American College of Cardiology: No Benefit to Lower Saturated Fat Intake

The recommendation to lower the consumption of saturated fat in the diet to reduce the risk of cardiovascular disease (CVD) has been the central theme in both the US and Canadian since 1977, and has been carved into our respective Dietary Guidelines since the 1980s.

A newly published study published by the American College of Cardiology has found no beneficial effect on either cardiovascular disease (CVD) or death of lowering saturated fatty acid (SFA) intake and that saturated fat intake is actually protective against stroke [1]. This reassessment of dietary saturated fat intake was based on a meta-analysis of randomized control trials (the strongest data available), as well as observational studies.

The newly published report stated;

Whole-fat dairy, unprocessed meat, eggs and dark chocolate are SFA-rich foods with a complex matrix that are not associated with increased risk of CVD. The totality of available evidence does not support further limiting the intake of such foods.”[1]

The Significance of These Findings

From 1977 onward, based on a belief that saturated fat caused heart disease, both Canada and the US changed their respective dietary recommendations to move the diet away from consuming fat — especially saturated fat, to a diet where more than half the calories (55-60% in Canada, 45-65% in the US) were from carbohydrate. The goal was to lower the risk of cardiovascular disease based on the fact that eating saturated fat raised total LDL (LDL-C), and it was assumed that higher total LDL was tied to increased risk of heart disease. The problem was that it wasn’t known until many years later that there are different types of LDL particles (you can read more about that here) and that it is the small, dense LDL particles that are associated with heart disease, not all LDL particles [2].  

Coinciding with the recommendation for people to eat less saturated fat and more carbohydrate as the main source of calories, we have seen obesity rates go from ~10% of the population in both countries, to 1 in 3 people in the US, and 1 in 4 people in Canada — with another 1/3 of people falling in the overweight category.

What this newly published reassessment of the data indicates is that the American and Canadian diet, which has shunned whole-fat dairy, unprocessed animal meats and eggs for the last 40+ years did so without benefit to cardiovascular disease rates, or rates of death.

Telling people to eat “low fat” everything and to avoid butter, red meat and eggs not only did not do what it was intended to do, it has likely been a significant contributor to the obesity epidemic we now face, along with astronomical rates of type 2 diabetes, hypertension and yes, cardiovascular disease. How ironic.

The report summarized;

“The dietary recommendation to reduce intake of SFAs without considering specific fatty acids and food sources is not aligned with the current evidence base. As such, it may distract from other more effective food-based recommendations, and may also cause a reduction in the intake of nutrient-dense foods (such as eggs, dairy, and unprocessed meat) that may help decrease the risk of CVD, type 2 diabetes, and other non-communicable diseases, but also malnutrition, deficiency diseases and frailty, particularly among “at-risk” groups. Furthermore, based on several decades of experience, a focus on total SFA has had the unintended effect of
misleadingly guiding governments, consumers, and industry toward foods low in SFA but rich in refined starch and sugar.“[1]

The Study’s Conclusion

The report concluded;

The long-standing bias against foods rich in saturated fats should be replaced with a view towards recommending diets consisting of healthy foods. What steps could shift the bias? We suggest the following measures:

1) Enhance the public’s understanding that many foods (e.g., whole-fat dairy) that play an important role in meeting dietary and nutritional recommendations may also be rich in saturated fats.

2) Make the public aware that low-carbohydrate diets high in saturated fat, which are popular for managing body weight, may also improve metabolic disease.”

“There is no robust evidence that current population-wide arbitrary upper limits on saturated fat consumption in the US will prevent CVD or reduce mortality.”

Final Thoughts…

I  remember when the 1977 guidelines first came out, and when the 1988 Canada’s Food Guide was new.  I also remember when the majority of people were normal body weight and it was the exception for someone to be overweight or obese. Here it is, more than 40 years later and we now have strong evidence that saturated fat from unprocessed meat, full fat dairy and eggs does NOT contribute to heart disease or death, and is protective against stroke.

Given this evidence, will Health Canada revisit its most recent Canada Food Guide of January 2019 and adjust it’s recommendation to “limit the amount of foods containing saturated fat, such as cream, higher fat meats…cheeses and foods containing a lot of cheese“?

More Info?

If you would like more information about restoring your weight and healthy by eating a diet lower in carbohydrate and which includes real, whole food such as unprocessed meat, full-fat dairy and eggs, please send me a note using the Contact Me form on the tab above.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd

References

  1. Astrup A, Magkos F, Bier, DM, et al, Saturated Fats and Health: A Reassessment and Proposal for Food-based Recommendations: JACC State-of -the-Art Review, J Am Coll Cardiol. 2020 Jun 17. Epublished DOI:10.1016/j.jacc.2020.05.077
  2. 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.

 

Copyright ©2020 BetterByDesign Nutrition Ltd.

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.

New Protocols for In-Person Clinical Operation for Health Professionals

WorkSafeBC has just released what will be required of regulated health professionals such as myself, as a Dietitian to safely run an in-person clinical practice in British Columbia during the ongoing Covid-19 outbreak, and it is much more involved than I imagined when I wrote a recent article. As well, these protocols are in addition to the obligations required prescribed by our professional college, as well as abide by any relevant orders, notices, or guidance issued by the provincial health officer, and the relevant health authority, in my case Fraser Health.

The WorkSafeBC protocols include sections on Understanding the Risk, Selecting Protocols for the Workplace, as well as detailed Protocols for Health Professionals.

Understanding the Risk

The WorkSafeBC website outlines that the virus that causes COVID-19 is spread in several ways, including through droplets when a person coughs or sneezes, and from touching a contaminated surface before touching the face. It is outlined that risk or person-to-person transmission is increased the closer a healthcare professional comes to other people, the amount of time a healthcare professional spends near them, and the number of people seen by a healthcare professional.  The site emphasizes that “physical distancing measures help mitigate this risk”. The WorkSafeBC website also emphasizes that the risk of surface transmission is increased when many people contact same surface, and when those contacts happen in short intervals of time, therefore “effective cleaning and hygiene practices help mitigate this risk”[1].

Selecting Protocols for the Workplace

The WorkSafeBC website notes that there are different protocols which offer different levels of protection and emphasize that “Wherever possible, use the protocols that offer the highest level of protection and add additional protocols as required”[1].

WorkSafeBC Covid-19 Hierarchy of Controls [1]
Elimination – first level protection –  Limit the number of people in the workplace  by implementing work-from-home arrangements where possible, limiting occupancy, rescheduling work tasks, or by other means. Rearrange work spaces to ensure that health professionals are at least 2 m (6 ft) from co-workers, customers, and other members of the public.

Engineering controls – second level protection : if it is not always possible to maintain physical distancing, then install barriers such as plexiglass to separate people.

Administrative controls – third level protection – WorkSafeBC encourges the establishing of clinic rules and guidelines, such as cleaning protocols, making sure there is no sharing of equipment, and implementing one-way doors, or walkways, in order to minimize risk.

Personal Protective Equipment (PPEs) – fourth level protection – If the first three levels of protection aren’t enough to control the risk, WorkSafeBC recommends considering the appropriate use of non-medical masks, and to be aware of limitation of non-medical masks to protect the wearer from respiratory droplets.

Protocols for Health Professions

The list of protocols for healthcare professionals is extensive and includes several categories, including those for;

(a) hygiene, cleaning and disinfection – Ensure adequate hand washing facilities are available, and provide approved alcohol-based hand sanitizers,
Encourage staff and clients to practice hand hygiene upon entering and exiting the clinic. Identify all common areas such as clinical space, washrooms, etc. and high contact surfaces such as door handles, stair rails and develop and implement a cleaning and disinfection schedule and associated procedures. Increase cleaning and sanitizing of shared equipment and facilities (e.g. scales, washrooms). Develop and implement protocols for sanitizing treatment areas and equipment to prevent surface transmission between clients. Ensure safe handling and effective application of cleaning products.

(b) modifying staff areas and workflowWork remotely whenever possible, develop and enforce policy that staff stay home when sick, hold meetings virtually through use of teleconference or online meeting technology and where in-person meetings are required ensure people are positioned at least two metres apart. Consider staggering start times / appointment times to reduce the number of people in the workplace at a given time. Minimize the number of co-workers that staff are interacting with, prioritize the work that needs to occur at the workplace in order to offer services. Minimize the shared use of equipment where possible, consider the requirement for staff to have dedicated work clothes and shoes, provide a place for staff to safety store their street clothes while working and change in/out of clothes to prevent cross-contamination upon entry and exit. Consider adjusting the ventilation such as increasing the amount of outdoor air while maintaining the indoor air temperature and humidity at comfortable levels for building occupants. 

(c) scheduling appointments and communicating with clientsDetermine how many clients can be within the clinic at a given time while maintaining at least two metres of physical distance and do not book appoints above this number. In order to accommodate physical distancing, appointment times may need to be staggered. When speaking with clients during scheduling and appointment reminders, ask clients to consider rescheduling if they become sick, are placed on self-isolation, or have travelled out of the country within the last 14 days and attending appointments alone where possible, and not bring friends or children. Consider emailing the client forms that need to be filled out so clients can complete them prior to arriving, and clinics with a website should consider posting information on modifications made to the location and appointment visit procedures.

(d) receptionPost signage at the entrance and within the clinic to assist with communicating expectations, such as hand hygiene, physical distancing, respiratory etiquette, reporting illness or travel history, occupancy limits and no entry if unwell or in self-isolation. Consider placing lines on the floor to mark a two metres distance from the reception desk. Consider use of a transparent barrier such as a plexiglass shield around reception desk, when there is insufficient space to maintain two metre distance between staff and clients. Screen all clients when they check-in for their appointment by asking if they have symptoms associated with COVID-19, have been advised to self-isolate, or have travelled outside of Canada within the last 14 days. Clients that respond in the positive should be asked to leave and reschedule the appointment when deemed clinically appropriate. During transactions, limit the exchange of papers such as receipts if possible and where possible, payments should be accepted through contactless methods.

(e) waiting areaArrange the waiting area in a way that allows at least two metres of physical distance between each client and consider removing extra chairs and coffee tables from the area to support this. Remove unnecessary items and offerings such as magazines etc. and use disposable cups or single- use items where necessary for beverages. Instruct clients to arrive no more than five minutes before their expected appointment. Where room size or layout presents challenges to physical distancing, consider alternative approaches, such as asking clients not to enter the clinic until they receive a text message or phone call to advise that their appointment can start.

