Low Carb Green Tea Matcha Smoothie – role in weight and abdominal fat loss

This delicious low carb high fat Matcha Smoothie can help you lose weight & abdominal fat. The science behind it, the recipe & the nutritional info in this article.

Green tea is the unfermented leaves of the Camellia sinensis plant and contains a number of biologically active compounds called catechins of which epigallocatechin gallate (EGCG) makes up ~ 30% of the solids in green tea [Kim et al]. Studies have found that green tea catechins, especially EGCG play a significant role in both weight loss and lower body fat composition.

Population studies and several randomized controlled studies (where one group is “treated” and the other group is not) have shown that waist circumference is smaller and levels of body fat is less the more green tea consumed   [Phung et al].  The anti-obesity effects of green tea are usually attributed to the presence of catechins [Naigle].

Several large-scale population studies have linked increased green tea consumption with significant reductions in metabolic syndrome – a cluster of clinical symptoms which include insulin resistance or hyperinsulinemia (high levels of circulating insulin), Type 2 Diabetes, hypertension or high blood pressurecardiovascular disease including coronary heart disease and atherosclerosis.

It is thought that epigallocatechin gallate (EGCG), the most abundant catechin in green tea, mimics the actions of insulin.  This has positive health implications for people with insulin resistance or Type 2 Diabetes [Kao et al].

EGCG also lowers blood pressure  almost as effectively as the ACE-inhibitor drug, Enalapril, having significant implications for people with hypertension (high blood pressure) and cardiovascular disease [Kim et al].

Research indicates that drinking 8-10 cups of green tea per day is enough to increase blood levels of EGCG into a measurably significant range [Kim et al].

The most effective way to reduce the symptoms associated with metabolic syndrome is through a low carb high healthy fat diet, however the addition of green tea as a beverage – especially as matcha green tea powder, may provide a means to preferentially target abdominal weight loss.


Catechins make up ~ 30% of green tea’s dry weight (of which 60–80% are catechins) and oolong and black tea  (which are produced from partially fermented or completely fermented tea leaves) contains approximately half the catechin content of green tea.

Matcha, a powdered green tea used in the Japanese tea ceremony and popular in cold green tea beverages contains 137 times greater concentration of EGCG than China Green Tip tea (Mao Jian) [Weiss et al].


A typical cup (250 ml) of brewed green tea contains 50–100 mg catechins and 30–40 mg caffeine, with the amount of tea leaves, water temperature and brewing time all affecting the green tea catechin content in each cup.

A gram (~1/3 tsp) of matcha powder contains 105 mg of catechins – of which 61 mg are EGCGs and contains 35 mg of caffeine. Most matcha drinks made at local tea and coffee houses are made and served cold and contain ~1 tsp of matcha powder which contains ~315 mg of catechins – of which ~183 mg are EGCs.


A 2009 meta-analysis (combining the data from all studies) of 11 green tea catechin studies found that subjects consuming between 270 to 1200 mg green tea catechins / day (1 – 4 tsp of matcha powder per day) lost an average of 1.31 kg (~ 3 lbs) over 12 weeks with no other dietary or activity changes [Hursel].


The effect of green tea catechins on body composition is significant – even when the weight loss between “treated” and “untreated” groups is small (~5 lbs in 12 weeks).

Even with such small amounts of weight loss;

– the total amount of abdominal fat decreased 25 times more with green tea catechin consumption than without it (−7.7 vs. −0.3%)


 total amount of subcutaneous abdominal fat (the fat just below the skin of the abdomen) decreases almost 8 times more with green tea catechin consumption than without it (−6.2 vs. 0.8%).


The mechanisms by which green tea catechins reduce body weight  and reduce the amount of total body fat and in particular reduce the amount of abdominal fat are still being investigated.  It is currently thought that green tea catechins;

–          increased thermogenesis; i.e. increased heat production which would result in increased energy expenditure (or calorie burning)

–          increase fat oxidation i.e. using body fat as energy. For those on a low fat high fat diet, this is good!

–          decrease appetite

–          down-regulation of enzymes involved in liver fat metabolism (fat storage)


While EGCG has also been found to be similar in its effect to etoposide anddoxorubicin, a potent anti-cancer drug used in chemotherapy [Bandele et al], high intake of polyphenolic compounds during pregnancy is suspected to increase risk of neonatal leukemia. Bioflavonoid supplements (including green tea catechins) should not be used by pregnant women [Paolini et al].

Low Carb Green Tea Matcha Smoothie Recipe

Total carbs: 2.5 gm per serving – contains ~315 mg catechins


1 tsp matcha (green tea) powder * (1 tsp = 2 gm)

12 cubes ice, crushed

1/2 cup (125 ml) coconut milk  

optional: 1/2 tsp Silan (Middle Eastern date syrup) – will add an additional 3.5 g carbs to the recipe


  1. Place 1 tsp matcha powder in a small stainless steel sieve and gently press through the sieve into a small bowl with the back of a small spoon
  2. Put the sieved matcha powder into a ceramic or glass bowl (not metal, as the tannins in the tea will react and give the beverage and “off” metalic taste)
  3. With a bamboo whisk (available at Japanese and Korean grocery stores) or a plain spoon, whisk 3 Tbsp boiled and cooled water into the matcha powder, until all the lumps are gone and the mixture is smooth
  4. Place a whole tray of ice cubes (12) into a blender
  5. Pour matcha and water mixture over ice in the glass
  6. Pour coconut milk on top of ice and matcha
  7. Pulse until desired texture is achieved*

*I blend mine just fine enough to be able to drink it through a straw.


Nutritional Information

Calories 91.48
Saturated Fat 7.7 gm
Cholesterol 0 mg
Sodium 7.5 mg
Carbohydrates 1 gm
Dietary Fiber 770 mg
Protein 1.1 gm

Calcium 8.8 mg
Vitamin A (Retinol Equivalents) 198.4 mg
B-Carotene 1.2 gm
Magnesium 4.6 mg
Vitamin B1 .12 mg
Potassium 54 mg
Vitamin B2 .027 mg
Phosphorus 7.0 mg
Vitamin B6 .018 mg
Iron .34 mg
Vitamin C .12 mg
Sodium .12 mg
Vitamin E .562 mg
Zinc .126 mg
Vitamin K 58 mcg
Copper .012 mg

Polyphenols 200 mg
Caffeine 50 mg
Theophylline 0.84 mg




Bandele, OJ, Osheroff, N. Epigallocatechin gallate, a major constituent of green tea, poisons human type II topoisomerases”.Chem Res Toxicol 21 (4): 936–43, April 2008.

Hursel R, Viechtbauer W, Westerterp-Plantenga MS. The effects of green tea on weight loss and weight maintenance: a meta-analysis. Int J Obes (Lond) 2009;33:956–61.

Kao YH, Chang MJ, Chen CL, Tea, Obesity, and Diabetes, Molecular Nutrition & Food Research, 50 (2): 188–210, February 2006

Kim JA, Formoso G, Li Y, Potenza MA, Marasciulo FL, Montagnani M, Quon MJ., Epigallocatechin gallate, a green tea polyphenol, mediates NO-dependent vasodilation using signaling pathways in vascular endothelium requiring reactive oxygen species and Fyn, J Biol Chem. 2007 May 4;282(18):13736-45. Epub 2007 Mar 15.

Nagle DG, Ferreira D, Zhou YD. Epigallocatechin-3-gallate (EGCG): chemical and biomedical perspective. Phytochemistry 2006;67:1849–55.

Park JH, Jin JY, Baek WK, Park SH, Sung HY, Kim YK, et al. Ambivalent role of gallated catechins in glucose tolerance in humans: a novel insight into nonabsorbable gallated catechin-derived inhibitors of glucose absorption. J Phyisiol Pharmacol 2009;60:101–9.

