests done now, I would have come home from his office with atorvastatin (brand name: Lipitor) or one of the other statin medication – just as he told me he would do a year and a half ago.
Note: Again, I am not advocating for anyone to not take medication prescribed it. I decided to change my lifestyle prior to being prescribed medication for dyslipidemia.
Instead, of getting my baseline labs measured and coming home with a prescription for Metformin, Lipitor and hydrochloridethiazide, I decided instead to follow a low carb high healthy fat diet and get my labs taken in 3 months.
out of obesity and overweight Denial
I knew how much I weighed a month ago, but it had been a year and a half – since August 2015 since I calculated my BMI – and more significantly, since I measured my waist circumference. Today, after a month of significant diet changes, I came out of denial with respect to my weight, and calculate my “numbers” – just as I do for my clients. After all, I am now my ‘first client’.
It turns out, I am overweightnow – which means I was just in the obesecategory at a BMI of 30.5 (obese is a BMI > 30) when I began this journey.
No matter how I calculate it, I still need to lose another 30 pounds.
By the Scale
Based on the scale, I need to lose 29 pounds for my BMI to be < 25. That is to even reach the high end of the “normal weight” category. To put myself in the mid-range of the normal weight category, I should really lose another 35 pounds.
By Fat Percentage
Based on my fat percentage, I need to lose 17% of my body weight (29. 1/2 pounds) to be at a healthy 23% (non-athlete, female). That’s 29 1/2 pounds.
By Waist to Height Ratio
For my waist circumference (in inches) to be half my height (in inches), I need to lose 30 pounds.
How do I know?
Because all these years, I kept my leather pant belt from when I was that size and I know how much I weighed, then.
MY RESULTS – ONE MONTH UPDATE
So how am I doing after one month eating low carb high healthy fat?
It is now the end of the 4th week and I have lost 6 pounds all together.
That’s right, I didn’t lose a thing this week. Am I upset? Not at all, because I lost another inch and a half off my waist.
my Waist Circumference
In the first two weeks, I lost an inch off my waist, the third week, another 1/2 inch came off and today I measured my waist again – without sucking in my belly (what would that prove?!) and it is down another inch and a half.
In total, in one month, I lost 3 inches off my waist.
Based on my Waist to Height Ratio (WHTR), I still have another 6.5 inches to lose off my waist – which would have seemed so discouraging a few weeks ago, except that these 3 inches came off effortlessly, with me following the Meal Plan that I designed for myself.
It's great having the skills to take my health into my own hands, knowing I am getting all the micronutrients that I need - but for those that need help getting started, there are Dietitians such as myself who can help!
During the entire 4 weeks I was never hungry because if I was, I could eat!
On top of that, I knew that I was meeting my daily requirement for protein and all micro-nutrients (including Calcium, Magnesium, Potassium, Vitamin K, Vitamin A, Vitamin C and Vitamin E).
Yes, my fat intake is high, but 80% of the fat I choose to eat is from monounsaturated fats* (such as olive oil and avocado oil) and omega-3 fats from fatty fish (such as salmon, mackerel) and other fish (such as cod). It is much higher than the recommended amount, but I could see no reason why eating this way posed any adverse health risk to me.
* Based on the literature, there is nothing inherently "bad" about eating saturated fat. Our bodies actually make it in the form of palmitic acid. I eat whole eggs (with the yolk!), full fat cheese and put cream and/or low lactose milk in my coffee but when it comes to my main sources of fat, I look to cold pressed olive oil which is 65-80% monounsaturated (oleic), 7-16% saturates (palmitic) or cold pressed avocado oil which are 76% monounsaturated (oleic and palmitoleic acids), 12% polyunsaturates (linoleic and linolenic acids) and 12% saturates (palmitic and stearic acids), as well as fat from nuts (almonds, pine nuts, macadamia nuts) and seeds (pumpkin, mostly).
The only thing that is “low” is carbs, but since I am meeting all of my daily micro-nutrient and protein requirements, I can see no physiological purpose for having more carbs.
my Fat percentage
I’ve gone from ~ 41.5 % body fat to 40 % body fat in a month. Okay, I’ve a long way to go, but I am doing what I need to do, the results will come.
My Blood Sugar
I should mention that to track my blood glucose accurately, I am using two glucometers; (1) one that is a year old made by GE and using it with brand new blood glucose test strips and (2) a brand new glucometer, made by Abbott which also takes Ketone Strips, so I can track my ketone levels.
