Note: This article is a combination of a Science Made Simple article with references below and an editorial which provides my opinion.
This past Monday, Health Canada released the Canada’s Food Guide “snapshot”[1] in 28 languages which is not intended to be a stand-alone resource, but to be used as a tool to guide people to the Canada’s Food Guide website.
Canada’s Food Guide includes Canada’s Dietary Guidelines[2], the healthy eating recommendations[3], and all of the other resources and information on the Canada’s Food Guide website. Links to the guidelines and healthy eating recommendations are available in the References, below.
The “Snapshot”
The main message of the “snapshot” is that “healthy eating is more than the foods you eat” â — which I think is an excellent way of summarizing the guidelines and recommendations and encouraging the public to want to learn more. From that point of view, the snapshot is successful in that it is likely to guide people to the website.
The main points on the Snapshot are;
Be mindful of your eating habits
Cook more often
Enjoy your food
Eat meals with others
Use food labels
Limit foods high in sodium, sugars or saturated fat*
Be aware of food marketing
Each of these points link to the sections of Canada’s Food Guide which address those points and in my opinion are all very helpful, except for one elaborated on below.
For example, under “Be mindful of your eating habits” is and encouragement for Canadians to be aware of;
how you eat
why you eat
what you eat
when you eat
where you eat
how much you eat
Being mindful can help you:
make healthier choices more often
make positive changes to routine eating behaviours
be more conscious of the food you eat and your eating habits
create a sense of awareness around your every day eating decisions
reconnect to the eating experience by creating an awareness of your:
feelings
thoughts
emotions
behaviours
Cheese, eggs and meat are high in saturated fat, and cured meats are high in sodium and saturated fat, and dates are certainly very high in sugar, but are not ultra-processed foods. Are these really foods that all Canadians should limit?
Is there irrefutable scientific evidence that healthy people should limit eggs, real cheese and whole fresh meats and poultry? Is it “unhealthy” for metabolically well folks to eat dates, which are very high in sugar? Or are we conflating whole, real food with ultra-processed food?
Using the NOVA food classification that foods such as cheeses, cured meats and olives or anchovies are minimally processed foods that have been processed to make them ore durable and palatable, but they are not “ultra-processed foods” akin to hot dogs, pizza and pop!
I don’t believe that it is helpful to lump “ultra-processed food” and whole, real food that are high in saturated fat, sodium and sugar, together.
It makes good sense to advise Canadians to limit ultra-processed food because they are high in refined carbohydrates and refined fats, and low in nutrient density — but when ultra-processed food is labelled with the advice “limit foods high in sodium, sugar or saturated fat”, whole, real foods are conflated with food-like products which displace real, whole food from the diet.
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If you would like more information about limiting ultra-processed foods, while including whole, real foods that are both plant-based and animal-based, I can help.
You can learn more about my services under the Services tab or in the Shop. If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.
LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only. The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.
Schulte EM, Avena NM, Gearhardt AN (2015) Which Foods May be Addictive? The Roles of Processing, Fat Content and Glycemic Load. PLoS ONE 10(2); e0117959. https://doi.org/10.1371/journal.pone.0117959
The maintenance of blood sugar is very tightly regulated; with a healthy person’s blood glucose being kept in the range from 3.3-5.5 mmol/L (60-100 mg/dl) between meals, however a new study indicates that it may be newer variant of a gene that determines how well (or not) we are able to maintain these levels.
After eating, the higher levels of blood glucose that comes from the broken-down carbohydrate-based food triggers the release of insulin by the pancreas, which in turn causes the release of a special transporter called GLUT4. The GLUT4 transporter acts like a taxi to remove excess glucose from the blood, taking it into muscle and fat tissue.
Newer Variant of an Older Gene
Between meals and with the help of a special protein (CHC22) produced by the CLTCL1 gene, the GLUT4 glucose transporter remains inside muscle and fat, so that some blood sugar will continue to circulate.
A newly published study [1] by research specialists in population genetics, evolutionary biology, ancient DNA and cell biology analyzed the human genomes to understand how the gene producing CHC22 has changed over human history [2].
By examining the genomes of 2,504 people from the global 1000 Genomes Project compared to the genomes of ancient humans, researchers found that almost half of the people in various ethnic groups have a variant of CHC22 protein that is produced by a new variant of the CLTCL1 gene that became more common as humans moved away from being hunter-gathers and began farming and raising crops. Researchers postulate that the increased consumption of carbohydrates may have been the selective force driving this genetic adaptation.
Researchers found that the newer CHC22 variant of the gene is less effective at keeping the GLUT4 glucose transporter inside muscle and fat tissue between meals, which means that the transporter can more readily clear glucose out of the blood*.
As a result, people with the newer variant of the gene will have lower blood sugar than those with the older variant of the gene.
“The older version of this genetic variant likely would have been helpful to our ancestors as it would have helped maintain higher levels of blood sugar during periods of fasting, in times when we didn’t have such easy access to carbohydrates, and this would have helped us evolve our large brains”[2] — lead author Dr Matteo Fumagalli
*Note: It’s important to keep in mind that only GLUT4 transporters are insulin-dependent. There are other glucose transporters that allow glucose into the cell that don’t involve insulin, such as the GLUT1 transporter that works on a concentration gradient. That is, the effect of this gene is not on all glucose regulation, but only glucose regulation in adipose and muscle cells that use GLUT4 transporters.
The higher carbohydrate diets that came as a result of the advent of agricultural meant that this newer variant of the gene could be advantageous, as it moves the excess blood sugar from the blood into the muscle and fat tissue and having the older variant of the gene may make people more likely to develop Diabetes and may also make worse the insulin resistance that underlies the process of developing Diabetes.
“People with the older variant (of the gene) may need to be more careful of their carb intake, but more research is needed to understand how the genetic variant we found can impact our physiology”[2] — co-author Dr. Frances Brodsky
Along with the 2015 study from Israel[3] that demonstrated substantial differences in blood glucose response between both healthy individuals and those with Diabetes predictable by their gut microbiome, this new research adds to the knowledge that multiple factors are involved with determining whether people can tolerate specific dietary carbohydrate loads.
Nutritional guidelines for maintaining healthy blood glucose levels are portrayed as universally applicable, however this new study and the 2015 Israeli study demonstrates that blood glucose varies significantly between individuals based on genetics as well as on gut microbiota composition, which necessitates the need for personalized nutrition in managing blood glucose levels.