Phung OJ, Baker WL, Matthews LJ, Lanosa M, Thorne A, Coleman CI. Effect of green tea catechins with or without caffeine on anthropometric measures: a systematic review and meta-analysis. Am J Clin Nutr 2010;91:73–81.

Paolini, M, Sapone, A, Valgimigli, L, “Avoidance of bioflavonoid supplements during pregnancy: a pathway to infant leukemia?”. Mutat Res 527 (1–2): 99–101. (Jun 2003)

Rains, TM, Agarwal S, Maki KC, “Antiobesity effects of green tea catechins; a mechanistic review” J or Nutr Biochem 22(2011):1-7

Weiss, DJ, Anderton CR, Determination of catechins in matcha green tea by micellar electrokinetic chromatography, Journal of Chromatography A, Vol 1011(1–2):173-180, September 2003


From Paleo to Present – a brief history of the human diet

Prior to the domestication of animals and the development of agriculture, the human diet centered around the ‘hunt’. They ate when they caught something, and didn’t eat until again until they either caught something else, or were successful in finding edible vegetation, berries or nuts. “Feasting” and “fasting” were normal events in the rhythm of life, and our bodies were designed to function using our fat stores for energy, as evidenced by our continued existence.

From hunter-gatherers to farmers

After the Ice Age, those that survived were left with an increasingly unpredictable climate, decreases in big-game species that were hunters’ first-choice prey, and increasing human population in the available habitats for hunting and gathering. To decrease the risk of unpredictable variation in food supply, people broadened their diets to second- and third-choice foods, which included more small game, plus plant foods which required much preparation, such as grinding, leaching and soaking. As I will demonstrate below, these plant foods, including grains were very different in carbohydrate and protein composition than they are today.

The domestication of animals and plant cultivation of ~ 13,000 years ago, forms a significant turning point in the human diet.

Humans began to transport some wild plants, including grains from their natural habitat to more productive selected habitats, and so began intentional cultivation, or farming. With the development of agriculture and the domestication of animals – the plants and animals themselves began to change.

This is important.

The fruit of today bear little resemblance to their ancient predecessors. The grains of today don’t either. For example, wild wheat and wild barley bear their seeds on top of a stalk, and sheds its seed spontaneously – enabling it to germinate where it falls.

Once people began bringing some wild wheat or barley seeds back with them in order to intentionally plant them, some seeds would accidentally spill along the way, germinating in new places. Over time, some seed would cross-pollinate with wild grain, while others would undergo spontaneous mutations, leading to wheat and barley varieties with non-self-shattering heads. Eventually, these non-shattering grains were selected for by humans for cultivating, leading to a very different type of grain than the wild species – and one with very different nutritional content than their wild predecessors.

Similarly, domesticated animals were selected based on traits that were considered desirable to people – chickens were selected to be larger, wild cattle to be smaller, and sheep to lose their bristly outer hairs and not to shed their soft inner wool. Eventually, the land where hunter-gatherers lived was overrun and replaced by people who had become agricultural – and who were ever-expanding the amount of land they required for raising animals, as well as for growing crops.

At Tell Abu Hureyra, in the Euphrates valley of modern Syria are the remains of a civilization that lived between 13,000 and 9,000 years ago, spanning the Epipaleolithic and Neolithic periods. This site is significant because the inhabitants of Abu Hureyra started out as hunter-gatherers, but gradually moved to agriculture, making them the earliest known farmers in the world. Meals consisting of the meat of gazelle, wild goat and game birds were supplemented with wild-growing Einkorn wheat-porridge, as well as berries, nuts or fruit, if in season.  Tools such as sickles and mortars for harvesting and grinding grain, as well as pits for storing it have been found at Tell Abu Hureya and remains of harvested Einkorn wheat (which was ground by hand and eaten as porridge) have been found at Tell Aswad, Jericho, Nahal Hemar, Navali Cori and other archeological sites.

The diet of man forever changed at that point.

As previously mentioned, plants underwent change as a result of both natural cross-pollination as both underwent change as a result of intentional manipulation by man.  This occurred everywhere that man settled – from the lush valleys of the Middle East*, to Africa and Asia.

[*yes, the Fertile Crescent of the Middle East was lush and green, then.]

The grain we know today as “wheat” and “rice” is nothing like their wild ancient predecessors. Likewise with fruit. The fruit of today has been bred to be sweet – not so with the wild cultivar. A brief history of wheat will help illustrate this type of change.

Evolution of Wheat – but one example

The first wild grass that was cultivated was Einkorn wheat. As cultivation techniques improved, Einkorn eventually became an essential component of the dietreducing the need for hunting and gathering. Einkorn wheat contained only 14 chromosomes.

Shortly after the cultivation of the first Einkorn, the Emmer variety of wheat (Triticum turgidum) appeared in the Middle East; a natural offspring of Einkorn and an unrelated wild grass, calledgoatgrass(Aegilops speltoids.

Emmer wheat is what is referred to in the Hebrew Bible (Exodus 9, Exodus 32, Isaiah 28, Isaiah 25) as Kes-emmet (כֻּסֶּמֶת) and both Eikorn wheat (חִטָּה) and “Emmet” (ֻּסֶּמֶת), translated in English as ‘spelt’, are referred to together as distinct species (e.g. Exodus 9:32).  It was the ancient Egyptians that are credited with the addition of wild strains of yeast in order to make bread rise – which gives an added dimension to the story of Passover, where the Jews left slavery in Egypt in “great haste”, “not having time to let their bread rise”.

Since plants do not combine genes but add (or sum) them which provides evidence of what cross-bred with what. Goatgrass added its genetic code to that of Einkorn , so Emmer wheat had 28 chromosomes.

Emmer wheat then naturally cross-bred with another wild grass called Triticum taushii, giving rise to the original cultivar of Triticum aestivum, the predecessor of modern wheat, which has 42 chromosomes. This was a higher yielding wheat variety which had many desirable baking properties that Eikorn and Emmer lacked.  This new strain remained largely unchanged until the mid-eighteenth century when Carolus Linneaus, who invented the Linnean system of categorizing species, counted only 5 species.

Today, Eikorn, Emmer and the original cultivated strains of Triticum aestivum have been replaced by almost 25,000 strains of modern human-bred wheat strains that are hundreds, if not thousands of genes apart from the original Eikorn and Emmer wheat species.

Our food is not the food of our ancestors.

Modern Triticum aestivum is on average 70% carbohydrate by weight and only 10% protein. Emmer wheat, on the other hand was 57% carbohydrate and 28% protein – and was suitable to supplement the protein of a meal.

Paleo Diet compared with the Low Carb High Healthy Fat diet

The premise of Paleo eating to eat like our Paleolithic ancestors did is understandable, however the foods that exist now are nothing like the foods our ancient ancestors ate. Fruit, for example is considered “paleo” -but the carb content of paleo fruit was substantially less than that of today.

In a low carb high healthy fat way of eating, carbs are not avoided. It is the foods that are high in carbs that are easily broken down to glucose and have little nutrient-density that are limited.

[It is hard to justify eating grain products made from varieties of wheat that were bred for no other reason than they could be grown in nutrient- poor soils in novel parts of the world.]

No justification is needed to eat carbs that come as part of fibre- and nutrient-rich non-starchy vegetables and to eat carbs found in nuts that are a good source of protein and monounsaturated fat.

A diet where 45 – 65% of calories are as carbohydrate is has us eating “carbs for carb’s sake”, but a low carb high healthy fat diet should not be about “fat for fat’s sake”.