I am purposely keeping my ketones low at this point, as I want to make sure I feel well eating this way first, and that the "numbers" (weight, waist circumference,fat%, blood glucose and blood pressure) decrease slowly and steadily.
As long as I kept my net carbs (carbohydrate minus fiber) at ~35 gm of carbs per day, I did very well, but above that my body could not handle the sugar load. Without a doubt, I was very insulin resistant –which is no surprise, considering I was diagnosed with Diabetes ~ 10 years ago.
This past week, I tracked my carbs carefully (easy to do and requiring no apps) and kept them at or below35 gm per day and my blood glucose continued to decrease this past week, in a linear fashion at all times of the day .
My body is doing exactly what it was designed to do; happily breaking down the fatI have stored up over the years and converting it into glucose for my blood.
This was my blood sugar last night, 2 hours after supper.
I haven’t seen post-prandial blood glucose levels like this since I’ve been Diabetic, which is 10 years!
This was supper;
As you can see, I am hardly starving!
I used to love fruit on my salad, but have found that snap peas cut up have just the right amount of sweetness, lots of fiber and a whole lot less carbs!
I should mention that to track my blood pressure accurately, I purchased a brand new, top-of-the-line sphygmomanometerwhich measures my blood pressure automatically 3 times, one minute apart and takes the average.
The first week my blood pressure was divided up between
50% Stage 1 hypertension
~30% Sage 2 Hypertension
1 hypertensive emergency (not good!)
The second week my blood pressure dropped to;
>80% Stage 1 Hypertension
This can largely be explained by naturesis (kidneys getting rid of the excess salt through the urine) in response to the insulin drop.
The third week my blood pressure was;
~85% Stage 1 Hypertension
Yes, it was a tiny bit higher, but very stable, with my diastolic pressure (the second number in blood pressure) hitting normal levels several times.
This week my blood pressure was;
~81% Stage 1 Hypertension
Its getting progressively lower each week.
The last few nights, I saw “normal” blood pressure readings;
No, my blood pressure readings are not (yet) always normal, it has only been FOUR WEEKS! On average, my blood pressure has come down 1 mmHg / day for 4 weeks in a row.
Data is data and while not scientifically ‘objective’ data and with a sample set of only 1, the “numbers” are convincing.
I feel well, I am eating better than I have in years. My sleep has improved significantly (except on the nights I have to get up to “pee” because my weight is dropping). My clothes fit looser and when I look in the mirror, the face that looks back is more familiar. An added benefit is that my fingers, which have been stiff for years, are much less so.
I can’t think of any drawback to eating this way, except for the space required to have lots and lots of fresh vegetables in the house and that I am going through them at an alarming rate! Thankfully, I have an extra fridge in the garage, so I don’t need to shop more than once a week.
Even food cost, which was a bit of a shock the first week (as I had to purchase ingredients I didn’t use before, and certainly not in that quantity) has leveled off. I spend a lot less money on milk and large amounts of cheese and a lot more on the best quality olive oil and avocado oil. Protein quantities are about the same as before, except there is more animal protein now, as I used to be mostly vegetarian. Protein sources are mainly fresh fish, chicken, and marinated flank steak. None of these are high in saturated fat, so even those of my peers that might worry about people who may be physiologically sensitive to higher saturated fat levels would not be concerned about the way I am eating. Yes, I am eating “high fat” but 80% of it is what even the most conservative health care practitioner would admit are “healthy” fats. Studies seem to show that even those who eat a much higher saturated fat diet, suffer no adverse health issues. At the end of the day, I am meeting all my dietary needs and the only thing that is missing is the “carbs”. So?
Unless someone can present me with a compelling reason why I need those carbs, I will keep eating the way I am eating and teaching others who wish to do so, the same.
To our health!
In an upcoming Journal entry, I will write about some of the other changes I’ve been making, including getting a bit of exercise, making sure I have enough sleep, taking care of my oral hygiene (and its role in heart disease), staying adequately hydrated and reducing stress.
This weekend has been a challenging one, as I received two pieces of news. The first was of one client’s incredible success following the low carb high healthy fat dietand the shocked reaction of his doctor, and the other was of the death of a friend who had Diabetes, high blood pressure and high cholesterol. In this blog, I will share how these two events embody the two options each of us have; (1) living a healthy life to the fullest or (2) living with diet-related disease and dying prematurely of ‘natural causes’.
“JP” – a Picture of Success
Last fall, I had a reasonably fit 35-year-old client contact me wanting to lose 15 pounds. He went to the gym twice a week for an hour, and ran 10 km per week, but had put on some pounds and wanted to lose them.