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If you are interested in a personalized approach aimed at helping you gain control of your blood sugar levels, I can help.
I offer both in-person services in my Coquitlam, British Columbia office as well as remote services via Distance Consultation. You can find more information about my packages under the Services tab or in the Shop and if you would like to learn more about how Distance Consultation services work, you can click here.
Have Questions?
If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.
LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only. The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.
References
Matteo Fumagalli, Stephane M Camus, Yoan Diekmann, Alice Burke, Marine D Camus, Paul J Norman, Agnel Joseph, Laurent Abi-Rached, Andrea Benazzo, Rita Rasteiro, Iain Mathieson, Maya Topf, Peter Parham, Mark G Thomas, Frances M Brodsky. Genetic diversity of CHC22 clathrin impacts its function in glucose metabolism. eLife, 2019; 8 DOI: 10.7554/eLife.41517
INTRODUCTION: There much debate in the health community about the effect of dietary fat — especially saturated fat on cholesterol levels and whether there is an association between dietary saturated fat intake and cardiovascular disease.
In the first part in this two-part series titled High Cholesterol and the Risk of Cardiovascular Disease, I explained what cholesterol is, the different types of cholesterol (HDL-C, VLDL, LDL-C and triglycerides (which are not actually cholesterol), what their role is, and what “high cholesterol” is.
In this article which is Part 2 in the two-part series, I will explain the association between dietary intake of saturated fat and higher levels of total LDL, and whether reducing total LDL — whether through the use of statin medication or diet lowers the risk of cardiovascular disease.
Dietary Saturated Fat and LDL
When people are told that they have “high cholesterol”, what is meant is that they have high total LDL. They are told they have high “bad” cholesterol, with no regard that there are different sub-fractions of LDL.
It is well known that eating foods high in saturated fat can raise LDL-C (total LDL cholesterol, but as covered in Part 1 of this two-part series, the first question one should ask when told they have “high LDL cholesterol” is “which LDL? The small dense ones or the large fluffy ones?”[1].
More often than not, the clinician that breaking the ‘bad news’ to the patients has absolutely no idea that there are different sub-fractions of LDL and that it is only the small, dense ones that are atherosclerotic [1].
Furthermore, there is almost a knee-jerk reaction on the part of many clinicians to prescribe statin medication in order to lower their LDL, on the assumption that lowering LDL will lower their risk of cardiovascular disease. In fact, aggressive treatment to lower total LDL-C has been at the (pardon the pun) heart of preventative cardiology for decades.
While statin medication (e.g. Lipitor®, Crestor®, etc.) is well-documented to reduce LDL-C levels, these are only surrogate markers (not direct markers) of cardiovascular disease (CVD). The assumption of an association between high LDL levels and CVD goes back as far as Ansel Keys and the Seven Country Study, and that the Diet Heart Hypothesis (covered in several previous articles) is simply an “establish fact”. But it is?
What evidence is there that lowering total LDL with statin medication lowers one’s risk of cardiovascular disease (CVD)?
The brand new guidelines on cholesterol management issued by the American Heart Association (AHA) and American College of Cardiology (ACC) which has just been published online ahead of print[2], places a renewed focus on LDL-C as a means to assess risk. In fact, these guidelines propose that non-fasting lipids be adopted as a screen in the general population, including “non-adults” (children and youth) [2]. As has been the case for decades., this is based on the assumption that total LDL (LDL-C) is an accurate surrogate marker for elevated cardiovascular risk, but does lowering LDL-C really lower CVD?
Of particular interest, the new American Heart Association (AHA) and American College of Cardiology (ACC) guidelines state that the traditional Friedewald equation which is used to calculate total LDL (i.e. LDL-C) as covered in Part 1 of this series of articles has been “prone to inaccuracy …at low-LDL-C and high triglyceride levels” — yet decades of statin treatment has been based on the previous “inaccurate” Friedewald equation. The new guidelines promote the use of a new Martin/Hopkins LDL-C calculation method which is said to “perform better in these settings”. The question remains ‘does lowering LDL-C lower the risk of cardiovascular disease?’.
There are 44 randomized controlled trials of drug or dietary interventions to lower total LDL ( LDL-C) published in the literature which show no benefit in lowering rates of death [3] and most did not reduce CVD events [4].
Furthermore, despite a 37% drop in LDL-C and a 130% increase in HDL-C (so-called “good cholesterol”), the ACCELERATE double-blind randomized control trial showed no significant reduction in CVD or death [3.4].
In addition, there does not appear to be a clear reduction in CVD deaths in Western European countries either as a result of using statins for prevention [5].
This begs the question as to whether using statin medication to aggressively lower LDL-C has any benefit.
A 2018 article published in Expert Review of Clinical Pharmacology concluded;
“For half a century, a high level of total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated and that statin treatment, in particular when used as primary prevention, is of doubtful benefit.” [6]
What about lowering the intake of dietary saturated fat? Does that lower the risk of cardiovascular disease?
A 2014 meta-analysis of data of 72 studies involving more than 600,000 participants from 18 countries published in the journal Annals of Internal Medicine in 2014 [7] concluded that total saturated fat; whether measured in the diet or in the bloodstream showed no association with heart disease [7].
Take away: While eating dietary fat may raise the level of total LDL cholesterol (LDL-C), lowering its intake does not show any benefit in reducing the incidence of heart disease, nor does lowering LDL-C using statin drugs.
Which LDL?
A brand new study published June 4, 2019 in the American Journal of Clinical Nutrition sheds some very helpful light [8].
The study enrolled 113 people and randomized them to either a high saturated fat diet (40% carbs, 24% protein, 35% fat; 14% saturated fat) or a low saturated fat diet (40% carbs, 24% protein, 35% fat; 7% saturated fat replaced by monounsaturated fat).
Each group changed their diet every 4 weeks from (a) a high red meat diet (mostly from beef), (b) a high white meat diet (chicken and turkey) and (c) a non-meat protein diet (legumes, nuts, grain and soy).
Researchers found that LDL cholesterol and Apolipoprotein B (explained in the first part of this article) were higher with red and white meat alike and that the increase “was due primarily to increases in large LDL particles” with no change in the small particles and no significant change in the total cholesterol to HDL ratio.
This is highly significant!