Some people think they should eat large amounts of saturated fat “just because they can”, and I suppose that’s true. One can certainly eat a pound of bacon, but when compared  with a fat marbled grain-fed steak or a Brome Lake- or wild duck, one is more nutrient-dense than the other. The yolks of free-range egg comes as part of a nutrient-dense package, which includes good quality protein, as well as other nutrients. A pound of bacon, does not. That doesn’t mean that eating bacon is “bad”, but in comparison to grilled salmon with a large serving of non-starchy vegetables bathed in cold-pressed olive- or avocado oil, it doesn’t quite measure up. It is not just about not being hungry, but about being healthy.

A Low-Carb-High-Healthy-Fat Diet is about “nutrient density” – not just “fat density”.

Final Thoughts

In a Low-Carb-High-Healthy-Fat Diet, carbs are not “bad” and fat is not “good”.

Carbs and fat that come in nutrient-dense food and in particular ratios are what we are striving for.

As well, protein quantity is based on physiological need and not unlimited (as excess in a low carb diet will be converted and stored as fat). The source of that protein ought to be considered, as well. For example, it is well documented that fatty fish such as salmon, mackerel and tuna are high in omega-3 fatty acids and are good for our brains and our hearts so for those that enjoy fish, eating it often is ideal.

The good thing about the Low-Carb-High-Healthy-Fat Diet is that it can be adapted to  culture- or religious restrictions. Don’t eat pork? No problem. Don’t eat beef? Not an issue. Take fast days? That is easily worked-in.

Want to know more?

Feel free to send me a note using the form on the “Contact Us” tab, above. Remember, Nutrition is BetterByDesign.

To your health!


Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 


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Binford LF. New Perspectives in Archaeology, 1968; 313–341

David, W. Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health Rodale Books, 2011; 15-32

Diamond J. Evolution, Consequences and Future of Plant and Animal Domestication. Nature, 2002; 418:700-7

Flannery KV. The Domestication of Plants and Animals, 1969;73–100

Hillman GC, Davies, MS. Measured Domestication Rates in Wild Wheats and Barley under Primitive Cultivation, and their Archaeological Implications. J. World Prehistory; 1990; 4:157–222

Raeker RO, Gaines CS, Finney PL, Donelson T. Granule size distribution and chemical composition of starches from 12 soft wheat cultivars. Cereal Chem 1998;75(5):721-8

Shewry PR. Wheat. J Exp Botany 2009;60(6):1537-53

Stiner MC, Munro ND, Surovell TA. The Tortoise and the Hare: small-game use, the broad-spectrum revolution, and Paleolithic demography. Curr. Anthropol. 41, 39–73 (2000).

Zohary D, Hopf M. Domestication of Plants in the Old World 3rd edn (Oxford Univ. Press, Oxford, 2000).

Two People, Two Options: living healthy or dying prematurely

This weekend has been a challenging one, as I received two pieces of news. The first was of one client’s incredible success following the low carb high healthy fat diet and the shocked reaction of his doctor, and the other was of the death of a friend who had Diabetes, high blood pressure and high cholesterol. In this blog, I will share how these two events embody the two options each of us have; (1) living a healthy life to the fullest or (2) living with diet-related disease and dying prematurely of ‘natural causes’.

“JP” – a Picture of Success

Last fall, I had a reasonably fit 35-year-old client contact me wanting to lose 15 pounds. He went to the gym twice a week for an hour, and ran 10 km per week, but had put on some pounds and wanted to lose them.

As I always do, I asked for a copy of recent blood test, assessing his fasting blood glucose, HbA1C (3 month average of blood glucose), cholesterol (lipid panel) and requesting his doctor-assessed blood pressure. (Sometimes people insist that I counsel them without seeing blood work, but I explain that they ran out of crystal balls when I was graduating, so I have no choice but to get labs.)  I gave my new client a Lab Test Request form to bring his doctor.  The GP scoffed at the Lab Test Request Form asking him to requisition a lipid panel for a young, fit 35 year old whose parents are both living. That changed when the tests came back, and this man’s triglyceride level was higher than I had ever seen anyone’s, ever. His non-HDL cholesterol was very high and his HDL was very low. LDL wasn’t even available because his triglycerides levels were through the roof. His ferritin was astronomically high – not a sign of excess iron, but likely inflammation.

His doctor called him into the office immediately and wanted to put him on statin medication right away and referred him to the Lipid Clinic at a major local hospital.

My client told his doctor he wanted to wait 3 months and first follow my dietary recommendations and see what would happen to his lipids, and was advised against it by his doctor. My client was insistent, so the doctor told him that his recommendations were for him to eat “decrease saturated fat and carbohydrates, increase fruit and vegetables, increase insoluble fiber and fish, make his plate 1/2 vegetables, 1/4 protein, 1/4 starch“.

After seeing me, he agreed to limit fruit to max 1 / day, preferably a few berries on top of 2 or 3 huge salads with plenty of good quality olive oil and to have most of his carbs as vegetables. He learned that “not all vegetables are created equal” and I taught him to differentiate between those he could eat as much as he wanted at each meal and those he should limit or avoid. We talked about milk consumption, and the health benefits of eating plenty of fatty fish, such as salmon, mackerel and fresh sardine. And we talked about carbs. We talked a lot about carbs. Carbs in fruit, carbs in milk, carbs in bread, pasta and rice, and carbs in vegetables.

I designed an Individual Meal Plan for him, making sure he obtained sufficient macronutrients (protein, fat and carbs) as well as micronutrients (especially potassium, magnesium, sodium, vitamin C and calcium, vitamin D and vitamin K) – and factoring in his desired weight loss. I explained that if he followed his Meal Plan, it is perfectly reasonable for his triglyceride levels to be <2.00 mmol/L in 2 more months.

Three weeks later, his doctor ran his labs again.  His triglyceride level was almost a third what it was! His non-HDL was down substantially and his HDL was rising nicely. When he was seen at the Lipid Clinic, they were willing to give him 2 more months to get his lipids in the normal range before starting him on medication.

Friday, he wrote me telling me that his triglycerides we down well below 2.00 mmol/L and added;

“this amazed the doctor!”

My client left his doctor’s office without a medication prescription and with only the recommendation to keep eating the way I taught him. My client added that he was already within 2 – 3kg of his goal weight.

It’s not magic.

The doctor should not have been amazed that diet alone can be this effective – even for someone for whom high cholesterol has a genetic component. The literature documents the role of a low carb high fat diet.

But it is easier to write a prescription than educate a patient.

My High School Friend – preventable premature death

Last night I learned that my friend since high school, died from natural causes. She had Type 2 Diabetes, high blood pressure and high cholesterol. She and I were the same age.

Three years ago, when my friend was first diagnosed as having Diabetes, she asked my opinion about having received Diabetes counselling in her province to eat 45 gm of carbohydrates at each meal and at least 15 gm of carbohydrates at each of 3 snacks – that’s 180 gm of carbohydrates per day.  A mutual friend of ours from the same province, who had also been recently diagnosed with Diabetes confirmed that she too was advised to eat 45 gm of carbohydrates at each meal and at least 15 gm of carbohydrates at snacks. At that time, I had explained to my friend what I had been learning about the role of excess carbs in Diabetes, hypertension (high blood pressure) and high cholesterol. While I provide distance consultations in my practice (using a combination of phone, email and fax), as Dietitians we are advised specifically not to provide dietary counselling to family members or friends. With my ability to help directly being very limited, I recommended that she find a Dietitian near her who could teach her about managing this triad (called “metabolic syndrome”) using a low carb high fat diet. She followed the standard dietary recommendations to the letter and took her multiple medications as prescribed. Her blood sugar levels came down using medication (but that was effectively treating the symptom of high blood sugar, not the cause which is the underlying insulin resistance). Her blood pressure kept going higher and higher despite medication, so more medication was added.  She then developed high       cholesterol.