As I always do, I asked for a copy of recent blood test, assessing his fasting blood glucose, HbA1C (3 month average of blood glucose), cholesterol (lipid panel) and requesting his doctor-assessed blood pressure. (Sometimes people insist that I counsel them without seeing blood work, but I explain that they ran out of crystal balls when I was graduating, so I have no choice but to get labs.) I gave my new client a Lab Test Request form to bring his doctor. The GP scoffed at the Lab Test Request Form asking him to requisition a lipid panel for a young, fit 35 year old whose parents are both living. That changed when the tests came back, and this man’s triglyceride level was higher than I had ever seen anyone’s, ever. His non-HDL cholesterol was very high and his HDL was very low. LDL wasn’t even available because his triglycerides levels were through the roof. His ferritin was astronomically high – not a sign of excess iron, but likely inflammation.
His doctor called him into the office immediately and wanted to put him on statinmedication right away and referred him to the Lipid Clinic at a major local hospital.
My client told his doctor he wanted to wait 3 months and first follow my dietary recommendations and see what would happen to his lipids, and was advised against it by his doctor. My client was insistent, so the doctor told him that his recommendations were for him to eat “decrease saturated fat and carbohydrates, increase fruit and vegetables, increase insoluble fiber and fish, make his plate 1/2 vegetables, 1/4 protein, 1/4 starch“.
After seeing me, he agreed to limit fruit to max 1 / day, preferably a few berries on top of 2 or 3 huge salads with plenty of good quality olive oil and to have most of his carbs as vegetables. He learned that “not all vegetables are created equal” and I taught him to differentiate between those he could eat as much as he wanted at each meal and those he should limit or avoid. We talked about milk consumption, and the health benefits of eating plenty of fatty fish, such as salmon, mackerel and fresh sardine. And we talked about carbs. We talked a lot about carbs. Carbs in fruit, carbs in milk, carbs in bread, pasta and rice, and carbs in vegetables.
I designed an Individual Meal Plan for him, making sure he obtained sufficient macronutrients (protein, fat and carbs) as well as micronutrients (especially potassium, magnesium, sodium, vitamin C and calcium, vitamin D and vitamin K) – and factoring in his desired weight loss. I explained that if he followed his Meal Plan, it is perfectly reasonable for his triglyceride levels to be <2.00 mmol/L in 2 more months.
Three weeks later, his doctor ran his labs again. His triglyceride level was almost a third what it was! His non-HDL was down substantially and his HDL was rising nicely. When he was seen at the Lipid Clinic, they were willing to give him 2 more months to get his lipids in the normal range before starting him on medication.
Friday, he wrote me telling me that his triglycerides we down well below 2.00 mmol/L and added;
“this amazed the doctor!”
My client left his doctor’s office without a medication prescription and with only the recommendation to keep eating the way I taught him. My client added that he was already within 2 – 3kg of his goal weight.
It’s not magic.
The doctor should not have been amazed that diet alone can be this effective – even for someone for whom high cholesterol has a genetic component. The literature documents the role of a low carb high fat diet.
But it is easier to write a prescription than educate a patient.
My High School Friend – preventable premature death
Last night I learned that my friend since high school, died from natural causes. She had Type 2 Diabetes, high blood pressure and high cholesterol. She and I were the same age.
Three years ago, when my friend was first diagnosed as having Diabetes, she asked my opinion about having received Diabetes counselling in her province to eat 45 gm of carbohydrates at each meal and at least 15 gm of carbohydrates at each of 3 snacks – that’s 180 gm of carbohydrates per day. A mutual friend of ours from the same province, who had also been recently diagnosed with Diabetes confirmed that she too was advised to eat 45 gm of carbohydrates at each meal and at least 15 gm of carbohydrates at snacks. At that time, I had explained to my friend what I had been learning about the role of excess carbs in Diabetes, hypertension (high blood pressure) and high cholesterol. While I provide distance consultationsin my practice (using a combination of phone, email and fax), as Dietitians we are advised specifically not to provide dietary counselling to family members or friends. With my ability to help directly being very limited, I recommended that she find a Dietitian near her who could teach her about managing this triad (called “metabolic syndrome“) using a low carb high fat diet. She followedthestandard dietary recommendations to the letter and took her multiple medications as prescribed. Her blood sugar levels came down using medication (but that was effectively treating the symptom of high blood sugar, not the cause which is the underlying insulin resistance). Her blood pressure kept going higher and higherdespite medication, so more medication was added. She then developed highcholesterol.
Today, my friend is dead, in what could have been an entirely preventable, premature death.
