diabetes

Ketogenic Diets are back

You’ve probably read the headlines and wondered whether you should take the plunge if the results – steady and sustainable weight loss and improvement of health markers - are really that dramatic and that easy. But are they, though? This post will give you the inside line on what the diet involves, whether it’s healthy and even sustainable for ‘normal’ people. Here goes …

The ketogenic diet is the ultimate low carb diet. It advocates a moderate protein intake and is very high in fat. It is similar to the Atkins diet, but it as a more modern version of it, now with a solid scientific basis. Both are very low carbohydrate diets, but the Atkins diet tends to be higher in protein, whereas keto somewhat restricts protein in favour of fat. Recent research over the last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many health conditions, including diabetes, polycystic ovary syndrome (PCOS), acne, neurological conditions - particularly epilepsy - and the management of respiratory and cardio-vascular risk factors.

Although dieters tend to lose weight, there is more of an emphasis of the ketogenic diet as a therapeutic diet, which may improve compliance for those that follow it for health reasons.

Like the Atkins diet, the ketogenic diet aims at keeping the body in permanent ketosis. Let’s take a look at what that actually is …

Glucose is the easiest molecule for your body to convert and use as energy so that it will be chosen over any other energy source. Insulin – a hormone made in the pancreas – is produced to process the glucose in your bloodstream by taking it into the cells. It’s the fat-storage hormone produced in direct proportion to the type and quality of carbs consumed. When you lower the intake of carbs in your diet, you force the body into a state of ketosis.

Ketosis is a natural process that helps you survive when food intake is low. When in this state, you produce ketone bodies or ketones, which are produced from the breakdown of fats in the liver. They are an alternative source of energy, when glucose is not available. Energy from ketones works just as well and feels no different – better, if anything, and the brain actually prefers ketones.

Photo by  Katherine Chase  on  Unsplash

Photo by Katherine Chase on Unsplash

What do you eat?

The ketogenic diet is largely based on protein and fat, and is filling and satisfying. This means no hunger cravings and consistent energy levels.

The downside is the diet is very strict. Cutting out carbs means more than just avoiding the bread, pasta, rice and potatoes that we think of as carbohydrates, but also other foods including many fruits and a number of starchy vegetables and even some nuts, such as cashews. What you might not be prepared for is having to cut back on alcohol. It’s not about cutting it out entirely – spirits are OK, but you have to watch the sugary mixers, and champagne and wine are not so bad in moderation, but a lot depends on your individual sensitivity to carbs. Your favourite cappuccino or latte may also be out.  

 

IN

Meat, fish, poultry, eggs.

Leafy Greens like spinach and kale.

Above-ground vegetables like broccoli, cauliflower, leeks, peppers, etc.

High Fat Dairy like hard cheeses, cream, butter, etc.

Nuts and seeds 

Avocado

Berries – raspberries, strawberries, blueberries blackberries, and other low GL berries

Other fats – coconut oil, high-fat salad dressing, saturated fats, etc.

 

OUT

Grains like wheat, rye, oats, corn, rice, barley.

Pulses such as chickpeas, soya, kidney beans, lentils.

Sugars: honey, agave, maple syrup.

Fruit like apples, bananas, oranges.

Potato, sweet potato, carrots, beetroot, etc.

 

Getting into ketosis

For most people, a ketogenic diet means that carbs are restricted to no more than 20g per day, however not everyone is equally sensitive to carbohydrates and some can get away with up to 50g. You’ll have to test where your carb threshold lies by measuring ketone bodies in the urine, blood or breath.  

You might be reading this thinking, ‘I can do this’, but the reality can be very testing. It can, in fact, take 4 weeks to get there and during the transition period many experience ‘keto flu’ – flu-like symptoms, headaches, tiredness, and weakness. This happens when the body runs out of glucose and has not yet learned to switch to using fat for energy – that’s because it hasn’t had to for such a long time. Until you become ‘fat adapted’ (i.e. your body has re-learned to use fat), there is a period of low energy. It is this taxing time that can put people off.

The people that do best on a ketogenic diet are those with a really compelling reason to do it, perhaps one of the chronic health conditions this diet can help. The rest of us mere mortals may struggle to be committed enough to get into and stay in ketosis. At the same time, be aware that the ketogenic diet may not be for you, for example if you are on insulin or blood pressure lowering medication. Make sure to educate yourself first to be safe.