Today, my friend is dead, in what could have been an entirely preventable, premature death.

So I am left asking myself ‘could following the standard recommendations of eating 180 gm of carbohydrate per day with Type 2 Diabetes, high blood pressure and high cholesterol — without treating the underlying cause (insulin resistance) have contributed to her death’?

The literature is certainly full of studies documenting the beneficial effects of a low carb high fat diet on metabolic syndrome – but she was never given that as an option.  She was prescribed medication for lowering blood sugar and blood pressure, but nothing was done to lower her insulin resistance.

A lifetime of work by the late Dr. Joseph Kraft with almost 300,000 people documents that it is the insulin resistance that underlies cardiovascular disease – not the high blood sugar. Furthermore, 65-75% of people with normal blood sugar levels still have insulin resistance – and the same elevated risk of having a heart attack.

We keep treating the symptoms and people keep dying anyways – and those without any symptoms are walking around with elevated risk of dying from cardiovascular disease, and don’t even know it.

We are told;

“Diabetes is a chronic, progressive disease”

which means that once diagnosed with Diabetes, you’ll have it forever – and that eventually it will get worse, requiring medication, then more medication and finally insulin.

When people have bariatric surgery (“stomach stapling”), their blood sugars come back to normal within weeks and at the end of a year, they no longer have any of the clinical symptoms of Diabetes.  Their fasting blood glucose levels are normal and their HbA1C levels are normal. They are essentially as if they don’t have Diabetes. Their Diabetes is in remission.

So is Diabetes REALLY a “chronic, progressive disease”? No, it can be stopped.

If the reason people became Diabetic was because of how they were eating, why is it SO hard to grasp the concept that they could get well, but changing how they are eating?

At the end of the day, we have a choice.

We can do as my client above did and put everything we have into changing how we eat based on good, sound scientific studies and with medical supervision, or we can keep doing what we’ve been doing, expecting different results.

I made my choice a month ago tomorrow, and will write an update in the blog titled “A Dietitian’s Journey” tomorrow, for week four  (see Food for Thought tab, above).  Here’s a teaser; two days ago my blood sugar levels were several times at normal levels – and were overall much lower than a month ago. Last night (twice) and once this morning, my blood pressure was in the normal range.  One month!

I ask myself, what will my labs look like in 3 months or 6 months of addressing the underlying insulin resistance (instead of the symptom of high blood sugar?) What will be life be like, when I have normal blood sugar levels and normal blood pressure and normal cholesterol levels?

It will look better than the alternative.

Rest in peace, dear friend.

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 

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A Low Carb High Healthy Fat Diet

Client Brochure on the Low Carb High Healthy Fat Diet – front

A low carb high fat (LCHF) diet is a way of eating that maximizes the body’s natural ability to access one’s own fat-stores for energy. Fat takes the place of carbohydrate as the preferred source of energy, so most of the body’s energy needs comes from a wide variety of healthy fats. A low carb high healthy fat diet  minimizes carbohydrate-based foods, has a moderate amount of protein and has a high amount of healthy fats.

We use the dietary fat that we eat and our own stored fat for energy and by keeping carb intake low, insulin levels are allowed to fall, which in time makes our cells more sensitive to it. As insulin levels fall, so does hunger – so we eat meals when hungryuntil we are no longer hungry – but are no longer hungry every few hours.

The low carb high healthy fat diet

These are the categories and types of food that are available to enjoy on a low carb high healthy fat diet;

Low Carb High Healthy Fat – food categories (acknowledgements: Dr. Ted Naiman)


The exact ratio of macronutrients in your diet (i.e. grams of carbs, fat and protein) will differ depending on your age, gender, activity level, current body composition as well as any health conditions or medication you may be taking.

Here are some general guidelines to give you an idea;


A low carb high healthy fat diet does not have unlimited amounts of animal protein, although some variations of this style of eating do. There is a reason for this. When carbs are reduced, the body can synthesize glucose from protein (through a process known as gluconeogenesis), so if you eat too much protein, it can slow down your body’s transition to burning fat stores, for energy. The type of low carb high healthy fat diet that I encourage, provides sufficient protein for our body’s needs based, but not excess.


One thing all low carb high fat diets have in common, is that they are lower in carbs than the conventional low fat calorie-restricted diet and high in fat.

People often ask me “isn’t saturated fat ‘bad’ for us?’, without realizing that ~80% of the saturated fat in our bodies is actually made by our body, and only 20% comes from diet. If it was that ‘bad’ for us, why would our bodies naturally manufacture it?

The questions often follow as to how much saturated fat should we eat? What about polyunsaturated fat? Monounsaturated fat?

Eating a diet that is high in carbs while eating lots of fat, including saturated fat is a concern, but eating a diet rich in saturated fat while eating low carbs is not inherently detrimental.

According to Phinney and Volek (The Art and Science of Low Carbohydrate Living), when someone is adapted to eating a low carb high healthy fat (i.e. are in “fat-burning mode”), saturated fats do not raise LDL cholesterol. That said, why eat only saturated fat? Eating a wide range of healthy fats from a variety of natural sources provides our bodies with all the essential fatty acids we can’t make, as well as provides us with foods that can reduce inflammation.

I recommend that people look mainly to plant-based fats such as those found in avocado, olive, avocado oil and coconut oil (which is largely made up of medium chain triglycerides that is processed through the lymphatic system rather than the liver), nuts and seeds as well as omega 3 fats found in fatty fish for the bulk of their fat sources, beyond the saturated fat that is found in their protein sources.

Nuts and seeds, including almonds, walnuts, pumpkin and sunflower seeds, pistachios etc. contain carbs – ranging from ~1.5–4 grams net carbs per ounce (30g). Cashews which are actually fruit not nuts, are the highest in carbs, ~ 7 net grams per ounce (30g) but more importantly, since nuts are high in omega-6 fats (which are pro-inflammatory and compete for binding-sites with the omega-3 fats from fish) I recommend that these be eaten in portioned quantities – such as added on top of a salad or a handful with a meal.

Chia and flax seed are approximately 1–2 grams net carbs per 2 Tbsp (50 ml) and are excellent sources of both soluble and insoluble fiber.

All fats on the meal plan are healthy – which is why I call this approach “low carb high healthy fat”, but for a small percentage of people for whom high LDL cholesterol continues to be a concern, eating less saturated fat may be beneficial. Each person’s needs and familial risks are different, so no one low carb high healthy fat Meal Plan is the same.


Carbs are a healthy part of the low carb high healthy fat diet, but excess carb is minimized.

There are naturally-occurring carbs in non-starchy vegetables and low-sugar fruit (such as lemon, lime, eggplant, cucumber and tomatoes) and berries, as well as those found in nuts and seeds – and these are not restricted.

When starting a Low Carb High Healthy Fat Diet

Although not everyone does, some people experience some of the following symptoms, which usually subside within a couple of weeks. For each, I have offered some suggestions to minimize them:

  • headaches: often a result of eating too little salt. As insulin levels fall, so sodium is excreted by the kidney in urine. The drop in sodium results in the headache.  Taking 1-3 gms of salt per day (I prefer sea salt) will alleviate this. If you are taking medication for high blood pressure, be sure to check with your doctor before making any changes to your diet.  “Bone broth” is another way to restore electrolytes that are lost as insulin levels fall. Be sure you’re drinking plenty of water and also consuming enough salt/sodium.
  • sleep disruption: often a result of needing to urinate more, but sometimes experienced when people of switching from being in “carb-burning mode” to being in “fat burning mode”. Some people find taking some magnesium (with calcium) before bed helpful.
  • digestive changes: some people find they get slightly looser stools or get slightly more constipated when starting.  I can help troubleshoot this with you to get things back on track.
  • aches and pains: some people feel a little achy and almost flu-like for a few days when they are switching fuel sources.  Some people call this the “keto-flu”.  Making sure to have a balanced amount of sodium/potassium and calcium/magnesium as well as taking extra omega 3 fatty acids is helpful.