So I am left asking myself ‘could following the standard recommendations of eating 180 gm of carbohydrate per day with Type 2 Diabetes, high blood pressure and high cholesterol — without treating the underlying cause (insulin resistance) have contributed to her death’?
The literature is certainly full of studies documenting the beneficial effects of a low carb high fat diet on metabolic syndrome– but she was never given that as an option. She was prescribed medication for lowering blood sugar and blood pressure, but nothing was done to lower her insulin resistance.
A lifetime of work by the late Dr. Joseph Kraft with almost 300,000 people documents that it is theinsulin resistance that underlies cardiovascular disease – not the high blood sugar. Furthermore, 65-75% of people with normal blood sugar levels still have insulin resistance – andthe same elevated risk of having a heart attack.
We keep treating the symptoms and people keep dying anyways – and those without any symptoms are walking around with elevated risk of dying from cardiovascular disease, and don’t even know it.
We are told;
“Diabetes is a chronic, progressive disease”
which means that once diagnosed with Diabetes, you’ll have it forever – and that eventually it will get worse, requiring medication, then more medication and finally insulin.
When people have bariatric surgery (“stomach stapling”), their blood sugars come back to normal within weeks and at the end of a year, they no longer have any of the clinical symptoms of Diabetes. Their fasting blood glucose levels are normal and their HbA1C levels are normal. They are essentially as if they don’t have Diabetes. Their Diabetes is in remission.
So is Diabetes REALLY a “chronic, progressive disease”? No, it can be stopped.
If the reason people became Diabetic was because of how they were eating, why is it SO hard to grasp the concept that they could get well, but changing how they are eating?
At the end of the day, we have a choice.
We can do as my client above did and put everything we have into changing how we eat based on good, sound scientific studies and with medical supervision, or we can keep doing what we’ve been doing, expecting different results.
I made my choice a month ago tomorrow, and will write an update in the blog titled “A Dietitian’s Journey” tomorrow, for week four (see Food for Thought tab, above). Here’s a teaser; two days ago my blood sugar levels were several times at normal levels – and were overall much lower than a month ago. Last night (twice) and once this morning, my blood pressure was in the normal range. One month!
I ask myself, what will my labs look like in 3 months or 6 months of addressing the underlying insulin resistance (instead of the symptom of high blood sugar?) What will be life be like, when I have normal blood sugar levels and normal blood pressure and normal cholesterol levels?
A low carb high healthy fat diet is a way of eating that maximizes the body’s natural ability to access one’s own fat-stores for energy. Fat takes the place of glucose as the preferred source of bodily energy, so most of the body’s energy needs comes from a wide variety of healthy fats. A low carb high healthy fatdietminimizes carbohydrate-based foods, has a moderate amount of protein and has high amounts of healthy fats.
We use the dietary fat that we eat and our own stored fat for energy, and by keeping carb intake low, insulin levels are allowed to fall, which in time makes our cells more sensitive to it. As insulin levels fall, so does hunger – so we eat meals when hungry, until we are no longer hungry – but are no longer hungry every few hours.
The low carb high healthy fat diet
These are the categories and types of food that are available to enjoy on a low carb high healthy fat diet;
The exact ratio of macronutrients in your diet (i.e. grams of carbs, grams of fat, grams of protein) will differ depending on your age, gender, activity level, current body composition as well as any health conditions or medication you may be taking. That’s where I come in. I’ll design an Individual Meal Plan just for you and will determine how much protein you need, how many carbs are most suitable for you, and then help you pick the best quality healthy fats to round out your diet.
Here are some general guidelines to give you an idea;
Unlike some low carb diets, a low carb high healthy fat diet does not have unlimited amounts of animal protein. There is a reason for this. When carbs are reduced, the body can synthesize glucose from protein (through a process known as gluconeogenesis), so if you eat too much protein, it can slow down your body’s transition into “fat-burning mode“.
A low carb high healthy fatdiet provides sufficient protein for our body’s needs based, but not excess.
One thing all low carb high fat diets have in common, is that they are low in net carbs (carbs minus fiber) and high in fat and while ~80% of the saturated fat in our bodies is made by the body and only 20% comes from diet – how much saturated fat should we eat? What about polyunsaturated fat? Monounsaturated fat?
Eating a diet rich in saturated fat while eating low carbs is not detrimental in any way, but why eat only saturated fat? Eating a wide range of healthy fats from a variety of natural sources provides our bodies with all the essential fatty acids we can’t make, as well as provides us with foods that can reduce inflammation.