(f) provision of health servicesConduct appointments virtually where clinically appropriate, conduct a point of care assessment for risk of COVID-19 for every client interaction and health services should not be performed on ill or symptomatic clients. Where the client requires timely treatment, ensure PPE is used in accordance with BC-CDC guidance. When possible, the clinical staff should position themselves at least 2 metres from the client and where physical distancing cannot be maintained consider the use of barriers and masks to reduce the risk of transmission. Clients should be required to wear masks for services in order to protect workers and workers should also wear masks to protect clients. Consider treating only one client at a time to minimize risks associated with moving between two or more clients, ensure clients are positioned at least 2 metres apart and shared equipment is cleaned and disinfected between uses by clients. If products / equipment is shared, they must be cleaned and disinfected between uses. Practice effective hand hygiene after each client by washing hands with soap and water or using an alcohol-based hand sanitizer approved by Health Canada. Where feasible, workers should avoid sharing equipment or treatment rooms and treatment rooms should be allocated to a single worker per shift.

(g) preparing for the next appointment and the end of the dayEnsure waiting and treatment areas and equipment are sanitized to prevent surface transmission between clients. Commonly touched surfaces and shared equipment must be cleaned and disinfected after contact between individuals even when not visibly soiled. Towels or any other items contacting a client are to be discarded or laundered between each use. Change into a separate set of street clothes and footwear before leaving work and work clothing should be placed in a bag and laundered after every shift. Shower immediately upon returning home after every shift.

As well, the WorkSafeBC website has protocols for documentation and training of staff, as well as links to the various professional colleges for health professionals to check additional requirements for their profession.

The Effect of these Necessary Protocols

These enhance protocols take time away from healthcare professionals being able to schedule actual clinical appointments. They require PPEs to be available and provided when necessary, as well as require extra time and labour for cleaning and disinfecting waiting areas, office equipment and washrooms, and to dispose of the waste. As much as we would all like things to “return to normal”, there is the need to accept that for now, this is the “new normal”.

For clinical practices that require a clinician to touch a client in the provision of services, such as in dentistry or registered massage therapy or physiotherapy there is no choice, but this is not the case in my practice. Thankfully, we are living in an era where there is secure video conferencing available which is ideal for the services that I provide as a Registered Dietitian, and is recommended by WorkSafeBC as the first approach when possible in the provision of health services.

Use of professional HIPAA and PIPEDA compliant telemedicine software

I have been providing Distance Consultations for over a decade; which are virtual ‘face-to-face’ visits that are functionally indistinguishable from the in-person services I provided prior to Covid-19. They are a very efficient use of my client’s time, as well as my own, and no PPEs are required, no disinfecting or extra hand-washing, or sanitizing of waiting areas, office space and washrooms between each client, and appointments are not spread out through the day due to the need to carry out decontamination tasks between clients.

I use secure HIPAA & PIPEDA compliant telemedicine software – with no download required.

During virtual appointments my clients and I see each other’s faces when we meet, and can comfortably talk, laugh and even sneeze without concern. and weight obtained from people’s own scales is more than adequate for the types of clients I see — and I provide my clients with written instructions for measuring their waist circumference the same way I would do it if they were in my office.

More Info?

If you would like more information about the different type of Dietetic services I provide, please have a look under the Services tab or in the Shop. If you have any service-related questions please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd

References

WorkSafeBC – Health professions: Protocols for returning to operation,  https://www.worksafebc.com/en/about-us/covid-19-updates/covid-19-returning-safe-operation/health-professionals

Copyright ©2020 BetterByDesign Nutrition Ltd.

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.

Diabetes Canada Deems Low Carb and Very Low Carb Diet Safe and Effective

Diabetes Canada has just released a new Position Statement acknowledging that a low carb and very low carb (keto) diet is both safe and effective for adults with diabetes.

Reflecting back on their 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada released in April 2018 and covered in this article from my affiliate practice, Diabetes Canada clarified in this new Position Statement that it was not their intention to restrict the choice of individuals with diabetes to follow dietary patterns with carbohydrate intake that were below the consensus recommendation of 45-60% energy as carbohydrate, nor to discourage health-care practitioners from providing low-carb dietary support to individuals who wanted to follow a low-carb meal pattern. 

In the new Position Statement, Diabetes Canada acknowledged what I’ve written about previously, that Diabetes Australia, Diabetes UK, and the American Diabetes Association (ADA) in conjunction with the European Association for the Study of Diabetes (EASD) have developed position statements and recommendations regarding the use of low carbohydrate and very low carbohydrate (ketogenic) diets for people with diabetes. They state that from these previous international position statements and recommendations, several consistent themes have emerged — specifically that low carbohydrate diets (defined as less than <130 g of carbohydrate per day or <45% energy as carbohydrate) and very low carbohydrate diets (defined as <50 g of carbohydrate per day) can be safe and effective both in managing weight, as well as lowering glycated hemoglobin (HbA1C) in people with type 2 diabetes over the short term (<3 months).

Diabetes Canada explained in the publication that they periodically develop position statements in order to address issues that are important for people living with diabetes, as well as their health-care providers and when there is either insufficient data to perform a systematic review, or there is no high level evidence (e.g. double-blind placebo controlled studies).

Diabetes Canada stated that this new position statement was developed in response to emerging evidence. as well as a shift in international consensus regarding lower carbohydrate diets — with the goal of providing important clarification for people living with diabetes, as well as health-care providers. It is their hope that this update will make effective engagement with multi-disciplinary teams easier, as well as avoid inter-professional tensions, as well as clearly identify areas where there are key safety issues and the need for clinical monitoring.

The purpose of the position statement was to summarize the evidence for the role of low carbohydrate diets (<51-130g carbohydrate/day) or very low- carbohydrate diets (<50g carbohydrate/day) in the management of people diagnosed with type 1 and type 2 diabetes.

Summary of the Evidence – type 2 diabetes

Low Carbohydrate Diets

A review of the evidence found that a low carbohydrate diet (<51-130g carbohydrate/day) may be effective for weight loss, improved blood sugar control including a reduction in need for blood sugar lowering medication (anti-hyperglycemic therapies).

Also noted in the position paper is that while other dietary approaches for managing type 2 diabetes may be effective for weight loss and better blood sugar control, they have not achieved this while also reducing the need for blood-sugar lowering medication. Diabetes Canada calls this a  “meaningful outcome”.

Very Low Carbohydrate Diets

Of significance, this new position statement states that a review of the current literature suggests that very low- carbohydrate diets (<50g carbohydrate/day) may be superior to higher carbohydrate diets for improving blood sugar control and body weight, and that it can reduce the need for blood sugar lowering medications in the short term (up to 12 months).

They state that evidence regarding longer-term benefits is limited.

Summary of the Evidence – type 1 diabetes

The new position paper states that “there is very little reliable data and major evidence gaps which make it difficult to make general  recommendations with any confidence” for those with type 1 diabetes.

That said, the paper does state that for those living with type 1 diabetes, significant improvements in outcomes such as lower HbA1C, reduced insulin requirements, less variability in blood sugar and weight loss have been reported by individuals who have chosen to follow a low carbohydrate or very low carbohydrate diet.

Diabetes Canada concludes that “in the absence of clear trial evidence to support generalized recommendations, as well as the positive results experienced by people following low- and very low- carbohydrate diets;

  • health-care providers will need to work as partners with individuals seeking to identify an optimal and sustainable dietary pattern that fits with their individual preferences.
  • Health-care providers will need to recognize that diverse approaches are required to address the complex challenges of diabetes and obesity.
  • Health-care providers should strive to engage with patients in supportive relationships which respect shared decision making. “[1]

Cautions and Safety

Diabetes Canada advised that insulin and/or sulphonylurea doses may need to be reduced or discontinued to avoid hypoglycemia (low blood sugar) in those following a low carb or very low carb diet, and that SGLT2 inhibitors may increase the risk of diabetic ketoacidosis in individuals following low carbohydrate diets. As well, Diabetes Canada states that some added caution may be needed to ensure detection and treatment of hypoglycemia.

Diabetes Canada’s Five Recommendations

  1. Individuals with diabetes should be supported to choose healthy eating patterns that are consistent with the individual’s values, goals and preferences.
  2.  Healthy low carb or very-low-carb diets can be considered as one healthy eating pattern for individuals living with type 1 and type 2 diabetes for weight loss, improved blood sugar control and/or to reduce the need for blood sugar lowering medications. Individuals should consult with their health-care provider to define goals and reduce the likelihood of adverse effects.
  3. Health-care providers can support people with diabetes who wish to follow a low-carbohydrate diet by recommending better blood glucose monitoring, adjusting medications that may cause low blood sugar or increase risk for diabetic ketoacidosis and to ensure adequate intake of fibre and nutrients.
  4. Individuals and their health-care providers should be educated about the risk of diabetic ketoacidosis while using SGLT2 inhibitors along with a low carbohydrate diet, and be educated in lowering this risk.
  5. People with diabetes who begin a low carbohydrate diet should seek support from a dietitian who can help create a culturally appropriate, enjoyable and sustainable plan. A dietitian can propose ways to modify carbohydrate intake that best aligns with an individual’s values, preferences, needs and treatment goals as people transition to- or from a low carbohydrate eating pattern.

Healthy Low Carb and Very Low Carb Diets

Finally, Diabetes Canada underscores that Canadians both with- and without diabetes who choose to adopt a low or very low-carbohydrate dietary
pattern “should be encouraged to consume a variety of foods recommended in Canada’s Food Guide”, and that “regular or frequent consumption of high energy foods that have limited nutritional value, and those that are high in sugar, saturated fat or salt, including processed foods and sugary drinks, should be discouraged.”

Final Thoughts…

As a Dietitian who has been helping individuals in Canada safely follow a variety of meal patterns over the past 12 years, as well as a low carbohydrate and very low carbohydrate diets over the past 5 years, I am delighted that Diabetes Canada shares the consensus of other international groups that have determined that these diets are both safe and effective for adults to follow in order to get much better blood sugar control, and for weight loss.

More Info?

If you would like more information about how I can help you get started on a low carbohydrate or very low carbohydrate diet, please reach out to me by sending me a note using the Contact Me form on the tab above.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lBetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Reference

  1. Diabetes Canada, Diabetes Canada Position Statement on Low Carbohydrate
    Diets for Adults with Diabetes: A Rapid Review Canadian Journal of Diabetes (2020), doi: https://doi.org/10.1016/j.jcjd.2020.04.001.