What this means is that yes, eating meat; whether it’s red meat (such as beef, lamb or goat) or white meat (such as chicken or turkey) DOES increase LDL —but it’s the large, fluffy LDL particles that are increased; the ones that are not associated with cardiovascular disease[1]!
In fact, in the paper, the researchers acknowledge;
“Large LDL particles, measured by several different methodologies, have not been associated with CVD in multiple population cohorts in contrast to the associations observed for concentrations of medium, small, and/or very small LDL… Thus, the estimated impact of red meat, white meat, and dairy-derived saturated fatty acids (SFA) on CVD risk as reflected by their effects on LDL cholesterol and ApoB concentrations may be attenuated by the lack of their effects on smaller LDL particles that are most strongly associated with CVD.
Essentially, there has been on over-reliance on total LDL cholesterol (LDL-C) as a marker of cardiovascular disease, without distinguishing the atherosclerotic small, dense LDL from the non-atherosclerotic large, fluffy LDL.
The authors conclude;
“…the impact of high intakes of red and white meat, as well as saturated fatty acid (SFA) from dairy sources, which selectively raised large LDL sub-fractions may be overestimated by reliance on LDL cholesterol, as is the case in current dietary guidelines.”
This means that eating red meat (such as beef or lamb) or white meat (such as chicken or turkey) or eating saturated fat from full-fat dairy (such as full fat milk, cheese and yogurt) are associated with increased levels of the large, fluffy LDL sub-fraction and based on multiple population studies the large, fluffy LDL subfraction has not been found to be associated with cardiovascular disease.
Simply put, this means that eating foods high in saturated fat does not raise small LDL particles (which are the atherosclerotic sub-fraction) and results in no change to the total cholesterol to HDL ratio, and increases the large, fluffy LDL-subfraction (which are NOT found to be associated with cardiovascular disease)!
While this is a small pilot study, it adds further evidence that eating saturated fat does not increase cardiovascular risk.
Note: high levels of the small, dense LDL sub-fraction is thought to be genetic, but is also associated with intake of trans fatty acids and high intake of refined carbohydrates. More on that in future articles.
More Info?
If you would like to learn more about my services, you can find more information under the Services tab or in the Shop and if you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.
LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only. The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.
References
Lamarche, B., I. Lemieux, and J.P. Després, The small, dense LDL phenotype and the risk of coronary heart disease: epidemiology, patho-physiology and therapeutic aspects. Diabetes Metab, 1999. 25(3): p. 199-211.
Cao J, Devaraj S, Recent AHA/ACC guidelines on cholesterol management expands the role of the clinical laboratory, Clinica Chimica Acta 495 (2019) 82—84, Available online 03 April 2019.
DuBroff R. Cholesterol paradox: a correlate does not a surrogate make. Evid Based Med,2017;22(1):15—9. doi: 10.1136/ebmed-2016-110602
Demasi M, Lustig RH, Malhotra A, The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance, Clinical Pharmacist, 14 July 2017.
Vancheri F, Backlund L, Strender L et al. Time trends in statin utilisation and coronary mortality in Western European countries. BMJ Open 2016; 6(3):e010500. doi: 10.1136/bmjopen-2015-010500
Ravnskov U, de Lorgeril M, Diamond DM, et al,LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature,Expert Review of Clinical Pharmacology, 2008;11:10,959-970,DOI: 10.1080/17512433.2018.1519391
Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Ann Intern Med. 2014;160:398—406. doi: 10.7326/M13-1788
INTRODUCTION: There is much debate in the scientific community about the effect of dietary fat— especially saturated fat on cholesterol levels and risk of cardiovascular disease. To best understand this complex topic, I have broken the subject into two articles. In this first part, I explain the different ways cholesterol values are assessed, what they are used for and what they mean. In the next part I will explain whether lowering LDL and dietary saturated fat lowers the risk of cardiovascular Disease.
What is Cholesterol?
Cholesterol is a essential structural component of all the cell membranes in the body and is used in the making of steroid hormones such as cortisol and aldosterone by the adrenal glands, sex hormones such as estrogen, testosterone and progesterone by the gonads, and is also used in the making of bile acid. Approximately 80% of cholesterol made daily by the body occurs in the liver and intestines, with the remainder being made in the adrenal glands and reproductive organs.
Different Types of Cholesterol
Triglyceride isn’t actually a type of cholesterol, but is measured on lipid panels along with cholesterol.
Triglyceride is made up of three fatty acids (hence “tri-“) attached to a glycerol molecule (also known as glycerine), which is a sugar alcohol. Some triglyceride is taken in through the diet and the rest is manufactured by the body during lipogenesis (literally meaning the ‘making of fat’). Lipogenesis is how the body stores the excess carbohydrate we eat in our diet that isn’t immediately needed for energy. Yes, excess dietary carbohydrate is stored in the body as glycogen and when glycogen stores are full, it is stored as fat.
As for cholesterol itself, there are several different types found in the blood;
high density lipoprotein (HDL)
low density lipoprotein (LDL)
very low density lipoprotein (VLDL)
Most people think of high density lipoprotein (HDL) as ”good cholesterol” and low density lipoprotein (LDL) as ”bad cholesterol” but there are actually two sub-fractions of LDL; the small, dense LDL sub-fraction which is associated with atherosclerotic plaque, and the large, fluffy LDL sub-fraction which is considered protective against cardiovascular disease[1].
This is important, because when people are told they have “high cholesterol“, this is usually implies that they have high LDL. This is often presented to them as them having a high level of “bad” cholesterol.
High Cholesterol
A couple of things need to be clarified about “high cholesterol”;
Firstly, “high LDL” cholesterol means high total LDL cholesterol. When blood tests are said to indicate “high LDL” a good question to ask is “whichLDL cholesterol is high; the small dense ones or the large fluffy ones?”. More on this below.
Secondly, it is important to note that lab tests don’t actually measure total LDL but calculate it from the Friedewald formula; which (in mg/dl) is calculated by total cholesterol (TC) – HDL lipoprotein (HDL)-cholesterol – triglycerides (TGs) / 5.
When people are told that they have “high LDL” results on a blood test, they are often presented with a recommendation to begin statin medication, but does high total LDL provide sufficient information about cardiovascular risk? More on this below. The use of statin medication will be covered in the subsequent article.