According to Phinney and Volek (The Art and Science of Low Carbohydrate Living), when someone is adapted to eating a low carb high healthy fat (i.e. are in “fat-burning mode“), saturated fats do not raise LDL cholesterol. The body actually preferssaturated fat and also uses monounsaturated fats which are the kinds of fat that I like to focus on for their wonderful anti-inflammatory benefits and because they are excellent sources of other nutrients, especially minerals such as magnesium and potassium. Long chain polyunsaturated fatty acids (PUFAs) such as EPA and DHA from oily fish are excellent for brain and heart health and are also anti-inflammatory in nature.
I recommend that people look to plant-based fats such as those found in avocado, olive, avocado oil and coconut oil (which is largely made up of medium chain triglycerides that is processed through the lymphatic system rather than the liver), nuts and seeds as well as omega 3 fats found in fatty fish for the bulk of their fat sources, beyond the saturated fat that is found in their protein sources.
Nuts and seeds, including almonds, walnuts, pumpkin and sunflower seeds, pistachios etc. do contain carbs – ranging from ~1.5–4 grams net carbs per ounce (30g). Cashews which are actually fruit not nuts, are the highest in carbs, ~ 7 net grams per ounce (30g). Since nuts are high in omega-6 fats (pro-inflammatory fats that compete for binding-sites with the omega-3 fats from fish) it is recommended that these be eaten in portioned quantities – such as added on top of a salad or a handful with a meal.
Chia and flax seed are approximately 1–2 grams net carbs per 2 Tbsp (50 ml) and are excellent sources of soluble and insoluble fiber.
For the vast majority of people, all fats are healthy – which is why I call this approach a “low carb high healthy fat” diet, but for a small percentage of people for whom high LDL cholesterol is a concern, eating less saturated fat may be beneficial.
Carbs are a healthy part of the low carb high healthy fatdiet, but excess carb is minimized.
There are naturally-occurring carbs in non-starchy vegetablesand low-sugar fruit (such as lemon, lime, eggplant, cucumber and tomatoes) and these are not restricted.
When starting a Low Carb High Healthy Fat Diet
Although not everyone does, some people experience some of the following symptoms, which usually subside within a couple of weeks. For each, I have offered some suggestions to minimize them:
headaches: often a result of eating too little salt. As insulin levels fall, so sodium is excreted by the kidney in urine. The drop in sodium results in the headache. Taking 1-3 gms of salt per day (I prefer sea salt) will alleviate this. If you are taking medication for high blood pressure, be sure to check with your doctor before making any changes to your diet. “Bone broth” is another way to restore electrolytes that are lost as insulin levels fall. Be sure you’re drinking plenty of water and also consuming enough salt/sodium.
sleep disruption: often a result of needing to urinate more, but sometimes experienced when people of switching from being in “carb-burning mode” to being in “fat burning mode”. Some people find taking some magnesium (with calcium) before bed helpful.
digestive changes: some people find they get slightly looser stools or get slightly more constipated when starting. I can help troubleshoot this with you to get things back on track.
aches and pains: some people feel a little achy and almost flu-like for a few days when they are switching fuel sources. Some people call this the “keto-flu”. Making sure to have a balanced amount of sodium/potassium and calcium/magnesium as well as taking extra omega 3 fatty acids is helpful.
My role as a Dietitian
As a Dietitian, I make sure that you understand the effect that following a low carb high healthy fatdiet can have on your body. If you are taking medication for high blood pressure (hypertension) or to lower blood sugar, I’ll ask you check with your doctor before starting, as blood sugar and blood pressure medications will need to be adjusted lower, as insulin levels fall. If you aren’t taking any medication, I’ll help you transition into understanding that fat in and by itself is not ‘bad’ and that eating good quality healthy fats, nutrient-dense carbohydrate-containing foods and high quality animal protein is part of a healthy diet that will enable you to feel better, lose weight and lower insulin resistance.
I’ll design your meal plan so that it is adequate in macronutrients (protein, carbohydrate and fat) as well as micronutrients (vitamins and minerals – especially Calcium, Magnesium, Potassium, B-Vitamins, Vitamin A, Vitamin D, Vitamin K and Vitamin C) and sufficient in soluble and insoluble fiber – suitable for your age, gender and activity level, and that factor in any diagnosed medical conditions you may have.
I’ll make sure that you are eating sufficient food in each of the food categories to meet yourdietary needs, while adjusting for weight loss – so that you can just focus on eating healthy, ‘real food’.
Have questions ?
Feel free to send me a note using the form on the Contact Us tab, above.