Copyright ©2020 BetterByDesign Nutrition Ltd.

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.

Now That Things Are Getting Back to Normal – clinical appointments

INTRODUCTION: Governments around the world are beginning to relax lock-down measures put in place due to the Covid-19 pandemic and with that, many people are looking forward to having life ‘get back to normal’. But will it, and how soon?

For the past few months, we’ve stayed at home and sheltered-in-place in order to keep the healthcare system from becoming overwhelmed with too many cases of Covid-19 all at the same time. While there is much debate on social media as to whether things were done soon enough, or whether the measures taken should have been implemented at all, here in British Columbia, we are expecting to see the restoring of some medically-related services under enhanced protocols beginning mid-May[1]. 

What can people expect when it comes to medically-related services such as Dentists, Physiotherapists, Registered Massage Therapists, Chiropractors and Dietitians? Each of these types of professionals require a different amount of physical contact with clients. For example, Dentists and Physiotherapists must be able to touch their clients in order to provide services, therefore the types of personal protective gear and physical distancing barriers they will need to use will be very different than for someone who is a clinical counsellor or for me, as a Dietitian.

In my case, there would be the need to space out in-person appointments so that clients can physically distance from one another as one client is leaving and another arrives. What this would mean is that I would either need to see fewer people in the course of a day to ensure that there was no overlap between clients, or to provide a waiting area with chairs spaced 2 meters apart, which would need to be sanitized after each use.  This extra time would eat into my clinical day and also provide me much less flexibility for me to spend more time with client should it been necessary, since ensuring adequate social distancing between clients would take precedence. In fact, regulations require that before an appointment is even set up, there is the need to screen for risk factors and symptoms of COVID-19.

Basic PPEs

To protect both my clients and myself, there would be the need for use of some basic personal protective equipment (PPEs).

For example, I would need to wear a face mask in order to greet my clients, as well as to invite them into my office and I would be wearing gloves and a mask to weigh them, and take their waist circumference. Then there would be the need to sanitize the equipment after each use.

My clients would also need to wash their hands well when they arrive, as put on a clean mask (as my mask helps protect them and theirs helps to protect me). I would need to have disposable masks on hand in the event a client didn’t bring one of their own.  I would also need a designated place to throw out used disposable gloves and masks — which would need to be treated as a hazardous waste container, since there would be no way of knowing if someone were an asymptomatic carrier of Covid-19. I would also need a place where I could wash my hands well with soap and water between glove changes, or to sanitize my hands with an alcohol based hand-sanitizer.

To protect both my clients and myself during the assessment, my desk would  need to have a clear plexiglass screen that would enable my clients and I to see each other, but that would protect each other should one of us sneeze or cough, not to mention should we laugh, or “speak moistly”.

illustration of a plexiglass protective barrier around my desk.

The washroom available for client use would need to have disposable towels available, as well as a designated bin for them to be disposed of as they too would need to be treated as potentially hazardous waste and the bathroom would need to be sanitized after each use.

These enhance protocols take time away from scheduling actual clinical appointments. They require PPEs to be available and provided when necessary, as well as require extra time and labour for cleaning and disinfecting waiting areas, office equipment and washrooms, and to dispose of the waste. For clinical practices that require a clinician to touch a client in the provision of services such as in dentistry or registered massage therapy or physiotherapy, there is no choice, but in my practice there really is no need.

I have been providing Distance Consultations for over a decade; which are virtual ‘face-to-face’ visits that are functionally indistinguishable from the in-person services I provided prior to Covid-19. Virtual appointments are a very efficient use of my client’s time, as well as my own, and no PPEs are required, no disinfecting or extra hand-washing, or sanitizing of waiting areas, office space and washrooms between each client. I can see many more clients in a day because appointments are not spread out due to the need to carry out decontamination tasks between clients.

During virtual appointments my clients and I see each other’s faces when we meet, and can comfortably talk, laugh and even sneeze without concern.  Weight from people’s own scales is more than adequate for the types of clients I see, and I provide each of my clients with written instructions for measuring their waist circumference the same way I would do it if they were in my office.

Until When…?

It is apparent that enhanced protocols will need to remain in place in a clinical office setting until there is either a safe and effective vaccine available, or herd-immunity is obtained. Herd immunity is where the spread of the contagious virus within a population is sufficiently low because people had developed antibodies to it from exposure to the virus itself.  The challenge in the Covid-19 pandemic is that a reliable vaccine is estimated to be a year or 18 months away and herd-immunity via exposure to the virus is unlikely given that only those who get very ill with Covid-19 produce antibodies.

As I wrote about in a recent post, an article published April 27, 2020 in the journal The Lancet reported that while ~90% of those who have been hospitalized with severe Covid-19 develop IgG antibodies in the first 2 weeks, in non-hospitalized individuals with milder disease or with no symptoms, under 10% develop specific IgG antibodies to the disease[2]. That means that people that don’t get sick enough to require hospitalization likely don’t produce antibodies to the virus, resulting in very low herd immunity. As a result, in a clinical setting, these enhanced protocols will likely need to be maintained until a safe and effective vaccine is available, which is not going to be anytime soon.

The New Normal

As much as we would all like things to “return to normal”, there is the need to accept that for now, this is the “new normal”.

Thankfully, we are living in an era where there is secure video conferencing available which is ideal for clinical work that does not involve clinicians touching clients such as the ones that I provide as a Registered Dietitian.

More Info?

If you would like more information about the different type of Dietetic services I provide, please have a look under the Services tab or in the Shop. If you have any service-related questions please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Reference

  1. Government of British Columbia, BC’s Restart Plan, May 6, 2020,  https://www2.gov.bc.ca/gov/content/safety/emergency-preparedness-response-recovery/covid-19-provincial-support/bc-restart-plan#next-challenge
  2. Altmann DM, Douek D, Boyton RJ, What policy makers need to know about COVID-19 protective immunity, The Lancet, April 27, 2020, DOI:https://doi.org/10.1016/S0140-6736(20)30985-5

 

Copyright ©2020 BetterByDesign Nutrition Ltd.

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.

 

 

Better Outcome in Covid-19 and T2D with Well-Controlled Blood Sugars

A new study published this past Friday (May 1, 2020) in the journal Cell Metabolism has reported that people with type 2 diabetes (T2D) are at much greater risk of having a poor outcome in Covid-19 if they have poorly controlled blood glucose.

The study looked at data from 7337 people who were hospitalized with Covid-19 in nineteen different hospitals in Hubei Province in China. Over 950 people had T2D (952) whereas the remaining almost 6385 people did not and among those with type 2 diabetes, 282 had well-controlled blood glucose, whereas the other 528 did not.

Consistent with what I reported in a recent review of a previous study in Covid-19, people admitted to hospital with the virus and who were diagnosed with T2D had poorer outcomes. In the present study, those with T2D required more medical interventions including requiring supplemental oxygen and/or ventilators than those without type 2 diabetes, and had much higher death rates (mortality) than those without T2D.  Mortality in Covid-19 in those with T2D was 7.8%, but in Covid-19 without T2D, mortality was only 2.7%. What was very encouraging was that those with people with T2D who were admitted to the hospital with COVID-19 and who had maintained well-controlled blood glucose ranging between 3.9 to 10.0 mmol/L (70-180 mg/dl) had much lower death rates than those people with poorly controlled blood glucose, with the upper limit of blood sugar readings exceeding 10.0 mmol/L (180 mg/dl).

Graphical illustration of survival rate in well-controlled T2D vs poorly-controlled blood glucose [1].
The findings were very sobering!

Almost 99% (98.9%) of those in hospital with Covid-19 and who had type 2 diabetes but well-controlled blood glucose survived Covid-19.

BUT

11% of those in hospital with Covid-19 and who had type 2 diabetes but poorly controlled blood glucose, died.

These findings provide clinical evidence that having better blood sugar control  leads to significantly better outcome in those hospitalized with COVID-19 and who have pre-existing type 2 diabetes.

More Info?

If you would like more information about how I can help you better control your blood sugar levels and aim put your type 2 diabetes into remission, please reach out to me.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Reference

Zhu L, She GZ, Cheng X, et al, Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metabolism, 2020; DOI: 10.1016/j.cmet.2020.04.021

Copyright ©2020 BetterByDesign Nutrition Ltd.

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.

Too Much and Too Little is Killing Us – reducing comorbidities

I just got “the call” that my mother who lives on the other side of the country, has tested positive for Covid-19. She has all of the major comorbidities, so prognosis is not good. Following the news, most of us know that age, obesity, hypertension and diabetes are known to significantly increase the risk of requiring hospitalization and death from Covid-19 (you can read more about that here, here and here), yet all but one of these comorbidities can be put into remission.  We can’t change our age, but we CAN reduce our weight, lower our blood pressure and normalize our blood sugar. To improve our quality of life outside of the pandemic, and to have the best chance of fighting it off if (or more likely when) we get it, we need to put our energy into achieving a normal body weight (and waist circumference), blood pressure and blood sugar now.

I am from a family of people that always ‘battled with their weight’.

My dad was tall and very fit when he was younger, a boxer and a ski-jumper but as he aged he accumulated excess weight around his middle. He then developed type 2 diabetes, high blood pressure and heart issues and eventually was diagnosed with Alzheimer’s disease, which is sometimes referred to as ‘type 3 diabetes’ by some clinicians. I wrote this article about that when he was first diagnosed.

My dad died just a few weeks shy of his 91st birthday, which is a ‘ripe old age’ of course, but for the last 40 years of his life, he was not in good health. He took several medications due to multiple metabolic conditions related to his diet and lifestyle. Except for his age, many of these conditions could have been put into remission — or at very least, been much better controlled with a change in diet and lifestyle.

My mom will be turning 85 this fall, and has been overweight since I was little. She too has type 2 diabetes and takes multiple medications for various conditions, many related to diet and lifestyle; conditions which could have been greatly improved, if not put into remission with a change in diet and lifestyle. It wasn’t for lack of trying “diets”. When I was young, she weighed her food, counted points and went to “groups” and at times she lost weight, only to put it all back, and then some. Eventually, she stopped trying. I can’t say that I blame her, given what I now know about the drivers to hunger.