Very low density lipoprotein (VLDL) is produced in the liver and the best way to understand its role is to think of it as a “taxi” which the liver makes and then release into the bloodstream to shuttle triglycerides around to the various tissues. VLDL cholesterol on blood test results isn’t actually measured either, but estimated as a percentage of the triglyceride value. High VLDL is said to be a risk for cardiovascular disease but as elaborated on below, a more accurate measure is the ratio of Apopoprotein B (the lipoprotein in VLDL) compared to the Apoprotein A (the lipoprotein in HDL).
Where does LDL come from?
Once a large amount of triglyceride has been unloaded in the tissues by the VLDL “taxi”, it becomes a new, smaller lipoprotein called low density lipoprotein, or LDL which 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.
A key point here is thatthe only source of LDL is VLDL. This is important.
LDL is what is left once the VLDL which is made by the body has offloaded its triglyceride ‘passenger’ to the tissues.
LDL and Heart Disease
Research has often reported that elevated LDL-cholesterol is a risk factor for cardiovascular disease, including heart disease and stroke and it has been assumed that lowering LDL-cholesterol in the blood would decrease cardiovascular deaths and illness. It is this premise that lead to recommendation of treatment of high LDL with statin drugs.
One major problem is that these studies looked at total LDL which doesn’t distinguish between the small, dense sub-fractions of LDL that are atherosclerotic, and the large, fluffy ones that are not [1].
Total LDL (LDL-C) calculates (not measures!) the total content or concentration of cholesterol within all the LDL particles.
LDL particle number (LDL-P) measures the particle concentration.
Since the amount of cholesterol in each particle varies, measuring LDL-C does not necessarily reflect the actual number of particles — but an increased number ofLDL particles occurs in patients with lots of small, dense particles.
Therefore, LDL-particle number (LDL-P) is a more accurate predictor of cardiovascular events than total LDL (LDL-C).
An NMR lipid profile test directly measures the number of LDL particles (as well as HDL particles). For LDL particles, a value of less than 1.000 in nmol/L is considered ideal, a value of 1000-1299 is considered moderate, a value of 1300-1599 is considered borderline high, and a value >1600 is considered high.
Apolipoprotein B:Apolipoprotein A
Apolipoprotein B (apo B) is the main lipoprotein in VLDL, and subsequently in LDL after the VLDL has offloaded its triglyceride to the tissues. ApolipoproteinB is correlated with the actual number of LDL-particles, which makes it a very good assessor of the risk of cardiovasculardisease,
Apolipoprotein A (apo A) is the main lipoprotein in HDL (commonly called “good” cholesterol).
Measuring ApoB to ApoA requires special blood tests, but a proxy can be calculated by dividing triglycerides (TG) by HDL-cholesterol (HDL-C) from a standard lipid panel. Studies have found this to be a very good assessor of cardiovascular risk.
Triglyceride:HDL Ratio
In Canada (as well as Europe), values are expressed as mmol/L and the ratios are interpreted as follows [2];
TG:HDL-C < 0.87 is ideal
TG:HDL-C > 1.74 is too high
TG:HDL-C > 2.62 is much too high
In the US, values are expressed in mg/dl and the ratios are interpreted as follows [2];
TG:HDL-C < 2 is ideal
TG:HDL-C > 4 is too high
TG:HDL-C > 6 is much too high
Several studies have found that TG:HDL-C ratio also reflects particle size;
One study from 2004 reported that almost 80% of people with a TG:HDL-C ratio of greater than 3.8 (when values are expressed in mg/dl) had mostly small, dense LDL particles, indicating cardiovascular risk. This same study found that more than 80% with a TG:HDL-C ratio of less than 3.8 (when values are expressed in mg/dl) had mostly large, fluffy LDL particles, indicating lower cardiovascular risk[3].
A 2005 study [4] reported that a TG:HDL-C ratio of 3.5 or greater was highly correlated with atherosclerosis in men, as well as insulin resistance and metabolic syndrome.
A recent 2014 [5] study found that a high TG:HDL-C ratio was a strong independent predictor of cardiovascular disease, coronary heart disease and all-cause mortality both before- and after adjustment for age, smoking, BMI and blood pressure.
Based on this metric, lower cardiovascular risk would be associated with lower triglycerides, raising HDL or both.
But how?
Lowering TG:HDL-C ratio
Losing weight will lower triglycerides, however low-fat diets are not usually helpful in this regard because they are often also high in carbohydrate[2].
Decreasing intake of carbohydrates — especially fructose which is found in fruit, as well as processed products made with high fructose corn syrup has been anecdotally reported to decrease hunger, making weight loss easier. Most importantly, clinical studies using well-designed low carbohydrate diets (already covered in several previous articles) are associated with both a lowering of triglycerides and a increase in HDL.
Lowering the risk of cardiovascular disease through weight loss, along with a lowering of triglycerides and an increase in HDL is where I can help.
UPDATE (June 23, 2019): Part 2 of this article titled Lowering LDL and Saturated Fat to Lower the Risk of Cardiovascular Disease is available by clicking here.
More Info?
If you would like to learn more about my services, you can find more information under the Services tab or in the Shop and if you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.
LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only. The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.
References
Lamarche, B., I. Lemieux, and J.P. Després, The small, dense LDL phenotype and the risk of coronary heart disease: epidemiology, patho-physiology and therapeutic aspects. Diabetes Metab, 1999. 25(3): p. 199-211.
Sigurdsson AF, The Triglyceride/HDL Cholesterol Ratio, updated January 12, 2019, https://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/
Hanak V, Munoz J, Teague J, et al, Accuracy of the triglyceride to high-density lipoprotein cholesterol ratio for prediction of the low-density lipoprotein phenotype B, The American Journal of Cardiology, Volume 94, Issue 2, 2004, Pages 219-222, https://doi.org/10.1016/j.amjcard.2004.03.069
McLaughlin T, Reaven G, Abbasi F, et al. Is there a simple way to
identify insulin-resistant individuals at increased risk of cardiovascular
disease? Am J Cardiol. 2005;96(3):399Y404.