My role as a Dietitian

As a Dietitian, I make sure that you understand the effect that following a low carb high healthy fat diet can have on your body.  If you are taking medication for high blood pressure  (hypertension) or to lower blood sugar, I’ll ask you check with your doctor before starting, as blood sugar and blood pressure medications may need to be adjusted lower, as insulin levels fall.

If you aren’t taking any medication, I’ll help you transition into understanding that fat in and by itself is not ‘bad’ and that eating good quality healthy fats, nutrient-dense carbohydrate-containing foods and high quality animal protein is part of a healthy diet that will enable you to feel better, lose weight and lower insulin resistance.

I’ll design your Meal Plan so that it is adequate in macronutrients (protein, carbohydrate and fat) as well as micronutrients (vitamins and minerals – especially Calcium, Magnesium, Potassium, B-Vitamins, Vitamin A, Vitamin D, Vitamin K and Vitamin C) and sufficient in soluble and insoluble fiber  – suitable for your age, gender and activity level, and that factor in any diagnosed medical conditions you may have.

I’ll make sure that you are eating sufficient food in each of the food categories to meet your dietary needs, while adjusting for weight loss, if that is also a goal – so that you can just focus on eating healthy, ‘real food’.

Have questions ?

Feel free to send me a note using the form on the Contact Us tab, above.

To your health!


Client Brochure on the Low Carb High Healthy Fat Diet – inside

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 

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Lactose Intolerance


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

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

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

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



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

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

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

How Is Lactose Intolerance Diagnosed?
Lactose Intolerance Test

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

Hydrogen Breath Test

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

Stool Acidity Test

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

Managing Lactose Intolerance

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

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

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


Prepared foods may also contain lactose, including:

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

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

Limiting, Rather than Avoiding Lactose

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

Limit your intake of foods that cause you discomfort.

hard cheddar

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

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

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

Greek yogurt
Lactose Free & Lactose Reduced

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

Calcium and Vitamin D

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

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

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

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

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


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

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




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



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

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

The Myth of ‘8 Glasses’

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

Why Water is Important

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

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

So How Much Water Do We Need?

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

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

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

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

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

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

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

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

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

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

Beyond the tap: Other sources of water

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

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

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

Staying Properly Hydrated

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

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

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

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

• Drink water before, during and after exercise.

Is it possible to drink too much water?

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

Flavoured Water

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

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


Limonana 2










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

How to make

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

Slice the lemons thinly and add to the pitcher.

Toss the torn mint leaves in.

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

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

Pour into glasses and enjoy!

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

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

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

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

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

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

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

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

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

The Heart and Stroke Foundation has concluded that

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

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

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

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

Something many people don’t realize is that;

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

Their finally recommendations are;

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

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

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

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

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

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

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

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 

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


The “Skinny” on Fats


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

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

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

Exogenous Fats

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

Endogenous Fats

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

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

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

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

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

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

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

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

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

So, this is a glycerol molecule;

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

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

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

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

Different Kinds of Oils

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

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

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

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

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

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

Lipogenesis – Our Bodies Making fat!

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

Unsaturated fatty acid lipogenesis

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

Saturated fatty acid lipogenesis

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

Cholesterol – The Good the Bad and the Ugly

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

Very Low Density Lipoproteins (VLDL)

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

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

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

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

What is LDL cholesterol?

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

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

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

Saturated Fat — not dangerous and can be beneficial

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

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

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

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

Some thoughts…

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

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

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

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

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

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

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

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

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

Stay Tuned

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

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 

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


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

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

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

Obesity became an epidemic.

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

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

Diabetes rates almost doubled.

In the 1970s, the rate of Type 2 Diabetes in women was 2.6% and 3.4 % in men, in the 1980s that number rose to 3.8% for women and 4.5% for men.  In the 1990s the rate was almost double what it was in 1970; 4.7% for women and 7.5% for men.

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

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

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

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

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

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

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

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

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

1. What are the different type of fats.

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

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

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

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

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

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

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

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

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

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

Spoiler alert!

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

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

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

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

Have a look at the services we offer and feel free to click on the “Contact Us” tab above, to find out how to get started.

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 

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What Food Needs to be Thrown Away after a Power Failure

The Canadian Food Inspection Agency (CFIA) advises that in the event of a power failure, an unopened fridge will only keep food cold for about four hours. So here are some guidelines to follow if you have been out of power for longer than that.

What do you need to get rid of?

Any food that spoils quickly and has been stored above 4 C for two or more hours should be tossed. This includes:

  • raw, thawing and leftover meat, poultry and seafood — including processed meat products such as hot dogs, sausages and cold cuts
  • any canned meat or seafood that has been opened
  • leftover pizza with meat toppings
  • any items that have come in contact with raw meat juices
  • fresh eggs, hard-boiled eggs in shell, egg products and dishes
  • salads containing meat, chicken, egg or seafood, as well as potato salad and pasta salads containing mayonnaise or vinaigrette
  • casseroles, soups and stews
  • gravy, stuffing and broth
  • milk (dairy and soy), cream, yogurt, sour cream and cream-filled pastries
  • baby formula
  • soft cheeses like brie, Edam, Camembert, cottage cheese and cream cheese, shredded cheese
  • cut fresh fruits, pre-cut and pre-washed packaged greens, opened vegetable juice, cooked vegetables (including potatoes) and tofu
  • leftover cooked pasta and rice, fresh pasta and open containers of pasta sauce
  • opened fish sauce and oysters sauce (but Worcestershire, soy, hoisin and barbecue sauces should be fine)
  • opened mayonnaise, tartar sauce and horseradish that has been left above 10 C for eight hours or longer

(Source: CFIA and Foodsafety.gov)

What to do about food in your freezer

If you have a fully packed chest freezer or fully packed freezer compartment of your refrigerator, your food may stay frozen for up to 48 hours, according to the CFIA, but if it is only half full or is an upright, expect your food to have thawed within 24 hours.

If you bought bags of ice within 2 hours of the power going out, you may have been able to keep the food at a safe temperature (below –  4 C).

If you had thawed food in your fridge that still feels “refrigerator cold” or is partially frozen, it can be cooked and eaten safely.

What food is safe to keep if the power goes out?

The good news is that some items you normally keep in your fridge will last longer if the power goes out.

Those items include:

  • ketchup, mustard, relish, pickles and olives
  • peanut butter and jam
  • butter and margarine
  • bread, rolls, tortillas, cakes and muffins (but throw out cookie, biscuit and roll dough)
  • fruit pies (but toss out custard, cheese-filled or chiffon pies, quiche and cheesecake)
  • raw fruits and vegetables, including fresh mushrooms
  • opened canned fruits and fruit juices
  • grated parmesan or Romano (or combined) cheese in a can or jar
  • hard cheeses, such as cheddar, Swiss, Colby and provolone
  • processed cheeses
  • opened vinegar-based dressings (but, get rid of opened creamy dressings)

(Source: Foodsafety.gov)

What do you do if you’re unsure about they safety of your food?

When in doubt, throw it out.