Shared comorbidities

When I became overweight and then obese, and developed type 2 diabetes and high blood pressure, I justified that I was at high risk since both of my parents had the same.  I realize now that the “high risk” was our shared diet and lifestyle, more than genetics. Our shared comorbidities were adopted.

I grew up loving to eat good food and unfortunately considered food as both a reward, and a comfort. When someone was happy, we celebrated with good food. When someone was sad, we consoled with “comfort food”.  Food was “medicine”, but not in a good way. It didn’t heal, but contributed to the underlying hyperinsulinemia that drove the disease process. (I’ve written several articles about this topic, but if you only want to read one, I’d recommend this one.)

Those who have followed me for some time know that 3 years ago I began what I call my “journey”.  It took almost two years to do, but I lost ~60 pounds and a foot off my waist and I put my dangerously high blood pressure and uncontrolled type 2 diabetes into remission, as a result.  I recently posted a summary here, to mark my three year health recovery anniversary; two years of active weight loss and a year of maintenance.

Left: April 2017, Middle: April 2019, Right: April 2020

So why am I writing this post?

Like many people, I am upset by this whole “Covid thing” — not just because of my mom being diagnosed. I’ve been following the news, and realize that the hope for a vaccine any time soon is dim, and effective treatments are still lacking. An article published in the journal The Lancet the other day reported that while ~90% of those who have been hospitalized with severe Covid-19 develop IgG antibodies in the first 2 weeks, in non-hospitalized individuals with milder disease or with no symptoms, under 10% develop specific IgG antibodies to the disease.  That means that except for the sickest people who actually survive being hospitalized for several weeks with Covid-19, more than 90% of people who get Covid-19 and recover outside of hospital don’t develop antibodies to this virus [1]. Since the whole purpose to develop a vaccine is to challenge the body to develop antibodies to the virus — the very fact that most of the time people who don’t get that sick don’t develop antibodies, means that the likelihood of most people developing antibodies to a vaccine may be minimal.  As well, in light of this data herd immunity is also a dim prospect because most people that get this disease don’t produce antibodies, which means they aren’t immune and can probably get this virus again.

With little immediate hope of an effective vaccine or of herd immunity, what CAN we do to lower our risk?

I think that we first need to realize that many experts believe it is simply a matter of time until we are all exposed to the SARS-CoV2 virus and develop Covid-19, so we must look at lowering our risk of having a poor outcome. We can’t change our age, which is the biggest risk factor but we CAN do something to change the high risk comorbidities such as obesity, high blood pressure and diabetes.

Too Much and Too Little is Killing Us

For many of us, having both too much and too little is killing us.

We have diets with way too much refined carbohydrate, usually combined with large amounts of refined fat, and our usual diet is full of these in the form of pizza, pastries, take out foods and snack foods.  We now know from a study that was published almost 2 years ago[2] that this combination of both refined carbs and fat results in huge amounts of the neurotransmitter dopamine being released from the reward centre of our brain — way more than when we eat foods with only carbohydrate, or only fat separately. This huge amount of released dopamine results in us wanting to eat these foods, and craving these foods, and being willing to pay more for these foods than foods with only carbs or only fat [2]. Dopamine makes us feel good, and is the same neurotransmitter that is released during sex and that is involved in the addictive “runner’s high” familiar to athletes. This is one powerful neurotransmitter! It is this dopamine that is driving why so many people on “lock-down” have turned to baking bread and pastries for comfort, and buying snack foods with this same combination once they finally get through a long line to get into a grocery store! 

Too much of these refined “foods” is contributing to 1/3 of Americans and 1/4 of Canadians being obese, and another 1/3 in both countries being overweight. These foods are driving the hyperinsulinemia that underlies many metabolic conditions, including type 2 diabetes and hypertension.  These diseases were killing a great many of us before Covid-19, but knowing that these comorbidities increase our risk of hospitalization and death when we get the virus, why don’t we consider limiting these? I think it is because eating these foods make us feel good and so we self-medicate our stressful lives with something that is socially acceptable. High carbohydrate and fat foods are much more socially acceptable but what will it take for us to see that this for what it is and to consider that we need to change how we eat. If we aren’t willing to admit that our obesity, high blood sugar and high blood pressure are a problem, then maybe we are simply in denial. I certainly was, and wrote about this in “A Dietitian’s Journey”, the account of my own health recovery.

No, I am NOT saying that “all carbs are evil” and I’ve written about this previously, but we need to differentiate between what most of us eat as “carbs” and whole, real food that have carbs in them. I believe we need to eat significantly less of the refined foods that are contributing to our collective weight problem and metabolic health issues, and eat more of the real, whole foods that have gone by the wayside in our diet. I’ve written about the science behind this type of dietary change in many previous articles, and that eating this way is both safe and effective. What I can’t do is motivate people to want to change.

It is my hope that by presenting the evidence, as I have in several recent articles posted on this website that comorbidities such as obesity, hypertension and diabetes are significant risk factors to requiring hospitalization or of dying of Covid-19, that it may motivate some people to consider making some changes. If not now, when — especially given that the hope of a vaccine and/or herd immunity is likely a long way off.

I wish each of you good health and a long life.

If I can help, please let me know.

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2020 BetterByDesign Nutrition Ltd.

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.

Reference

  1. Altmann DM, Douek D, Boyton RJ, What policy makers need to know about COVID-19 protective immunity, The Lancet, April 27, 2020, DOI:https://doi.org/10.1016/S0140-6736(20)30985-5
  2. Di Feliceantonio et al., 2018, Supra-Additive Effects of Combining
    Fat and Carbohydrate on Food Reward, Cell Metabolism 28, 1–12

 

 

My Three Year Health Recovery Anniversary – a Dietitian’s Journey

I delayed posting this update to due to the current Covid 19 pandemic, but thought by now we could all use with a little distraction. I hope that this post about my health and weight recovery serves as encouragement as to what is possible simply by eating real, whole food, and sticking with it.

Me – April 2017, 2019 and 2020

Three years ago, on March 5th, 2017 I was sitting at my desk in my office and I didn’t feel well. I didn’t even know what kind of “unwell” I felt.  I decided to take my blood pressure to see if that would give me a clue.  I was alarmed with the results and decided to lie down and take it again. That didn’t help. Not only was my blood pressure high, it dangerously high.  I was having what is known as a “hypertensive emergency”.  While I hadn’t done so in way too long, I also decided to take my blood sugar. The result was 13.2 mmol/L (238 mg/dl) only a half an hour after I ate, which was way too high — even for someone who had been diagnosed with type 2 diabetes five years earlier.  Here I was, an obese Dietitian with a body mass index (BMI) well over 30, dangerously high blood pressure and blood sugar that clearly showed my type 2 diabetes was not well controlled and I knew that all of these factors put me at significant risk of having a stroke or heart attack. I was scared. Actually I was terrified.

As I’ve said on every podcast I’ve been a guest on, and have written about many times, what I should have done at that point was to have gone straight to my doctor’s office;  even knowing that he would have sent me directly to the hospital by ambulance or taxi due to my dangerously high blood pressure.  I should have gone, let them treat me to get my blood pressure down, including taking the medications they prescribed. Then, with my doctor’s oversight I could have begun a well-designed therapeutic diet to lower all of these significant metabolic markers and in time had my doctor gradually de-prescribed the various medications I would have been given, as my weight, blood pressure and blood sugars normalized.

I didn’t. It was foolish. What I did instead was to immediately change my diet and lifestyle and while I fully acknowledge that this was not a wise choice, that’s what I did.

I was so scared.

In the preceding 6 months, I had two girlfriends die within 3 months of each other; one of a massive heart attack, and the other of a stroke. Both worked in healthcare their entire lives and both had become overweight and had developed some of the same metabolic issues I had. I was terrified because I realized that if I didn’t change, I could be next.

April 2017

That day, I printed off my last set of blood test results, and took all my body measurements as if I were a client. I then designed a Meal Plan for myself as I do for others and from that day on, implemented it “as if my life depended on it”, because quite literally, it did.

There’s been no looking back! March 5, 2017 was the beginning of my health and weight recovery journey; A Dietitian’s Journey.

April 2018

In the first year, I lost 32 pounds and 8 inches off my waist, and my glycated hemoglobin (HbA1C) no longer met the criteria for Type 2 Diabetes (i.e. was ≤ 6.0 %), and my blood pressure ranged between normal and pre-hypertension. Updated lab work indicated that my triglycerides and cholesterol levels were optimal, however my updated measurements showed that my waist circumference was still not half my height, which is what it needed to be (you can read more about the reason for that here). In addition, my fasting blood sugar remained higher than it should be. I still had work to do. I was in recovery, but not recovered yet.

After consulting with two physician colleagues, I made the decision to lower my carbohydrate intake, and continued to monitor my blood pressure daily and blood sugar several times per day.  I also began doing some resistance training exercises with equipment I had on hand (and that had been collecting dust for years).

April 2017 & April 2019 (same outfit)

After 2 years on my recovery journey, I had lost a total of 55 pounds and 12 inches off my waist but since my blood pressure remained between the pre-hypertensive and hypertensive range, and in discussion with my doctor’s colleague, I decided to go on a “baby dose” of Ramipril to protect my kidney function. Even though my blood sugar was good and my HbA1C was below the cut-off for type 2 diabetes, my endocrinologist started me on Metformin as a result of my father’s recent diagnosis of Alzheimer’s disease.

I didn’t look at starting on either of those medications as “failure”, as I probably would have been prescribed those at much higher doses from the beginning had I gone to see my doctor March 5, 2017. It was part of my recovery process. My goal however was to make changes so that blood pressure medication would no longer be necessary, but I didn’t know what other changes I could make to have it to come down to a normal level, and for my fasting blood glucose to continue improve as well. After much reading in the scientific literature about circadian rhythms , I realized that to be successful I needed to change when I ate (and didn’t eat) as well as when I was exposed to bright light in order to get my body working according to its natural circadian (24-hour) cycles. I made the changes documented in the literature and began to sleep much better (falling asleep and staying asleep, when I had previously had poor sleep for years). A few months of home monitoring indicated my blood pressure was normal or slightly below and I was getting fasting blood glucose numbers I hadn’t seen before (4.7mmol/L – 5-2 mmol/L). I hadn’t “arrived” but my recovery phase was definitely approaching the end.