Vega GL, Barlow CE, Grundy SM et al, Triglyceride to High Density Lipoprotein Cholesterol Ratio is an Index of Heart Disease Mortality and of Incidence of Type 2 Diabetes Melletus in Men, Journal of Investigative Medicine & Volume 62, Number 2, February 2014
INTRODUCTION: National dietary guidelines in both Canada and the US focus on the variety of foods available in each of several defined ‘food groups’ and make recommendations about “healthy eating” based on how much of particular nutrients are in specific foods. In Canada for example, foods that are rich in saturated fat, sodium or sugar are said to undermine health. This type of classification results in dishes rich in cheese and fried chicken both being deemed as unhealthy, as both are high in saturated fat and sodium.
This article outlines an internationally established way of classifying foods that is based on the degree of food processing they have undergone — which I believe provides a better framework to help people to choose which foods they should aim to eat most often.
Many of us have heard the alarming health statistics in both the US and Canada, but they are worth repeating.
Obesity has risen in Canada from < 10% in 1970-1972 to almost 15% in 1989, to over 23% in 2004 [1,2]. That is, in the early 1970s, only one in 10 people in Canada was obese and now almost 1 in 4 people in Canada are obese [3]. The prevalence of obesity among American adults is almost 40% as of 2015-6 [4].
And it’s not only adults.
As of 2015, over 10% (1 in 10) children between the ages of 5 and 17 years of age in Canada were obese[3] and that figure rises to 20% (1 in 5 kids) in the United States [4].
It’s not only obesity.
As of 2015, >25% of Canadians adults have been diagnosed with high blood pressure[3] and as of 2013, >30% of American adults have high blood pressure [5]. That’s 1 in 4 in Canada and 1 in 3 in the US [4] with hypertension; a major risk factor for heart attack and stroke.
Over 8% in Canada have been diagnosed with coronary heart disease (CHD) [3] and in the US, coronary heart disease accounts for ~13% of deaths as of 2016 [6] and over 8% of Canadians has diabetes [3] and in the US, almost 9.5% of Americans has diabetes [7].
What has changed over this time period to account for this?
Too Many Carbs?
When I first started writing articles about obesity and the increased rates of metabolic diseases ~ 4 years ago, I thought it was largely related to the increased in carbohydrate content of the diet due to changes in the national dietary guidelines that occurred in Canada and the US in 1977. To some degree there is a relationship between these, but it is not as clear-cut as I once thought.
With further reading in the scientific literature, I came to believe that it was the inclusion of novel “seed oils” (also called “polyunsaturated vegetable oil”) including canola, soybean, corn and cottonseed oil — along with too much carbohydrate in the diet that lay at the root of obesity and metabolic disease and while this is certainly part of the story, I was still missing a vital piece of the puzzle.
Manufactured Food-like Products
As national dietary guidelines in both Canada and the US in 1977 focused on reducing dietary intake of fat — especially saturated fat, food manufacturers sought to fill the gap left by the removal of butter, cream, lard and tallow (saturated fats) from the diet, and began to manufacture products that were made up of bothrefined carbohydrate and industrial seed oils (“polyunsaturated vegetable oils”). The food industry heavily marketed these manufactured products and promoted them as being “low in saturated fat”, which was perceived by the general public as being equivalent to “healthy”.
Since the mid-1980s, the food supplies of high-income countries such as Canada, the US, Australia and the UK have been dominated by pre-packaged, ready-to-eat “convenience foods” [13]. In fact, the percentage of energy (calories) in the diet of Canadians of these “ultra-processed foods” rose from <25% in 1938 (when manufactured products such as Crisco and soy oil were first created) to almost54%in 2011 (9). Similar trends have been observed worldwide (10-12).
It is my now my conviction that it has been the over-consumption of these ultra-processed“convenience foods” that are high in bothrefined carbohydrate and seed oils which precipitated the huge deterioration of the Western diet, and which has fueled the concurrent epidemics of obesity, diabetes and other chronic diseases, such as hypertension and coronary heart disease [8].
Hundreds of thousands of people in Canada, and millions worldwide are metabolically unwell because the bulk of the diet has centered around eating these manufactured food-like products — from our morning sweetened cereal or spreads on toast to the burger with ‘plastic cheese’ and French fries we grab in place of real food.
So how do we distinguish real food from food-like products?
The NOVA Food Classification system – defining “processed food”
From the time food is harvested to when it is eaten, most food is processed in some way. Some of this processing may be as simple as peeling and chopping it, to cooking it, but food doesn’t become “unhealthy” just because it is processed. The issue is how much it is processed.
NOVA is a food classification system developed in Brazil and used in the US, Canada and other countries around the world to define the level of food processing.
The NOVA definition of types of food processing are as follows [13]:
Minimally processed foods are defined as ”unprocessed foods altered in ways that do not add or introduce any new substance (such as fats, sugars, or salt) but often involve removal of parts of the food.” Examples of these include fresh, dry, or frozen vegetables, root vegetables, grains and legumes, fruits and nuts, and meats, fish, seafood, eggs, and milk [13]. For the most part, minimal processing is what’s involved in preparing it for eating and/or improving its palatability.
Processed foods are defined as ”foods made by adding fats, oils, sugars, salt, and other culinary ingredients to minimally processed foods to make them more durable and usually more palatable, and by various methods of preservation“. They include simple breads and cheeses; salted, pickled or cured meats, fish and seafood; and vegetables, legumes, fruits and animal foods preserved in oil, brine or syrup.
Canned fish in oil would fall in this category, as would hummus (ground chickpeas with sesame seed butter, garlic and lemon juice), as well as bacon and sausages.
These foods can be part of a healthy diet, depending on how they are prepared and used in dishes and meals [13] and how much of these are eaten at a time.
Ultra processed foods are defined as ”not modified foods, but formulations of industrial ingredients and other substances derived from foods, plus additives. They mostly contain little if any intact food. The purpose of ultra-processing is to create products that are convenient (durable, ready-to-eat, -drink or -heat), attractive (hyper- palatable), and profitable (cheap ingredients). Their effect all over the world is to displace all other food groups. They are usually branded assertively, packaged attractively, and marketed intensively.“
Foundations for Healthy Eating using Degree of Food Processing
I like to define foods as being either “everyday foods” or “sometimes foods”. The issue is how much and how often we eat them.
“Everyday Foods”
Choosing foods to make up a meal should aim to include mostly unprocessed foods (whole foods in their original state) and minimally processed foods. This is how our grand-parents and great-grandparents ate (when obesity, hypertension and diabetes rates were a fraction of what they are now!).
Another way to determine what foods to include in a meal is to eat food that your great-grandparents would recognize as food.