Just because you can’t see or smell any spoilage doesn’t mean the food in question is safe to eat. No food, regardless how costly is worth risking getting food poisoning over.

Disinfecting your fridge / freezer

Once you’ve discarded everything that needs to be thrown out, be sure to disinfect the inside of the fridge with a mild bleach solution and wash any soiled cloths used in the clean-up process in hot soapy water, with a bit of bleach. This will prevent contaminating other surfaces or food with the bacteria from the spoiled food.  Wearing gloves while doing this is also a good idea.  If you don’t have any available, be sure to wash your hands well with hot soapy water long enough to sing “row row row your boat” or “Mary had a little lamb”.

While you may have lost costly food items and had the inconvenience of having no power for an extended period of time, following these simple steps will help minimize the risk of getting ill or making someone else ill from spoiled food.


(Source: Nick Logan, Global News)




Weight Gain as a Hormone Imbalance not a Calorie Imbalance

scaleWeight gain is not caused simply by taking in more calories than you burn (the so-called “calorie-in / calorie-out” model).  Calories in and calories out are interdependent factors, so when calories are restricted the body actually slows its metabolism, lowering the energy it uses for vital bodily functions. Basal Energy Expenditure (BEE) can decrease by as much as 30-50% in order to spare calories!

On the opposite end, when too many calories are taken in by someone who is already overweight, the body will try to get rid of them by increasing its Basal Energy Expenditure, usually by speeding up respiration, increasing heart rate and breathing and generating more heat.

The body does this because its ‘set point’; the weight at which your body likes to be and will tend to stay with very little effort, is highly regulated. It really isn’t that easy to gain or lose weight if we haven’t already compromised this built-in homeostatic mechanism.

That is why trying to control calories doesn’t work for long term weight loss. When we restrict calories, and increase our exercise, our body responds by increasing hunger, initiating craving (especially for foods such as simple carbs that can be broken down quickly to glucose for your blood) and by decreasing the amount of energy it uses.

Have you ever skipped a meal or lowered your calories so much that you feel cold; even though the room is at an adequate temperature and you are dressed appropriately? You are shivering because your body is sparing calories it would normally use for heat generation.


Body Weight is Regulated by Hormones

Body weight is not really under our control as much as we’d like to believe.  It is a tightly regulated process that involves a variety hormones including leptin (a hormone that regulates fat stores by inhibiting hunger), ghrelin (a hormone that increase hunger when your stomach is empty) and insulin, which plays a very significant role in hunger, eating behavior and fat management.

To understand how significant a role insulin plays in weight regulation, let’s look at a situation where there is insufficient insulin. Type I diabetes results from the destruction of the insulin-producing pancreatic islet cells stemming from an autoimmune disorder. One of the hallmarks of this disease and it’s very low levels of insulin is severe weight loss. Type I diabetics need to take insulin injections to correct for the insulin deficiency but the more insulin that is taken, the more weight gain there is. As insulin levels go up, hunger is triggered and we feel the urge to eat.

Insulin is one of the major controllers of the body set point.

As mentioned, if we don’t take in sufficient calories, then our body decreases our Basal Energy Expenditure so that we end up maintaining our body weight in response to whatever the number of calories are that we take in.  The issue in weight gain is not how to reduce calories but how to reduce insulin.


Insulin as the Main Factor in Weight Gain

When we eat food, our body releases insulin in response to the rise in glucose in our blood, coming from the digested food. Insulin acts as a messenger to instruct the body’s cells to absorb glucose, in effect reducing blood glucose levels.

Insulin resistance is a condition in which the cells of the body become resistant to insulin and fail to respond normally to normal levels insulin, leading to higher blood sugar. The pancreas tries to compensate to this condition by producing more and more insulin.  As long as the pancreas is able to produce enough insulin to overcome this resistance, blood glucose levels remain normal but when the pancreas can no longer produce enough insulin, the blood glucose levels begin to rise.

Initially, this added rise in blood glucose happens after meals (when glucose levels are already at their highest) and more insulin is needed – but eventually these higher levels of glucose are seen first thing in the morning when the person hasn’t eaten for 8 or 10 hours. When blood sugar rises abnormally above specific clinical levels, the person is diagnosed as having Type 2 diabetes. Insulin resistance is often called “pre-diabetes” because it precedes the development of Type 2 Diabetes.

Consistently high blood glucose levels along with insulin resistance lead to cells that are starved of glucose even though there is plenty of glucose in the blood. Since the cells aren’t getting any of the glucose even though it is there, it is not available to the cells because insulin is not binding it and taking it in. As a result, hunger signals are sent to the brain, leading to eating, even though the person has recently eaten.

As more and more glucose accumulates (both from the food being eaten and as you will see in a minute, through the making of glucose due to the effect of cortisol, another hormone) the high levels of glucose trigger the body to store the excess glucose as body fat.


The Effect of Stress on Weight Gain

Cortisol, the so-called stress hormone also plays a role in weight gain. Let’s look at another medical conditions to illustrate the effects of cortisol. In Cushing Syndrome, cortisol is over-produced by the body and weight gain results.  When we give people a synthetic form of cortisol as a medication (e.g. prednisone) they get something called Cushinoid Syndrome.  That is, they look like they have Cushing ’s disease. Not only do they gain weight, but there is a particular distribution of this weight gain called truncal obesity which means that fat is gained around the belly, rather than on the arms and legs.

In adrenal insufficiency (also known as Addison’s disease) which produces the opposite effect, the adrenal gland becomes damaged due an autoimmune condition and is unable to produce cortisol.  The hallmark of Addison’s disease is weight loss.

So what role does cortisol play in healthy individuals? Cortisol is released as a result of ordinary events such as waking up in the morning or exercising, but also is released in response to physiological and psychological stress.  Physiological stress might be an illness or injury and the release of cortisol services a needed function to make sure we have enough glucose to heal.

Under stressful conditions, cortisol also plays the role of providing the body with glucose by tapping into protein stores via gluconeogenesis in the liver. This energy can be helpful in a “fight or flight” type of stressor, such as when one is being chased by something however under constant levels of psychological stress, elevated cortisol over leads to higher levels of glucose being made from protein in the body the long term.  So in addition to glucose coming from the food we eat (exogenous sources), we now have the body making its own glucose (endogenous sources).  The combined exogenous glucose from good and the endogenous glucose triggered by cortisol, now leads to even higher blood sugar levels that without the long term stress.

With continually high levels of cortisol, the body will take fat that is stored as triglycerides in our liver and relocate them to visceral fat cells — those under the muscle, deep in the abdomen. Just like in Cushing’s syndrome, we now see truncal obesity triggered by stress, mediated by cortisol.


Weight Gain is due to Hormonal Triggers and not a Lack of Will-Power

Cortisol also directly influences appetite and cravings by binding to hypothalamus receptors in the brain, triggering us to eat and crave foods that are easily broken down to glucose.  Cortisol also indirectly influences appetite by modulating other hormones that stimulate appetite. Simple carbohydrates like bread, pasta, candy and pop are common foods that people reach for in response to these craving because they are easily broken down to simple sugars. So, it is actually the higher levels of cortisol that lead to increased appetite and in particular cravings for high-calorie foods, not simply a lack of will-power.

As you can see, we don’t really control our body weight any more than we control our heart rates.  To a large degree, body weight is regulated automatically under the influence of hormones; hormones that indicate to eat and indicate when we are satiated.  Hormones signal our bodies to increase energy expenditure and when calories are restricted, hormones will slow energy expenditure.


Why All Diets Work and often All Diets Fail

It doesn’t really matter which diet people follow, whether it is Atkins, South Beach, or the good old fashioned low fat, low calorie diet, all diets in the short term produce weight loss. Yes, some are healthier than others, but they all “work”.