A visit to my doctor’s office just before Covid 19 began indicated I had blood pressure that was just below the normal cutoff of 120/70 for someone who is not diabetic, so my doctor de-prescribed the blood pressure medication and recent lab test results indicated that I have completely normal fasting blood sugar [5.2 mmol/L (94 mg/dl)]. Over the past year without trying, I lost another 5 pounds and a little less than an inch off my waist and I am guessing this was probably the result of continued loss of fat balanced by increased weight from added muscle I gained as a result of the intermittent resistance training I was doing.

April 2020

I am now a normal body weight. I have an optimal waist circumference (slightly less than half my height). I am in remission of type two diabetes; both as assessed by fasting blood glucose and HbA1C, and my high blood pressure is in remission. I went from taking 12 different medications three years ago, to leaving my doctor’s office a few weeks ago with one prescription for something non-metabolically related, and a prescription for glucose test strips.

I feel good about myself, about my health and how I look — so much so that in September of this past year I decided to stop straightening my hair and now wear it the way it grows out of my head.  I am “comfortable in my own skin” (and hair) for the first time in almost 3 decades. I didn’t lose weight quickly but it took me many years to become THAT metabolically unhealthy that I gave myself the time I needed to get well and am staying well, without any added effort. The process wasn’t at all difficult to accomplish, or difficult to maintain. All it took was eating real, whole food and reducing the amount of carbohydrate-based foods I ate.  What is nice is that after 3 years on a therapeutic diet, I am now able to add in small amounts of higher carbohydrate-based whole foods into my diet, and tolerate them very well.

While there are many studies showing many others have accomplished similar clinical results as I have eating the same way, doing it myself enables me to encourage my clients because I have “been” there, and I came back!

More Info?

If you would like more information about how I can help you lose weight and keep it off or improve blood pressure, blood sugar or cholesterol please reach out to me. All my services are now provided via Distance Consultation but I already have more than a decade of experience providing virtual nutrition support, so this is nothing new for me. I am licensed as a Dietitian in every province in Canada except PEI and can also provide nutrition education services to those in the US and elsewhere.

You can find more about the details of the different packages I offer by looking under the Services tab or in the Shop. If you have any service-related questions please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2020 BetterByDesign Nutrition Ltd.

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.

 

Obesity Most Significant Risk Factor to Covid-19 Hospitalization after Age

A new large-scale preliminary US study[1] looking at data from more than 4000 Covid-19 patients who sought medical care at Langone Health Hospital in New York City found that outside of older age (> 75 years of age), obesity was the single most significant risk factor that contributed to requiring hospitalization and critical care, such as requiring being on a ventilator. This is a different study than the one that I wrote about yesterday [2] which found that in people under the age of 60, obesity poses a significant risk factor of hospitalization, especially with respect to requiring Acute Care or Intensive Care (click here to read that article).

We Need to “Get” This

Taken together, these two large-sample US studies find that being obese (which is having a Body Mass Index (BMI) of 30 or more) puts those under 60 years of age at significantly greater risk of being hospitalized and requiring critical care than any other factor, including high blood pressure (hypertension), diabetes and cardiovascular disease (CVD) [2], and having a BMI of 40 is the most significant risk factor after older age[1]. Old or young, being obese is a significant risk factor to requiring medical intervention in Covid-19. What many don’t realize is that 2/3 people in the US and Canada are either overweight or obese. 

How Big an Issue is Obesity?

One in three adults in the US are obese and one in four adults in Canada are obese. Not just overweight, but obese.

We have become used to this being common place, so much so that many of us consider “average weight” what is actually overweight (BMI between 25 and 30) and consider someone to be “overweight” when they are actually obese.

As mentioned in an article from earlier this week, recent US data found that 90% of patients hospitalized due to Covid-19 had underlying medical conditions including hypertension (high blood pressure), obesity, diabetes and cardiovascular disease and as noted in that article, only 12% adults are considered metabolically healthy as defined as having a healthy waist circumference and normal systolic and diastolic blood pressure, blood glucose and HbA1C and cholesterol such as HDL, as well as triglycerides.

Looking at this information together, we need to understand that something as straight-forward as losing weight, particularly the weight that we carry around our middles can significantly improve our outcome should we become infected with Covid-19. 

With many experts suggesting that it is only a matter of time until we are all exposed to Covid-19, it would seem that it ‘s not a matter of “if”, but “when” and while we can’t change our age, but if we are overweight or obese, we can lose weight. If we are carrying excess fat around our abdomen (the risk of having an increased waist circumference) — even at normal body weight, we can lower that. It takes being willing to make dietary and lifestyle changes and it take some time, but in a matter of weeks, someone who is currently in the class I obesity category can be re-categorized as overweight and with persistence can achieve a healthy body weight and waist circumference.  Previous studies indicate that significant risk factors such as high blood pressure and abnormal blood sugar can be normalized in as little as 10 weeks with a well-designed diet of whole, real food and by making these changes now we can significantly lower our risk in a fairly short amount of time. Why would we not want to do so now given there is currently no vaccine for Covid-19 and no consistently effective medication yet?

[Note: If I hadn’t already gone from being obese to a normal body weight a few years ago, I certainly would be very motivated to do it now.]

For the past 5 years I have spent about half my clinical time helping others do just that, while helping them considerably improve their lab markers for several different metabolic conditions. Since we are already eating most of our meals at home, now is an ideal time to make the dietary changes needed to lower our risks of requiring hospitalization should we get Covid-19.

More Info?

If you would like more information about how I can help you lose weight and then keep it off, please reach out to me. All my services are now provided via Distance Consultation but I already have more than a decade of experience providing virtual nutrition support, so this is nothing new for me and I am licensed as a Dietitian in every province in Canada except PEI. I can also provide nutrition education services to those in the US and elsewhere.

You can find more about the details of the different packages I offer by looking under the Services tab or in the Shop. If you have any service-related questions please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

References

  1. Christopher M. PetrilliSimon A. JonesJie YangHarish RajagopalanLuke F. O’DonnellYelena ChernyakKatie TobinRobert J. CerfolioFritz FrancoisLeora I. Horwitz, 
  2. Lighter J, Phillips M, Hochman S et al, Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission, accepted manuscript, Clinical Infectious Diseases. doi: 10.1093/cid/ciaa415,  https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa415/5818333
  3. Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metabolic Syndrome and Related Disorders Vol 20, No. 20, pg 1-7, DOI: 10.1089/met.2018.0105

Obesity Poses Significant Risk to People less than 60 years with Covid-19

As covered in the preceding article, we now know from US data between March 1-30, 2020 that older adults and those with hypertension (high blood pressure), obesity, diabetes and CVD are at an increased risk of requiring hospitalization should they contract Covid-19, but a new study finds that so are young people with obesity.

A study released ahead of publication found that of the more than 3600 people who tested positive for Covid-19 in a large academic hospital in New York City, more than 20% had a BMI of 30-34 (Class I obesity) and more than 15% had a BMI > 35 (Class II obesity or higher). When stratified by age, researchers found significantly higher rates of hospital admission and the requirement for ICU care in patients <60 years of age with obesity.

Compared with patients with a BMI of < 30 (i.e. overweight but not obese), patients under 60 years of age with Class I obesity were;

  • 2.0 times more likely to be admitted to Acute Care
  • 1.8 times more likely to be admitted to intensive care

Compared with patients under the age of 60 years old with a BMI <30 (not obese), patients with a BMI of 35 and above (Class II obesity and higher) were;

  • 2.2 times more likely of being admitted to Acute Care
  • 3.6 times more likely to be admitted to intensive care

Among the 3600 patients who were subjects in this study, there was no significant difference in hospitalization rates and intensive care needs by BMI among people 60 years of age and older, which is consistent with findings reported in the preceding article which found that obesity was a significantly higher risk factor of hospitalization in those 18-49 years of age [1].

Note: As covered in the previous article, hypertension (i.e. high blood pressure) is a significant underlying condition to adults ⩾ 65 years of age hospitalized with Covid-19.

Patients with a BMI of ⩾30 in the current study represented 36% of all patients; which is fairly representative of the US population as a whole which is estimated to have an obesity rate of BMI ⩾30 of 40% [3,4]. Given that obesity rates of BMI ⩾30 in Canada [5] is ~ 33%, it is possible that need for hospitalization and acute or intensive care may be somewhat lower here (i.e. more reflective of the slightly lower obesity rates in Canada).

With a vaccine for COVID-19 a year or longer away, current efforts to reduce the risk of contracting the virus necessarily focus on physical and social distancing, personal hygiene including proper hand-washing techniques and avoiding touching one’s face, as well as wearing face coverings in public places. These are all very important, however those under the age of 60 years of can reduce the risk of getting serious complications or dying from complications from the virus by achieving, then maintaining a healthy body weight.

Weight Loss – easier said than done?

Most people know that achieving and maintaining a healthy body weight is important to lower the risk of getting type 2 diabetes, hypertension and cardiovascular disease. Since we are already eating most of our meals at home and with a covid-19 vaccine a year or more away, now is an ideal time to make the dietary changes needed to achieve a healthy body weight and lower our risks of requiring hospitalization should we get Covid-19. In fact, most people in the class I obesity (BMI > 30) category can make the dietary changes necessary to achieve a normal body weight within in a few months. 

I can help.

More Info?

If you would like more information about how I can help you lose weight and then keep it off, please reach out to me. All my services are now provided via Distance Consultation, but I already have more than a decade of experience providing virtual nutrition support, so this is nothing new for me.  I have both the experience and expertise to help.

You can find more about the details of the different packages I offer by looking under the Services tab or in the Shop. If you have any service-related questions please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

References

  1. Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. ePub: 8 April 2
  2. Lighter J, Phillips M, Hochman S et al, Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission, accepted manuscript, Clinical Infectious Diseases. doi: 10.1093/cid/ciaa415,  https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa415/5818333
  3. Ogden, C.L., et al., Prevalence of Obesity Among Adults, by Household Income and Education – United States, 2011-2014. MMWR Morb Mortal Wkly Rep, 2017. 66(50):p. 1369-1373
  4. State of Obesity, Adult Obesity in the United States, https://stateofobesity.org/adult-obesity/
  5. Statistics Canada, Health at a Glance, Adjusting the scales: Obesity in the Canadian population after correcting for respondent bias,  https://www150.statcan.gc.ca/n1/pub/82-624-x/2014001/article/11922-eng.htm

Copyright ©2020 BetterByDesign Nutrition Ltd.

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.