“Sometimes Foods”
For people who are metabolically healthy, eating “processed foods” such as breads and cheese, salted, pickled or cured foods (including meat, fish, seafood, vegetables, legumes) and whole foods preserved in oil or brine are perfectly fine to add to unprocessed foods (whole foods in their original state) and minimally processed foods to make up a meal.
For those who are already overweight or metabolically unhealthy, focusing on making up a meal of real, whole foods in their original state (i.e. unprocessed foods) and minimally processed foods is best, while limiting processed foods. How much bacon, olives, bread and cheese can be eaten really depends on a person’s metabolic health. This is where having a Meal Plan designed by a Dietitian is helpful because everybody’s needs are different.
Ultra-Processed Food
Ultra-processed food isn’t food. They are products made from a combination of refined carbohydrates (including sugar) and seed oils. These are convenient, hyper-palatable and cheap, and displace real food in the diet.
According to a 2015 study, some of the most addictivefoods are in this category; including breakfast cereal, muffins, pizza, cheeseburgers, French fries and fried chicken — as are the desserts that often eaten with them including chocolate, ice cream, cookies and cake, and the soda we wash them down with. Even our favourite snacks like popcorn and chips are really nothing more than a combination of refined carbs and industrial seed oil eaten in place of real food.
These ultra-processed food-like products are intended to displace real food in the diet and as such are not something we should consider as components for making up a meal.
Does that mean we should never eat a slice of pizza or a cheeseburger? Of course not. But let’s be fully aware that this is not real food. It is something we eat in place of real food.
As well, there is a huge difference between a homemade burger with real melted cheddar cheese on top — sandwiched between fresh leaf lettuce and tomato, and what can be picked up at a 1000 drive-throughs in cities around the Western world.
National Food Guidelines as foundations for healthy eating
National food guidelines in both Canada and the US have traditionally categorized food based on the variety available in each food group; including grains and cereals, vegetables &/or fruit. milk and dairy, and meats and alternatives.
New Canada Food Guide (2019)
In the case of the new Canada Food Guide, it recently eliminated the Milk and Dairy food group and combined those foods with Protein foods. The other two food groups are now Grains and Vegetables and Fruit.
The new Guide centers it’s dietary advice around 3 “Guidelines”.
Guideline 1 of the new Canada Food Guide focuses on eating from the different food groups and stresses that Canadians should eat plant-based foods more often because they lower intake of saturated fat.
Guideline 2 of the new Canada Food Guide encourages Canadians to limit processed or prepared foods and states the reason is because they contribute excess sodium, sugar and saturated fat.
Based on this definition, dishes made with lots of cheese and fried chicken are high in saturated fat and sodium, and thus are categorize as foods that undermine healthy eating.
Does eating cheese really undermine healthy eating?
Or a rib steak?
Or milk?
As covered in previous articles I’ve written on the new Canada Food Guide, I am not convinced that there is a compelling reason to limit real, whole food simply because it is high in saturated fat.
Guideline 3 of the new Canada Food Guide encourages Canadians to learn how to prepare and cook their own food and promotes the use of nutritional food labels as a tool to help them make informed choices.
The fact is, there are no nutrition food labels on unprocessed food (real, whole foods).
Choosing Healthy Food
As I’ve said in prior articles, Canadians can use the new Canada Food Guide to make up healthy meals by focusing on the part of Guideline 1 which encourages them to eat “real, whole food” and on the part of Guideline 2 which encourages them to “limit processed or prepared foods” — and by defining “processed foods” using the NOVA category of “ultra-processed foods” given above. In this way they will be able to design meals with a wide range of healthy and interesting foods.
Defining what is healthy based on how much a food is processed makes good sense. In this way people are free to add bread and cheese, and salted, pickled or cured foods (including meat, fish, seafood, vegetables, legumes) to their unprocessed foods (whole foods in their original state) and minimally processed foods to make up an interesting and healthful meal.
Furthermore, categorizing food using the NOVA categories based on the degree of food processing avoids lumping foods made with lots of real cheese withfried chickenas those that undermine healthy eating, based on their saturated fat and sodium content.
More Info?
If you would like to have a Meal Plan designed to meet your health and nutritional needs, I can help.
You can learn more about my services under the Services tab or in the Shop. If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.
LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only. The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.
Public Health Agency of Canada, Canadian Institute for Health Information. Obesity in Canada. A joint report from the Public Health Agency of Canada and the Canadian Institute for Health Information. Ottawa: Public Health Agency of Canada & Canadian Institute for Health Information; 2009. 62 pages.
Katzmarzyk PT. The Canadian obesity epidemic: an historical perspective. Obes Res. 2002, Jul;10(7):666-74.
Public Health Agency of Canada. Canadian Chronic Disease Indicators, Quick Stats, 2017 edition. Ottawa: Public Health Agency of Canada; 2017. 4 pages
NCHS Data Brief, Prevalence of Obesity Among Adults and Youth: United States, 2015-2016, https://www.cdc.gov/nchs/data/databriefs/db288.pdf
American Heart Association, Statistical Fact Sheet 2013 Update, High Blood Pressure, https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf
American Heart Association, Heart Disease and Stroke Statistics-2019 At-a-Glance, https://healthmetrics.heart.org/wp-content/uploads/2019/02/At-A-Glance-Heart-Disease-and-Stroke-Statistics-%E2%80%93-2019.pdf
Centers for Disease Control and Prevention, New CDC report: More than 100 million Americans have diabetes or prediabetes, https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
Liu AG, Ford NA, Hu FB, Zelman KM, Mozaffarian D, Kris-Etherton PM. A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion. Nutr J. 2017 Aug 30;16(1):53. doi: 10.1186/s12937-017-0271-4.
Moubarac JC, Batal M, Martins AP, Claro R, Levy RB, Cannon G, et al. Processed and ultraprocessed food products: Consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res. 2014 Spring;75(1):15-21.
Monteiro CA, Moubarac J-C, Cannon G., Ng SW, Popkin B. Ultra-processed products are
becoming dominant in the global food system. Obes Rev. 2013 Nov;14 Suppl 2:21-8. doi: 10.1111/obr.12107.
Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultraprocessed food and drink industries. The Lancet. 2013 Feb 23;381(9867):670-9. doi: 10.1016/S0140-6736(12)62089-3.