One would hope that by continuing to eat according to what ever diet we’ve chosen and by exercising, that our body’s set point would reset at a lower level, but this doesn’t happen.

Insulin levels stay high, continuing to drive hunger and eating.

How does this affect weight loss?

A few months into our diet, regardless what diet we follow, weight loss begins to plateau.  As the plateau continues, people get discouraged, and think to themselves ‘if I’m not losing weight, then I may as well eat – fill in the blank’. This is either followed by an abandoning of the diet completely and a regaining of the weight previously lost (or more) or by a stubborn insistence to restrict calories and fat even further — leading to a downshifting of basal energy expenditure. It’s a vicious cycle.


But why does Body Weight Plateau in the First Place?

In response to weight loss, the body tries to return to its original set point.  First it slows metabolism to try and slow down weight loss – resulting in slowed weight loss and eventual plateauing.

The reason is because we’ve done nothing to lower insulin levels.

Think of set point like a ‘body weight thermostat’. With a thermostat, when the air is hot enough, the furnace turns off and when it is too cool, the thermostat turns the furnace on.  Regardless what kind of diet a person follows, there will be weight loss effects in the short term, but eventually, even with continued compliance, body weight plateaus and in time, the person begins to regain the weight.


What about exercise?

Surely exercise will help us lose weight, right?

Basal energy expenditure which is the amount of energy we use at rest is estimated to be approximately 12-15 calories per pound.  For someone confined to complete bed-rest, caloric needs are calculated as 1.2 times Basal energy expenditure (BEE).

To visualize the effect exercise has on calorie loss, let’s take a 140 pound person as an example, whose basal caloric needs are 2200 – 2500 calories per day. Say they start exercising.  They start walking at a moderate pace (2 miles/hour) for 45 minutes every day, and burn roughly 104 calories.  Let’s look at that in terms of basal energy expenditure – that is only 4% of the BEE.  Okay, so say the person starts working out at a more vigorous pace, calorie burning will go up, right?  But how much?  6% of BEE?  8% of BEE? That’s about it.

The bottom line is, the vast majority of calories you take it; about 95% of caloric intake is used to heat the body and other metabolic processes, including keeping your heart beating, breathing, digestion, brain function, liver and kidney function, etc.

Set point is a tightly regulated mechanism, like a thermostat.  When we burn more calories through exercise two things happen.  Studies show that people actually end up decreasing their activity outside of the period of exercise and the other is they increase their caloric intake in response to exercise. That’s where the phrase “working up an appetite” comes from.

The reason exercise is not that effective for weight loss is because of metabolic compensation.  We understand this intuitively though, don’t we? When know when we cut calories, restrict certain foods and increase our exercise that our body responds by being more hungry and increasing cravings. We try to take extreme measures only to find that we don’t really have a chance at making the weight loss last long term.

Don’t misunderstand; exercise is good for you.  There are many benefits to regular exercise such as improved cardiovascular function, increased strength and flexibility, and lowering stress which will lower cortisol but weight loss is not one of the significant benefits of exercise.

So if restricting calories causes are energy usage to slow and results in us being more sedentary outside of the times we exercise or eating more in response to exercise, how do we lose weight and keep it off?

To keep weight off long term, we need to address the underlying hormonal trigger to hunger and appetite; mainly insulin. To lower weight and keep it off, we need to lower our insulin level.

There are two aspects to lowering insulin levels (1) the foods we eat and (2) when we eat and this will be the topic of the next blog.




Obesity Rates in Canada and Changes to Canada’s Food Guide

Introduction: Many people look to Canada’s Food Guide (CFG) as the “measuring stick” as to whether they are eating a healthy diet, but did you know that over the years, CFG has changed dramatically? Canada’s first food guide, the Official Food Rules, was introduced to the public in July 1942. This guide acknowledged wartime food rationing, while endeavoring to prevent nutritional deficiencies and to improve the health of Canadians. Over the years the names of the food groups, the serving sizes and numbers of servings has changed.  Serving sizes are now given in ranges; and one has to wonder if these changes have resulted in “over-nutrition”.

Changes in Canada’s obesity rates seems to parallel the changes in Canada’s Food Guide which is the topic of this blog.

Canada’s Food Rules – 1949

The post-WWII “Canada’s Food Rules” of 1949 emphasized people taking in sufficient nutrients to prevent nutritional deficiency as well as to avoid excess, by stressing that “more is not necessarily better”.

Adult guidelines promoted;

canadas_food_rules_19492 cups or more of full fat milk

1 serving of citrus or tomatoes daily & 1 other fruit

2 serving potatoes plus 2 servings other vegetables (preferably yellow or green and frequently raw)

4 slices of bread with butter and 1 serving whole grain cereal

one serving meat, fish or poultry or dried beans, eggs (3x / week), cheese (3x / week)

use liver frequently



Canada’s Food Guide – 1961

In the 1961 version the language softened; with “Guide” replacing “Rules” in the title. Canada’s Food Guide now sought to emphasize its flexibility and wide-ranging application for healthy eating, recognizing that many different dietary patterns could satisfy nutrient needs.

Adult guidelines promoted;

1961-eng1 1/2 cups or more of full fat milk (decreased by ½ cup)

1 serving of citrus or tomatoes daily & 1 other fruit

2 serving potatoes plus 2 servings other vegetables (preferably yellow or green and frequently raw)

4 slices of bread with butter and 1 serving whole grain cereal

one serving meat, fish or poultry, eggs (3x / week), cheese (3x / week) or dried beans

use liver frequently


Nutrition Division, National Department of Health and Welfare (1961). Rules out – guide in. Canadian Nutrition Notes, 17(7):49-50 (cited in Health and Welfare Canada. Action towards healthy eating: technical report. 1990).

Canada’s Food Guide – 1977

In 1977 Canada’s Food Guide underwent a dramatic revision. There were now four food groups, instead of five, as fruits and vegetables were combined since their nutrient content overlapped and the name of those groups changed, too.

The Milk group became Milk and Milk Products, to highlight the inclusion of other dairy foods, Meat and Alternates replaced Meat and Fish allowing for vegetarian choices — but also resulting in the inclusion of things like peanut butter in this category, rather than categorized in the ‘fat’ category as occurs in other systems, such as the Food Exchanges.

Most significantly, serving ranges were added.

The big focus was on more carbs and less fats (regardless of what the sources of those fats were) — there was no differentiation between lard and olive oil. There was a shift to using low fat dairy products and the beginning of generations of “fat phobic” Canadians began.  “Low Fat” products became all the rage.

cfg_history_1977_two_small2 servings (skim, 2%, whole) milk, buttermilk or yogourt (1 serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

4-5 servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

3-5 servings of Bread and Cereal

2 servings  Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or 1 cup dried cooked legumes or ½ – 1 cup* nuts or seeds)


In 1977, there was introduction of a concept of “energy balance”; balancing energy intake with energy output (“calories in / calories out” model) which makes the assumption that basal metabolic rates stays the same.

With the goal of reducing diet-related chronic diseases (such as heart disease and high blood pressure), Canada’s Food Guide encouraged Canadians to reduce salt and fat, without distinguishing between sources of fats. In the process, the quantity of all kinds of fat, including healthy monounsaturated fats such as olive oil and nut and seed oil were all reduced.  Canada’s Food Guide encouraged Canadians to eat plenty of fruits and vegetables without distinguishing between high fiber, non-starchy vegetables and high carbohydrate starchy vegetables. More on that below.

Before 1977, the obesity rate [measured as Body Mass Index (BMI) ≥ 30 kg / m2] of Canadian adults was <10%.  Keep that number in mind. It changes considerably over the years as Canada’s Food Guide recommendations changed.