Why Underlying or Comorbid Conditions are Very Important in COVID-19

It is well-known that older adults are at greater risk of getting serious complications from COVID-19, but few people realize that the majority of people that require hospitalization in the US [1] (and presumably the data is similar in Canada) have very common underlying medical conditions (known as “comorbid” conditions), including high blood pressure (hypertension), obesity, diabetes and cardiovascular disease and chronic lung disease [1]. With a vaccine for COVID-19 coronovirus more than a year a way, current efforts to reduce the risk of contracting the virus focus on physical and social distancing measures, personal hygiene including proper hand-washing techniques and avoiding touching one’s face, as well as wearing face coverings in public places but there is more we can do to reduce the risk of getting serious complications or dying from complications from the virus — and that is addressing dietary and lifestyle changes that are documented to put comorbid conditions such as high blood pressure, type 2 diabetes and obesity into remission.

Early release of a research study on April 8, 2020 [1] reported that between March 1-30, 2020, hospitalization rate in 99 counties of 14 US states was 4.6 people per 100,000 population, and rates were highest amongst those who were ≥65 years of age and those with underlying medical conditions. Among almost 1500 laboratory-confirmed COVID-19–associated hospitalizations, almost 25% were between the ages of 5–17 years, almost 25% were aged 18–49 years, ~30% were aged 50–64 years and 43% were aged ≥65 years. Among those patients with data on underlying medical conditions, almost 90% had one or more comorbid conditions — with almost 50% of patients having hypertension (high blood pressure) or obesity and almost 30% having diabetes or cardiovascular disease. This is huge.

“These findings suggest that older adults have elevated rates of COVID-19–associated hospitalization and the majority of persons hospitalized with COVID-19 have underlying medical conditions.”[1]

Underlying comorbid conditions among US adults with COVID-19

Changing What’s in Our Control to Change

Many of us feel somewhat powerless during this COVID-19 outbreak and while the internet is full of recommendations for dietary supplements, many overlook the most obvious way to lower risk of serious complications by lowering any known comorbid conditions we may have. We can achieve and maintain a normal body weight and waist circumference, normalize blood pressure and blood sugar, and lipid markers such as improving HDL cholesterol and lowering triglycerides.

As covered in an earlier article, a study published in November 2018 reported that 88% of Americans are already metabolically unhealthy[2]; that is, only 12% have metabolic health defined as [2];

  1. Waist Circumference: < 102 cm (40 inches) for men and 88 cm (34.5 inches) in women
  2. Systolic Blood Pressure: < 120 mmHG
  3. Diastolic Blood Pressure: < 80 mmHG
  4. Glucose: < 5.5 mmol/L (100 mg/dL)
  5. HbA1c: < 5.7%
  6. Triglycerides: < 1.7 mmol/l (< 150 mg/dL)
  7. HDL cholesterol: ≥ 1.00 mmol/L (≥40 mg/dL) in men and ≥ 1.30 mmol/L (50 mg/dl) in women

When considering only waist circumference, blood glucose levels and blood pressure levels~50% of Americans were considered metabolically unhealthy [3].  Given the slightly lower rates of obesity in Canada as in the United States, there is likely a slightly lower percentage of Canadians who are metabolically unhealthy, but the similarity of our diets may make that difference insignificant.

While we obviously can’t reduce our age or the presence of chronic lung conditions such as asthma or COPD, we can lower our risk of having severe outcomes should we contract the virus;

  • If we are overweight, we can lose weight.
  • If we have high blood pressure we can make safe and effective dietary changes to lower that, and by adding other lifestyle changes, achieving normal blood pressure without the need for medication is possible.
  • If we have higher than normal blood sugar, we can normalize that through dietary and lifestyle changes. Type 2 diabetes need not be a “chronic progressive disease”! It can be put into remission.
  • If we have abnormal lipid panel (cholesterol), we can change the way we eat to lower triglyceride levels, as well as increase HDL (“good”) cholesterol levels.

Final Thoughts…

There is much about the current situation we can’t change. Physical (social) distancing measures will likely be in place for some time. The need for consistent hand hygiene and avoiding touching our face will likely be come second nature for most of us, as may be the wearing of face coverings in public for many.

But with all of us eating at home almost all of time, now is an ideal time to find out how to eat in such a way to improve our metabolic health and lower our risk of serious outcomes should we contract the virus.

More Info?

If you would like more information about how I can help you and your family eat better, or how I can help you lose weight, lower blood pressure or blood sugar or lower cardiovascular risk, please reach out to me. While all my services are now provided via Distance Consultation, I have more than a decade of experience providing virtual nutrition support.

You can find more about the details of the different packages I offer by looking under the Services tab, or in the Shop and if you have any service-related questions, please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

References

  1. Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. ePub: 8 April 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6915e3
  2. Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metabolic Syndrome and Related Disorders Vol 20, No. 20, pg 1-7, DOI: 10.1089/met.2018.0105

 

Copyright ©2020 BetterByDesign Nutrition Ltd.

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.

Canada Told to Prepare for Possible Pandemic Amidst 7th Case in BC

Note: This article is a follow-up to two previous articles (this one and this one) about the presence of the COVID-19 coronavirus in the Vancouver area, as well as recommendations from the Federal Chief Medical Officer about preparing for an “outbreak” or “pandemic”.

Yesterday, Monday February 24, 2020, Provincial health officer Dr. Bonnie Henry said a 7th case of COVID-19 has been identified in BC [1] and that this patient is a man in his 40s who is a close contact of B.C.’s 6th case, a woman in her 30s who recently returned from Iran [2,3]. Apparently, the man had symptoms prior to the woman being diagnosed. The Globe and Mail reports that the Provincial Health Authority has been working with the Fraser Health Authority to try to identify anyone who may have been in touch with the two latest cases. This would include the fact that Fraser Health Authority sent a letter to all school districts in its region this past Friday, which includes Burnaby, New Westminster, Maple Ridge, Pitt Meadows and the Tri-Cities — warning them that contacts of the woman with coronavirus “may have attended schools in the region and are currently isolated” [4].

The 6th case (and perhaps the 7th case too, as the woman was reported to have a travelling companion) also flew from Montreal to Vancouver on Valentine’s Day, February 14th [5,6]. On February 23, 2020, the BC Provincial Health Authority (PHSA) had advised Air Canada that it planned to contact all passengers who flew out of Montreal that day and who were seated within three rows of the woman so that they can monitor their health for a 14-day period and report any symptoms to a health professional [5,6].

In a dramatic shift from earlier indications that the risks in Canada are “low”, this morning’s Ottawa Citizen newspaper reported that Chief Medical Officer of Health Dr. Theresa Tam acknowledged yesterday (Monday, February 24, 2020) that “Canada may no longer be able to contain and limit the virus if it continues to spread around the world” and that she said “governments, businesses and individuals should prepare for an outbreak or pandemic” [7]. Yes, the “pandemic” word has now been uttered.

The Globe and Mail also reported that Dr. Tam said yesterday, “The window of opportunity for containment – for stopping the global spread of the virus – is closing”, and “…that we have to prepare across governments, across communities and as families and individuals, in the event of more widespread transmission in our community” [8].

Further thoughts…

In addition to the original COVID-19 outbreak in Wuhan, China, a growing outbreak of COVID-19 in Iran and South Korea is of particular concern, especially in the Greater Vancouver area which has thriving Chinese, Iranian and South Koreans communities.

With regards to the possibility of others having arrived from Iran with coronovirus prior to it being identified there, Dr. David Fisman, professor of epidemiology at the Dalla Lana School of Public Health at the University of Toronto said in the Globe and Mail report, “I think it’s highly unlikely that that’s the only individual from a country without [declared] coronavirus disease who has come into Canada [8]”. I think it is likewise reasonable to assume that it is highly unlikely that no one arrived from South Korea before the first cases were identified there, as well.

Practical advice (outside of preparing to have sufficient non-perishable food on hand in case there is a need to self-isolate at home for 14 – 28 days) is to avoid the easiest means of transmission, which is touching someone or something that is contaminated with the virus, and then touching one’s eyes, nose or mouth. Use of alcohol gel is an alternative, when soap and water and a good hand wash for 20 seconds is not possible. Since transmission of COVID-19 can occur from an infected person to others within ~2 meters / 6.5 feet (even if the infected person has no symptoms), avoiding crowded public places such as restaurants, food courts, cashier line-ups and waiting rooms would be prudent. 

With no vaccine against this novel coronavirus or medicine available to treat it, practicing ‘social distancing’ is good advice; which is limiting one’s exposure to places where groups of people gather, decreasing opportunity for the virus to spread. This is where Distance Consultations can help. These have always been very popular with those on the other side of the city and across the country, but with seven local COVID-19 cases, people in the immediate vicinity are glad to have this option especially given me having a decade of experience providing them. You can find out more about Distance Consultations by clicking on the tab above.

More Info?

If you would like more information about the services that I provide, please have a look under the Services tab or in the Shop. If you have service-related questions, please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2020 BetterByDesign Nutrition Ltd.

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

References

  1. The Globe and Mail, Andrea Woo, Feb. 24, 2020, B.C. identifies seventh case of coronavirus, https://www.theglobeandmail.com/canada/british-columbia/article-bc-identifies-seventh-case-of-coronavirus/
  2. Montreal Gazette, Susan Schwartz, February 23, 2020, Passenger from Iran on flight from Montreal to Vancouver tests positive for new coronavirus, https://montrealgazette.com/news/local-news/passenger-from-iran-on-flight-from-montreal-to-vancouver-tests-positive-for-new-coronavirus
  3. CBC, B.C.’s 6th presumptive COVID-19 case flew from Montreal to Vancouver on Feb. 14, https://www.cbc.ca/news/canada/british-columbia/bc-coronavirus-flight-montreal-vancouver-1.5473283
  4. Global News, Sean Boynton, Passenger on Air Canada flight to Vancouver is not a new case of COVID-19: B.C. officials, Feb 23 2020 2:11 pm, updated 5:18 pm), https://globalnews.ca/news/6586274/covid19-air-canada-vancouver-montreal/
  5. Montreal Gazette, Susan Schwartz, February 23, 2020, Passenger from Iran on flight from Montreal to Vancouver tests positive for new coronavirus, https://montrealgazette.com/news/local-news/passenger-from-iran-on-flight-from-montreal-to-vancouver-tests-positive-for-new-coronavirus
  6. CBC, B.C.’s 6th presumptive COVID-19 case flew from Montreal to Vancouver on Feb. 14, https://www.cbc.ca/news/canada/british-columbia/bc-coronavirus-flight-montreal-vancouver-1.5473283
  7. Ottawa Citizen, Elizabeth Payne, Canadians being told to prepare for a possible novel coronavirus pandemic, https://ottawacitizen.com/news/local-news/canadians-being-told-to-prepare-for-a-possible-novel-coronavirus-pandemic
  8. The Globe and Mail, Kelly Grant, February 24, 2020, Canada steps up screening efforts as coronavirus inches toward a pandemic, https://www.theglobeandmail.com/canada/article-canada-steps-up-screening-efforts-as-coronavirus-inches-toward-a

(UPDATED Feb 23) Sixth Case of COVID-19 Coronavirus in Vancouver called a Sentinel Event

Note: This article is a follow-up to an earlier article about COVID-19 coronavirus in the Vancouver area that was posted on February 6th, 2020. Please note this article was updated twice on February 23rd, with the updates posted below.