Baker P, Friel S. Food systems transformations, ultra-processed food markets and the nutrition transition in Asia. Global Health. 2016 Dec 3;12(1):80.
Moubarac JC. Ultra-processed foods in Canada: consumption, impact on diet quality and policy implications. Montréal: TRANSNUT, University of Montreal; December 2017.
Schulte EM, Avena NM, Gearhardt AN (2015) Which Foods May be Addictive? The Roles of Processing, Fat Content and Glycemic Load. PLoS ONE 10(2); e0117959. https://doi.org/10.1371/journal.pone.0117959
Yesterday I had an occasion to wear a new little black dress that I had bought, and remembered the last time I wore one. Ironically, it was for my Master’s convocation just over 11 years ago, and the dress was a size 16. My degree was in Human Nutrition, yet I was very overweight and had pre-diabetes.
May 25, 2008
The degrees on the wall did not help me understand why â — despite my best efforts to “exercise more and eat less”, I was still overweight. Despite my research related to the neurotransmitter dopamine, it was not known at the time how dopamineis involved in the potent joint reward system of eating foods that are a combination of both carbohydrate and fat (you can read more about that here).
I did not understand why following the advice of my physician didn’t help. I ate according to the (then) Canadian Diabetes Association (now called Diabetes Canada)’s recommendation to eat 65 g of carbohydrate at each meal and 25-45 g of carbs at each snack â — along with lean protein and monounsaturated and polyunsaturated fat and participated in exercise several days each week. I ate “plenty of healthy whole grains” and “lots of fruit and vegetables“, along with low fat dairy, yet a year later progressed to Type 2 Diabetes; what I was told was a “progressive, chronic disease”.
My studies didn’t help me understand the impact of high levels of circulating insulin on obesity and the effect of the after-meal and after-snack rise in insulin and then it’s drop shortly later on hunger. The reality was, the advice we were taught to “eat less and move more” did nothing to address the underlying issue of being hungry every few hours. In fact, the detrimental effects of high circulating levels of insulin weren’t taught; only the effects of high blood sugar.
My studies didn’t help me understand that “plenty of healthy whole grains” for someone who is already insulin resistant, with high levels of circulating insulin isn’t helpful. I didn’t understand how eating plenty of fruit was further contributing to my problems; both because of it’s high carbohydrate load, as well as it being a high source of fructose. I drank 3 glasses of low-fat milk daily, but didn’t understand the effect of all of those extra carbohydrates on my blood sugar, as well as underlying insulin response. It was not part of what I studied â — either in my undergraduate degree or Master’s studies, because it simply was not well known.
It is only recently (April 18, 2019)that the American Diabetes Association (ADA) issued their Consensus Report which indicated that “reducing carbohydrate intake has the most evidence for improving blood sugar” (you can read more about that here). In fact, the ADA now includes both a low carbohydrate eating pattern and a very low carbohydrate (keto) eating pattern as Medical Nutrition Therapy for the treatment of those with pre-diabetes, as well as adults with Type 1 or Type 2 Diabetes.
While these are not currently part of Diabetes Canada‘s options, they are recommendations available to those in the United States. In fact, the European Association for the Study of Diabetes (EASD) also classifies low carb diets as Medical Nutrition Therapy and Diabetes Australia released their own updated position paper for people diagnosed with Diabetes who want to adopt a low carbohydrate eating plan.
Many studies already demonstrate that a well-designed low carbohydrate diet is both safe and effective for the treatment of obesity and Diabetes (see the Physician and Allied Health Provider tab on my affiliate low carbohydrate web site for more information) but much of this has only come to light in the years since I graduated with my Master’s degree.
In the last 4+ years since I first learned about the therapeutic use of a low carbohydrate diet, I have read scores of studies in an effort to become well-informed and continue to do so in order to stay current with the emerging evidence.
April 2017 – April 2019
On March 5, 2017 I began what I have called “A Dietitian’s Journey”. Over the subsequent two years, I put my Type 2 Diabetes into remission, lowered my dangerously high blood pressure and achieved a normal body weight and optimal waist circumference.
I have been in maintenance mode for more than three months and have been able to maintain my weight loss and health gains with little effort.
This photo was taken of me yesterday in my new “little black dress”.
The bulk of my Dietetic practice in the past focused on food allergy and food sensitivity (including Celiac disease, Irritable Bowel Syndrome, Inflammatory Bowel Disease), but I am now able to provide a range of options for weight loss and improvement in many metabolic conditions, including Type 2 Diabetes, hypertension and abnormal cholesterol that I was unable to offer a few years ago. I offer variety of evidence-based approaches, including a Mediterranean Diet, a plant-based whole foods approach (vegetarian or including meat, fish and poultry), as well as a low carbohydrate approach (which is what I follow).
If you would like to learn how I can help you, you can learn more about my services under the Services tab or in the Shop.
If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.
LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only. The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.
Note: this article is both an editorial (expressing my personal opinion on the subject) as well as an article rooted in the literature.
The new Canada’s Food Guide (CFG) hangs on three Guidelines and unfortunately many people discount the Guide entirely because of the caveats to which they are linked. In my opinion, this is a little bit like “throwing the baby out with the bath water”. The essence of the three Guidelines are sound and worth considering.
I have elaborated at length in previous fully reference articles (such as here and here) as to why I believe that one of these caveats, the insistence that dietary saturated fat is associated with heart disease is less than clear. Even the Canadian Heart and Stroke Foundation position statement titled ”Saturated Fat, Heart Disease and Stroke” released in September 2015 concludes the same, but that does not mean that the Guidelines themselves should be entirely discounted or discarded.
I have also explained in a few previous articles (such as this one and this one) why I believe that a diet that is highly carbohydrate-centric may not be suitable for the vast numbers of people that are already metabolically unwell (88% based on a recent US study) and that a meal pattern that has a lower percentage of carbohydrate would be better suited to those who are insulin resistance, or who are already pre-diabetic or have Type 2 Diabetes already. That said, the three Guidelines on which the new Canada’s Food Guide is based are largely correct.
In this article, I will highlight what I feel the new Canada Food Guide got entirely right.
Guideline 1 – Real, whole food
Guideline 1 – vegetables, fruit, whole grains and protein foods should be consumed regularly
Guideline 1 of the new CFG is that nutritious foods are the foundation for healthy eating and the Guide defines nutritious foods as vegetables, fruit, whole grains and protein foods that include fish, shellfish, eggs, poultry, lean red meat including wild game, milk, yogurt, kefir and cheese, as well as legumes, nuts, seeds, tofu and fortified soy beverages.