A report submitted to Health Canada in 1977 by the Committee on Diet and Cardiovascular Disease advised the government to take action to prevent diet-related chronic diseases such as heart disease and high blood pressure, so the emphasis in the revised 1982 Canada’s Food Guide was towards even lower fat products.

Lower fat in products often meant more sugar (as fructose or high fructose corn syrup) being added to products such as yogourt, to help make up for the missing taste. Portions of nuts and seeds which contain heart-healthy monounsaturated fats were reduced in the ongoing push to lower all fat in the diet.

There was a continued shift towards carbs as the main source of calories; not only from Breads & Cereals, but from Fruit & Vegetables too — and in this category, there was no distinction between starchy vegetables (such as potatoes, peas, corn, squash and yams) and non-starchy vegetables, such as salad greens or asparagus.  As a result, a serving of sweet potato was categorized no differently than a serving of salad greens.

Furthermore, a serving of fruit juice was considered equivalent to a serving of fruit; with no concern for the fact that there was no fiber in the juice and significantly more carbohydrates per serving.  Carbs were perceived as “good” and fat was promoted as “bad”.  As a result of these changes, under this new Canada’s Food Guide, one could have 3 glasses of juiceone serving of potato and a tiny salad and “meet” the guidelines.

Canada’s Food Guide – 1982

Adult guidelines promoted;

cfg_history_1982_two_small2 servings (skim, 2%, whole) milk, buttermilk or yogourt (1 serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

4-5 servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

3-5 servings of Bread and Cereal

2 servings  Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or 1 cup dried cooked legumes or ½ cup* nuts or seeds)


Ballantyne, R.M., Bush, M.B. (1980). An evaluation of Canada’s food guide and handbook. Nutrition Quarterly, 4(1):1-4.

Canada’s Food Guide – 1992

In 1992, Canada’s Food Guide became Canada’s Food Guide to Healthy Eating.

A new “total diet approach” aimed to meet both energy (calories) and nutrient requirements, resulted in large ranges in the number of servings in the four food groups.

To meet higher energy needs, the Guide encouraged selection of more servings from the Grain Products and Vegetables and Fruit groups – resulting in an even higher percentage of carbohydrates in the diet.

Adult guidelines servings changed as follows:

cfg_history_1992_two_small3-5   5-12 servings of Bread and Cereal

4-5   5-10 servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

2   2-4 servings (skim, 2%, whole) milk, buttermilk or yogourt (serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

2   2-3 servings Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or ½ – 1 cup cooked legumes or 2 Tbsp. peanut butter)


Grain Products were now 1st on list (5-12 servings!); reflecting the shift that most of calories (45-65% of calories) were to come from carbs.

Vegetables and Fruit were put 2nd on the list (5-10 servings) and could still be chosen as all carbs (potato, yams, other starchy vegetables, fruit, fruit juice) and along with this, there was a continued decrease in calories from fat (e.g. nut butters went from ½ cup – 1 cup in 1977 to ½ cup 1982 to 2 Tbsp. in 1992)

Also in this Guide, cheese was categorized with milk and yogourt – even though other ways of accounting for food such as the Diabetic Exchanges, classify cheese with Meat and Alternates (and nut butters with fat).

In 2005, there were even more changes to Canada’s Food Guide to Healthy Eating.  This is the Guide currently in use in Canada.

The numbers of servings were broken down based on stage of life and gender, but continuing the emphasis on high carbohydrate, low fat.  There were different number of servings per day for children aged 2-3, aged 4-8, aged 9-13, adolescent girls (aged 14-18), adolescent boys (aged 14-18), men (until aged 50), women (until aged 50) and then men over 50 and women over 50.

While Vegetables and Fruit were now put 1st instead of Grain Products, these could still be chosen as mostly carbs (potato, yams, other starchy vegetables, fruit, fruit juice), so with Grain Products put 2nd, carbs still formed the bulk of daily calories.

Canada’s Food Guide – 2005

Adult guidelines promoted (adults aged 19-50 years):

CFG 20055-10   7-8 (women) 8-10 (men) servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

5-12   6-7 (women) 8 (men) servings of Grain Products

2-4   2 (women and men) servings (skim, 2%, whole) milk, buttermilk or yogourt (serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

2-3 servings Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or ½ – 1 cup cooked legumes or 2 Tbsp. peanut butter)

Recommendations include:

Vegetables and Fruit

go for orange vegetables such as carrots, sweet potatoes* and winter squash*

*Note: starchy vegetables such as sweet potato and winter squash contain the SAME number of carbohydrates per serving as a serving of Breads and Cereals i.e. 15 g carbohydrate per ½ cup serving compared with non-starchy vegetables such as asparagus, broccoli and salad greens.

Under this Guide, Vegetables and Fruit can contribute 105 g – 150 g carbs per day (400 – 600 calories per day) if chosen as starchy vegetables and fruit / fruit juice.

Milk and Alternates

The Guide recommends: “Drink skim, 1% or 2% milk each day” which overlooks the satiety (feeling fuller) effect of higher fat dairy.

“select lower fat milk alternates” – fails to look a the fact that loads of sugar as flavouring replaces the fat, contributing the equivalent of 2 – 4 servings of carbs per 3/4 cup serving (where a serving of carbs as per the Food Exchanges is considered 15 g carbohydrate per serving)

Oils and Fats

The Guide recommends: “include a small amount (2-3 Tbsp.) of unsaturated fat each day.  This includes oil for cooking, salad dressing, margarine and mayonnaise. Use vegetable oils such as canola and soybean” resulting in the decrease of healthy-monounsaturated fats such as olive oil, nuts and seeds.


The Guide recommends to “serve small nutritious meals and snacks daily

Three meals AND a few snacks?

What effect have these dietary recommendations had on obesity statistics?

Let’s look at children;

  • In 1978, only 15% of children and adolescents were overweight or obese.
  • By 2007, that rate doubled to 29% of children and adolescents being overweight or obese.
  • By 2011, obesity prevalence alone for boys was 15.1% and for girls was at 8.0% in 5 to 17 year olds.

What about adults?

  • The prevalence of obesity [body mass index (BMI) ≥30 kg/m2] in Canadian adults increased from 10% in 1970-72 to 26% in 2009-11
  • Based on waist circumference 37% of adults and 13% of youth are abdominally obese.
  • Looking at these numbers slightly differently, as of 2013, there were approximately 7 million obese adults and 600 000 obese school-aged children in Canada

One has to wonder whether this dramatic increase in obesity and overweight after 1977 is correlated to Canada’s Food Guide shift to lower fat, higher carbohydrate diets.

In my  Dietetic practice, I give clients a choice of meal plan patterns because I don’t believe three meals and three snacks per day with 45-65% of calories as carbohydrate is the best way for people to address the matter of their excess weight.

For clients that come to me insulin resistant and/or overweight, I explain based on the literature why I recommend a meal plan pattern based on full meals without snacks with most of the calories coming from heart healthy satiety-offering monounsaturated fats. When clients are able to eat until they are satisfied without feeling hungry between meals and without feeling deprived, they are able to lose weight naturally and relatively easily.

Of course if clients want a meal plan based on the traditional 3 meals and 3 snack meal pattern I provide that for them using current recommendations.  There is no question that both ways, people can lose weight and lower their blood sugars, but my interest as a Dietitian is not only to see people’s weight and blood sugar and cholesterol come down, but to also see them feeling good and being happy with the process.

If you would like more information on the services I offer, please click on the Contact Us tab, above to send me a note.  I look forward to hearing from you and feel free to ask questions, if you wish!