Provincial health officer Bonnie Henry announced Thursday, February 20th that a woman in her 30s who just returned from Iran this week is British Columbia’s sixth case of the novel COVID-19 coronavirus.  The woman was assessed at a hospital and is now in self-isolation at home in the Fraser Health region. Health officials won’t say which area she is in, but only that the Fraser Health region spans from Burnaby to Hope[1].

Note: The north shore (North Vancouver) is well known for its vibrant Iranian community, but so is Coquitlam, which is part of the Fraser Health region.

Health officials are now investigating details of the woman’s travel and working to determine whether other passengers on her flight home will need to be notified and tested.

This case is unusual in that the travel was to Iran, and not China or Singapore. Dr. Henry said that this is what is called a “sentinel event”, which is “a marker that something may be going on broader than what we expect[1].”

Earlier this week, on February 16th two Canadians returned to British Columbia from having been on the Westerdam cruise, and were asked by officials to put on protective face masks at Vancouver International Airport as an American woman who was on the cruise with them has tested positive for the COVID-19 coronovirus, and both she and her husband have been hospitalized with pneumonia [2,3]. The Global News headline for the story read “COVID-19 fears spike after woman let off cruise ship in Cambodia tests positive“.  The story’s opening paragraph reads, “The feel-good story of how Cambodia allowed a cruise ship to dock after it was turned away elsewhere in Asia for fear of spreading the deadly virus that began in China has taken an unfortunate turn after a passenger released from the ship tested positive for the virus [3].”

A week ago, a 5th case of COVID-19 had been identified in British Columbia in a woman in her 30s who travelled to the Shanghai area of China. “She was not in Hubei province and was not in an area where travel was restricted,” said Dr. Bonnie Henry, B.C.’s Chief Medical Health Officer. “She came home from Shanghai through YVR (the Vancouver International Airport) and then travelled by private vehicle to her home in the interior,” said Henry. The woman was tested on February 11th, and the lab returned a positive result on Thursday February 13th [4]. Global News reported that they think that the woman’s symptoms started around her time of arrival. Henry said, “We’re still working out the seating and looking at the flights“.  Global News also reported that “health officials are still working to contact everyone who sat within three rows of the woman to discuss what to do if they show symptoms”. Officials are not saying what flight the woman was on, or where she lives in the interior because “because they don’t want to unnecessarily alarm people“, Henry said [4].

It is also known that 5 million people left Wuhan before quarantine was set up in that city in preparation for the lunar New Year[5]. Where did they go? We know for sure that two people from Wuhan came to Vancouver during that time and that a woman in her 50s with whom they were staying contracted COVID-19 from them [6,7]. Since incubation period for the illness is believed to be up to 14 days and these individuals they were without symptoms while touring Vancouver sites, it is unknown how many individuals in the greater Vancouver area may have also been exposed to the coronavirus over the last few weeks by being in close contact with these three individuals. It is also unknown how many other people from the outbreak area may have come to Canada before the quarantine was in place. 

Some thoughts…

Medical officials are continuing to assure the public that the risks of getting COVID-19 are “low”, but “low” is a relative term.

Risk would certainly be “low” when compared to Wuhan where the coronavirus originated from (based on the sheer number of individuals infected there) and would also be “low” compared to those who were quarantined on the Diamond Princess off of the coast of Japan, but people in the Greater Vancouver area are very much on edge knowing that being within 2 meters (6.5 feet)  for any length of time of those who are contagious may put them at risk. Two meters is the distance between tables in  a restaurant, the distance between people in front and behind in a long line up at a checkout line, or at popular locations including the airport. Given that people can have no symptoms whatsoever and be contagious for 14 days has many people concerned.

In addition to a growing outbreak of COVID-19 in Iran, also of concern is the recent emergence of hundreds of cases of COVID-19 in Seoul, South Korea — as both of these countries have strong ties to local communities, and neither country is currently restricting travel.

Distance Consultations

Over the past decade that I have provided services via Distance Consultation, they had become increasingly popular with local-area clients as it saved them travelling booking time off work, or arranging childcare. As events related to coronavirus have unfolded, many local clients are glad to have the ability to consult with me remotely, especially given my experience in doing so. 

You can find out more about Distance Consultations by clicking on the tab above.

More Info?

If you would like more information about the services that I provide, please have a look under the Services tab or in the Shop. If you have service-related questions, please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Update: February 23, 2020: Several media outlets [8,9] are reporting that the woman that tested positive for the new coronavirus and had recently flown from Iran, also flew from Montreal to Vancouver on Valentine’s Day, February 14th. The BC Provincial Health Authority (PHSA) advised Air Canada that it plans to contact all passengers who flew out of Montreal that day and who were seated within three rows of the woman so that they can monitor their health for a 14-day period and report any symptoms to a health professional [8.9].

Global News reported later this afternoon that the Fraser Health Authority sent a letter to all school districts in its region on Friday, which includes Burnaby, New Westminster, Maple Ridge, Pitt Meadows and the Tri-Cities — warning them that contacts of the woman with coronavirus “may have attended schools in the region and are currently isolated.”  Fraser Health’s medical health officer Ingrid Tyler wrote in the letter that “these contacts were not showing any signs or symptoms of illness while attending school, and remain well” and the health authority has assured that “there is no public health risk at schools in the region” and “no evidence that novel coronavirus is circulating in the community” [10].

Copyright ©2020 BetterByDesign Nutrition Ltd.

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

  1. Globe and Mail, Andrea Woo, B.C. hit with sixth case of coronavirus after woman returns from Iran, https://www.theglobeandmail.com/canada/british-columbia/article-bc-hit-with-sixth-case-of-coronavirus-after-woman-returns-from-iran/
  2. CBC News, Austin Grabish, As Canadians return home from Westerdam cruise, health officials urge them to self-isolate, February 16, 2020 https://www.cbc.ca/news/canada/british-columbia/westerdam-cruise-canadians-return-home-1.5466131
  3. Global News, Sopheng Cheang, Eileen Ng, Grant Peck (Associated Press), COVID-19 fears spike after woman let off cruise ship in Cambodia tests positive, February 17, 2020, https://globalnews.ca/news/6559821/cambodia-cruise-ship-coronavirus-positive/
  4. GlobalNews, Stuart Little, B.C. identifies 5th presumptive case of COVID-19, woman who travelled near Shanghai, https://globalnews.ca/news/6552744/british-columbia-covid-19-update/
  5. CTVNews, Erika Kinetz, Where did they go? Millions left Wuhan before quarantine. February 9, 2010, https://www.ctvnews.ca/health/where-did-they-go-millions-left-wuhan-before-quarantine-1
  6. CityNews 1130, Paul James and Kathryn Tindale, Health officials track coronavirus in Metro Vancouver, risk remains low, posted Feb 5, 2020 11:31 am PST, last Updated Feb 5, 2020 at 11:32 am PST,  https://www.citynews1130.com/2020/02/05/virus-expert-tracking-infected/
  7. National Post, Richard Warnica, Fifth suspected coronavirus case in Canada is B.C. woman who had ‘close contact’ with Wuhan visitors, Posted February 4, 2020 and 11:33 PM EST, https://nationalpost.com/news/canada/fifth-suspected-coronavirus-case-in-canada-is-b-c-woman-who-had-close-contact-with-wuhan-visitors
  8. Montreal Gazette, Susan Schwartz, February 23, 2020, Passenger from Iran on flight from Montreal to Vancouver tests positive for new coronavirus, https://montrealgazette.com/news/local-news/passenger-from-iran-on-flight-from-montreal-to-vancouver-tests-positive-for-new-coronavirus
  9. CBC, B.C.’s 6th presumptive COVID-19 case flew from Montreal to Vancouver on Feb. 14, https://www.cbc.ca/news/canada/british-columbia/bc-coronavirus-flight-montreal-vancouver-1.5473283
  10. Global News, Sean Boynton, Passenger on Air Canada flight to Vancouver is not a new case of COVID-19: B.C. officials, Feb 23 2020 2:11 pm, updated 5:18 pm), https://globalnews.ca/news/6586274/covid19-air-canada-vancouver-montreal/

(Updated Feb.17) Health Officials Tracking Coronavirus Exposure in Metro Vancouver

Note: This post is based on two articles about the spread of coronavirus to the Vancouver area; one which is a was published by the National Post on Tuesday, February 4, 2020 and the other that was published on the News 1130 website on Wednesday February 5, 2020, and represent my thoughts on the subject.] Please see the most recent updates, below.

Secondary Coronavirus Case in Vancouver

This past Tuesday, February 4, 2020 BC’s provincial health officer, Dr. Bonny Henry announced that a woman in her 50’s who had not been to China recently but who had relatives visiting from Wuhan, China the past several weeks had tested positive for the coronavirus, and is now in hospital [1] in the Vancouver area.  Based on several reports, her relatives left Wuhan prior to the lock down of the city resulting from the coronavirus epidemic, but since incubation period for the illness is believed to be up to 14 days, they were without symptoms while recently touring Vancouver sites. The woman with whom they were visiting has since contracted coronavirus, but it is currently unknown how many individuals in the greater Vancouver area may have also been exposed to the coronavirus over the last few weeks.