The caveat to this advice that plant-based should be chosen more often and that animal-based foods be lower in fat and sodium and this is based on the enduring belief that foods containing saturated fat and/or sodium contribute to heart disease. As mentioned above, I’ve already addressed the saturated fat issue in several previous articles and the concern about excess carbohydrate-based foods for those who are metabolically unwell, but it is true that nutritious foods as vegetables, fruit, whole grains and protein foods that include fish, shellfish, eggs, poultry, lean red meat including wild game, milk, yogurt, kefir and cheese, as well as legumes, nuts, seeds, tofu and fortified soy beverages are nutritious foods.
Yes!
Whole vegetables and whole fruit, and a variety of animal based and even plant-based protein foods and even unrefined grains are nutritious foods and suitable for healthy individuals.
How much and what types of fruit and how much and what type of carbohydrate-based foods a given person should consume will vary depending on a their specific metabolic health, however there is no reason to vilify any whole food as being unhealthy.
For more information about why I don’t believe that carbohydrates are inherently “evil” please read my previous article titled Carbohydrates Are Not Evil located here.
Vegetarians can choose their protein as tofu, nuts and seeds, yogurt, kefir, eggs and cheese, whereas pescatarians can include fish and seafood, and omnivores can include meat, including wild game — and all can include whole vegetables and fruit. Inclusion of “healthy whole grains”, as well as how much and how often really depends on which meal patterns someone has chosen, as well as their metabolic health. As to the matter as whether one can exclude an entire food group is addressed in this article on my affiliate low carb website.
Regardless of a person’s chosen meal pattern — be it whole-food plant-based, whole-food pescetarian or omivore, Mediterranean or low carbohydrate, whole, real food is nutritious food.
I decided to pull some food out of my own fridge and take a picture of what whole, real, food looks like in my own meal pattern (low carbohydrate omnivore), but this by no means defines or limits what nutritious food can look like for you!
Example of whole, real food (low carb omnivore)
Perhaps the idea of buying a chicken the way I choose to doesn’t appeal to you and you’d prefer to buy your boneless and skinless wrapped in plastic on a Styrofoam tray. Go for it! It’s still nutritious, real food.
Buying a whole rotisserie chicken at the store is totally good, too!
So is buying pre-made salad or veggies that are already cut up and frozen or packed ready-to-cook!
If it looks like something your grandparents or great grandparents would recognize as real food, it has a greater chance of falling in what is “nutritious food”.
Guideline 2 – Limit Processed or Prepared Food
Guideline 2 – Processed or prepared foods should not be consumed regularly
Guideline 2 of the new Canada Food Guide is that processed or prepared foods should not be consumed regularly, as these undermine healthy eating.
The caveat to this advice is that these contribute to excess sodium, free sugars or saturated fat which are believed to pose a risk to health and while I’ve previously addressed some of these in earlier articles, regardless of meal pattern processed foods make more energy available for absorption than the whole food from which they are made. In the case of those who have pre-diabetes or Type 2 Diabetes, they also make more carbohydrate available for ready digestion, contributing to a higher insulin response and higher blood sugar response. More information is available in this article as well asthis one).
Regardless of the type of meal pattern a person follows, processed or prepared foods ought to be “sometimes foods” and not “everyday foods” — and it doesn’t matter if the processed food is a bake-and-eat frozen pizza, a low carb fat-head pizza or a pre-prepared fake meat burger. These aren’t real, whole foods. Sure, they are nice for an occasional treat but as elaborated on in several previous articles (links above), foods prepared from refined, processed foods have a very different impact on blood sugar response and insulin response than the whole foods from which they are made.
Remember, real, whole foods are usually ones that your grandparents or great-grandparents would recognize as real food.
Guideline 3 – Know How to Prepare and Cook Food
Guideline 3 – food skills are needed to navigate the food environment and support healthy eating
Guideline 3 of the new Guide is that food skills such as buying, preparing and cooking are needed to navigate the complex food environment and support healthy eating.
I agree.
a cut up whole chicken; ready-to-cook parts and for stock parts
Unfortunately, it is my experience that many people lack the basic skills to buy foods as simple as raw vegetables such as whole broccoli, or a whole squash and know how to prepare them for eating.
In fact, so many young people lack basic food preparation skills such as how to prepare a simple meal that some school districts have toyed with the idea of bringing back “home economics” to the secondary school curriculum.
Of course, not everyone needs to know how to cut up a chicken (such as I did to the one above) but knowing how to cut up chicken legs into drumsticks and thighs, cut up broccoli or cauliflower or prepare a salad can save people money and increase their availability to eating nutritious (real, whole) food.
Some Final Thoughts…
I said in one of my earlier articles that I consider myself a “nutritional centrist” — that I don’t feel it is necessary to be “tribal” about food allegiances.
People choose different types of meal patterns for all kinds of reasons; from vegetarianism for religious or ethical reasons, to low carb for health reasons, and my role as a Dietitian is to help support them in eating healthy, nutritious food that fits the meal pattern they have chosen.
While I have two specific misgivings about the new Canada’s Food Guide (1) their continued insistence that saturated fat is associated with heart disease and (2) a carbohydrate-centric meal pattern approach when much of the public is already metabolically unwell, there are three things the new Guide got right;
Real, whole foods are nutritious and should be foundational for healthy eating
It is preferable to limit processed and prepared foods
Food skills such as buying, preparing and cooking are needed to support healthy eating
More Info?
If you would like to learn how the essence of these Guidelines can be adopted to you, I can help.
You can learn more about my services under the Services tab or in the Shop. If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.
LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only. The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.
References
Health Canada, What are Canada’s Dietary Guidelines? https://food-guide.canada.ca/en/guidelines/what-are-canadas-dietary-guidelines/
Health Canada. Food, Nutrients and Health: Interim Evidence Update 2018. Ottawa: Health Canada; 2019.
Health Canada. Evidence review for dietary guidance: technical report, 2015. Ottawa: Health Canada; 2016.
After eating, the higher levels of blood glucose 
Guideline 1 of the new Canada Food Guide focuses on eating from the different food groups and stresses that Canadians should eat plant-based foods more often because they lower intake of saturated fat. 