An article on News 1130 published Wednesday, February 5th stated that “medical officers are tasked with tracking down anyone who may have been in contact with carriers of the (coronavirus) virus” [1]. The article went on to elaborate that “anyone who would be in close range of about two meters (~6.5 feet) of an individual who’s infected and spends a significant amount of time in that space would be at highest risk for picking it up”, said infectious disease expert Susy Hota of the University of Toronto’s Faculty of Medicine. She added that “There’s no guarantee that they will pick it up, in fact, most people won’t“. Not mentioned is the risk associated with the more common way of catching viruses, such as by someone contagious sneezing into their hand and then touching surfaces we then touch, such as public restroom door knobs.

Dr. Michael Gardam, who is an infectious disease specialist at Toronto’s Humber River Hospital was reported in the National Post article to have said, “We’re all worried about the potential of this becoming a problem in Canada. I don’t think this is going to be a short-term thing,” he said and added “because of the nature of how it’s spreading and what’s happening in China, we could unfortunately be dealing with this story for the next two years[2].”

The National Post highlighted that what makes this most recent case of coronavirus in Vancouver significant is that the person had not travelled to China. Dr. Isaac Bogoch, an infectious disease specialist at the University of Toronto was reported to have said, “That’s called secondary spread. That’s a problem[2].”

The story published on News 1130 web page elaborated that medical officials in the Vancouver area “want to reach out to the close contacts of that individual” which they explain tend to be household members, or those who interact very commonly with the individual(s). “Each person contacted will be assessed for early symptoms (of coronavirus) and given information on how to react if symptoms develop”.  Susy Hota of U of T’s Faculty of Medicine was reported to say “while tracking of those people will be underway, the risk of other people being infected remains low“.

Final thoughts…

“Low” is a relative term. Risk would certainly be “low” when compared to Wuhan where the coronavirus originated from, based on the sheer number of individuals infected there, and would also be “low” compared to those currently quarantined on cruise ships off the coast of Japan and Hong Kong, but it is unknown how many people in the Metro Vancouver area were within 2 meters of this woman and her relatives for any significant amount of time while they were in Vancouver over the last several weeks. These individuals had no symptoms of having coronavirus at the time, but based on the known two-week incubation period before people manifest symptoms, people that were within 2 meters of them for an extended period of time may currently be contagious.  It would seem, in my understanding that this could include those seated at an adjacent table in a restaurant, standing nearby in a crowded shop for significant amount of time, or waiting in the same check-out line at a store.

There is a high degree of concern about coronavirus among the people I speak with on a daily basis; with most concerned that they may be at risk of contracting the virus, or now wondering if they have already been exposed to it, and have not yet manifested symptoms.  While health officials continue to encourage people that the risk of getting coronavirus in Metro Vancouver is “low”, people remain concerned about what is not known.

Since I already had over a decade of experience providing Dietetic services via Distance Consultation, and almost two-thirds of my clients already chose to meet with me remotely, it seemed to makes good sense at this time for me to provide all services in this manner. 

You can find out more about Distance Consultations by clicking on the tab above. 

Please see updates on this story, below. 

More Info?

If you would like more information about the services that I provide, please have a look under the Services tab or in the Shop. If you have service-related questions, please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq


UPDATES: 

(February 8, 2020): While not directly related to the current situation in Vancouver, this new story indicates how this virus is spreading without any direct or secondary connection to China. Five British nationals have been diagnosed with the new coronavirus at a French ski resort, and apparently caught it from a British national who had recently visited Singapore and had attended a business meeting from January 20 to 23 which had business delegates from around the world. None of the UK nationals had visited China [3], so this would not be “secondary spread” of the virus, as in Vancouver, but tertiary spread. Vancouver is a major city and Canadian Pacific port hub, with ships arriving daily. It is concerning that coronavirus is now being transmitted in other countries from those who have not visited China.

(February 9, 2020): It is now known that 5 million people left Wuhan before quarantine was set up in that city [4], in preparation for the lunar New Year. Where did they go? We know for sure that 2 came to Vancouver, and it is unlikely that they were the only ones. It is unknown how many more people from the outbreak area came to Canada before the quarantine was in place.

(Feb 11, 2020): Spread of the novel coronavirus (dubbed Covid-19) is suspected to be linked to an outbreak at a single shopping mall near Beijing, China and none of the 33 people that worked or shopped there had history of travel to Wuhan.

(Feb 14, 2020): A fifth case of Covid-19, the novel coronovirus has been identified in British Columbia in a woman in her 30s who travelled to the Shanghai area of China. “She was not in Hubei province and was not in an area where travel was restricted,” said Dr. Bonnie Henry, B.C.’s Chief Medical Health Officer. “She came home from Shanghai through YVR (the Vancouver International Airport) and then travelled by private vehicle to her home in the interior,” said Henry. The woman was tested on Feb. 11th, and the lab returned a positive result on Thursday February 13th [6]. Global News reported that they think that the woman’s symptoms started around her time of arrival. Henry said, “We’re still working out the seating and looking at the flights“.  Global News also reported that “health officials are still working to contact everyone who sat within three rows of the woman to discuss what to do if they show symptoms”. Officials are not saying what flight the woman was on, or where she lives in the interior because “because they don’t want to unnecessarily alarm people”, Henry said [6].

(Feb 17, 2020) Two Canadians who returned to British Columbia yesterday (Sunday) from having been on the Westerdam cruise were asked by officials to put on protective face masks at Vancouver International Airport as an American woman who was on the cruise with them has tested positive for the Covid-19 coronovirus, and both she and her husband have been hospitalized with pneumonia [7,8]. The Global News headline for the story read “COVID-19 fears spike after woman let off cruise ship in Cambodia tests positive“.  The story’s opening paragraph reads, “The feel-good story of how Cambodia allowed a cruise ship to dock after it was turned away elsewhere in Asia for fear of spreading the deadly virus that began in China has taken an unfortunate turn after a passenger released from the ship tested positive for the virus” [8].

 


Copyright ©2020 BetterByDesign Nutrition Ltd.

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

  1. CityNews 1130, Paul James and Kathryn Tindale, Health officials track coronavirus in Metro Vancouver, risk remains low, posted Feb 5, 2020 11:31 am PST, last Updated Feb 5, 2020 at 11:32 am PST,  https://www.citynews1130.com/2020/02/05/virus-expert-tracking-infected/
  2. National Post, Richard Warnica, Fifth suspected coronavirus case in Canada is B.C. woman who had ‘close contact’ with Wuhan visitors, Posted February 4, 2020 and 11:33 PM EST, https://nationalpost.com/news/canada/fifth-suspected-coronavirus-case-in-canada-is-b-c-woman-who-had-close-contact-with-wuhan-visitors
  3. Global News, Marine Pennetier, 5 UK Citizens Contract Coronavirus at French Ski Resort, February 8, 2020, https://globalnews.ca/news/6525402/5-uk-coronavirus-resort/amp/
  4. CTVNews, Erika Kinetz, Where did they go? Millions left Wuhan before quarantine. February 9, 2010, https://www.ctvnews.ca/health/where-did-they-go-millions-left-wuhan-before-quarantine-
  5. New York Times, Coronavirus Update: Quarantine ordered as cases are linked to shopping centre,  https://www.nytimes.com/2020/02/11/world/asia/coronavirus-china.html
  6. GlobalNews, Stuart Little, B.C. identifies 5th presumptive case of COVID-19, woman who travelled near Shanghai, https://globalnews.ca/news/6552744/british-columbia-covid-19-update/
  7. CBC News, Austin Grabish, As Canadians return home from Westerdam cruise, health officials urge them to self-isolate, February 16, 2020 https://www.cbc.ca/news/canada/british-columbia/westerdam-cruise-canadians-return-home-1.5466131
  8. Global News, Sopheng Cheang, Eileen Ng, Grant Peck (Associated Press), COVID-19 fears spike after woman let off cruise ship in Cambodia tests positive, February 17, 2020, https://globalnews.ca/news/6559821/cambodia-cruise-ship-coronavirus-positive/

Five Pounds or Fifty Pounds of Fat – in very real terms

Whether one loses 5 pounds of fat or 50 pounds of fat, I think it is very helpful to visualize just how much that is. Yes, five pounds of fat is much larger than most people realize!

This past week, I purchased a life-sized model of 5 pounds of fat from a well-known nutrition supplier; the same supplier I have purchased life-sized food models from, which I used to use a lot in my practice.  When I received it, I was quite surprised how much room it took up and just how heavy it was.

Here is a photo of the life-sized model 5 pounds of fat on a scale, with my left hand for a size reference:

5 pounds of fat on a scale, with adult hand as reference – © BBDNutrition

Here is a photo of it on an ordinary steno chair:

5 pounds of fat on a steno chair – © BBDNutrition

…and here is 5 pounds of fat being held in my hand:

5 pounds of fat in adult hand – © BBDNutrition

Finally, here is 5 pounds of fat being carried as one would carry an infant:

holding 5 pound of fat – © BBDNutrition

Five pounds of fat is a lot! Sure there is the initial water-loss at the beginning of weight loss, but here I’m talking about fat.

Fat takes up a fair amount of room around one’s waist, or worse inside one’s abdomen or organs. If someone has 20 pounds of fat to lose, that is four of those fat models distributed over their body; legs, belly, arms, neck, back and face and perhaps some in their liver.

I had 55 pounds of excess fat before beginning my journey.

Comparing these two full length photos, it is easy to see how I had the equivalent of one of those fat models over the length of each leg, one distributed between each arm, one distributed over my neck and face and 2 spread out around my waist and hips and some no doubt, in my liver and pancreas. But still, I can’t actually imagine where I was carrying 11 of those, all told!

The fat in my abdomen must have been more than I imagined, as it was wreaking metabolic havoc on my body.  I had very high blood pressure and had type 2 diabetes for 8 years.  You can read the entire story (including lab test results) under “A Dietitian’s Journey” on my affiliate low carb web site by clicking here. Keep in mind that I chose to follow a therapeutic low carbohydrate diet, but there is no one-sized-fits-all diet that is right for everyone.  

Whether you have 5 or 10 pounds of fat to lose, or like me ⁠— a whole lot more, it is really only done a pound or so at a time.  If you have significant amount of weight to lose,  I can not only help you do that, but since I’ve been through it myself, I can encourage you and coach you through it. I provide services across Canada (except PEI) via HIPAA-compliant video conferencing, and most extended benefits providers reimburse for licensed Dietitian services.

More Info?

If you would like more information about the services I offer, please have a look under the Services tab or in the Shop for more information. If you have service-related questions, please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

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Copyright ©2020  BetterByDesign Nutrition Ltd.

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.