If you are keen to find out more about ketogenic diets or if you'd like to book a complimentary call to discuss which approach to weight loss would best suit you, please do get in touch.

 

Gotta love fat

Park that notion that fat is bad. It is not. In fact, most of us aren’t eating enough of it. Fat can help you lose weight, protect against heart disease, absorb vitamins and boost your immune system.

Here’s why fat is essential in the body…

  • It’s a concentrated energy source.   Gram for gram, fat is twice as efficient as carbohydrates in energy production. Or in other words: fat has twice the calories of carbohydrates or protein, and here lies the problem: If we believe that a calorie deficit (calories in < calories out) is required for weight loss, then obviously the easiest way to achieve that is by reducing fat.
  • Fat can be an energy store. Excess fat is stored for future energy production (excess calorific intake). We can only store very little carbohydrate and no protein.
  • Protection – internal (visceral) fat protects your internal organs, like the kidneys and spleen. Too much of it is not desirable though, because we now know that this kind of fat secretes pro-inflammatory chemicals, making us sick.
  • ‘Subcutaneous adipose tissue’ (that’s code for the fat that you can feel by pinching your skin) helps to maintain normal body temperature and provides padding. Who wants to sit on their pelvic bone?
  • Fats regulate inflammation, mood and nerve function.
  • Every cell membrane in our body is made of fat – the brain is 60% fat. Without fat, there is no life.
  • Many hormones are made from fat. These are known as steroid hormones and they govern stress, sex, and immune function.  
  • Fats are actually essential for survival (experiments on rats in the 1920s showed that, then fat was removed from the diet they died).
  • Fat is the preferred fuel for muscles and the heart. The brain can also burn fat for fuel.
  • Essential fatty acids are required for healthy skin, healthy cell membranes, healthy nerves, healthy joints and to help with absorption of fat-soluble vitamins A, D, E and K.

In the world of nutrition “essential” means: We need to eat it, our body can’t make it. There are essential fats (omega-3 and omega-6), there are essential amino acids (building blocks of protein), but there are no essential carbohydrates. Do you think there’s a clue there?

How did fat get such a bad name?

Fat has got a bad reputation. Over the last 70 years low-fat products have been marketed as the saviour of our health. And the message from governments and the media was – and largely still is – that, when eaten, fat gets stored as fat in the body and puts us at greater risk of heart disease. However, when it comes to the human body, things are hardly ever that simple, and they are not in tis case either.

Part of the problem, of course, is that we use the same word for the fat we don't want (on the hips, around the middle and so on) and the fat we eat. Our current dietary guidelines imply that if we don’t eat (much) fat, we won’t get fat. Have a look around you and check how well that is working for us. If you listened to The Food Programme this week you will have heard Prof. Louis Levy of Public Health England (the people behind the Eatwell Guide) say:

The real thing about the Eatwell Guide is that it’s there to help people understand what a healthy diet is. What it won’t do is make you eat it.
— Prof. Louis Levy, Public Health England

So there we have it: If you are overweight or obese, suffer from diabetes and/or heart disease then evidently that’s your own fault. If only people would do as they're told already, we would not have a major public health crisis. Yet, statistics show that we actually have listened: We are eating less meat and butter, buy a lot more low-fat products than we used to and base our diets around carbohydrates – just as instructed. I see it in clinic every day: Clients tell me that they do follow a healthy diet, they are cutting the fat off their meat or avoid meat altogether - let alone butter or cream - and always go for low-fat yoghurt, cheese, hummus and guacamole. But it's not working! Obesity researcher Zoe Harcombe has taken apart the SACN report Prof Levy quotes in the interview. If you would like to read it, click here, but the gist is that the evidence Public Health England claims to have based the Eatwell Guide on does not actually hold up.

The demonisation of fat began when an American scientist called Ancel Keys produced the first ‘evidence’ linking saturated fat to heart disease in 1953. He based his scientific opinion on observational data of heart disease, death rates and fat consumption in six countries (ignoring statistics from a further 16 countries because they contradicted his hypothesis) and assumed a correlation between heart disease and eating fat. (As an aside, when another scientist looked at the same research, this time considering all 22 countries’ data, no correlation was found. The data is still available and what researchers now find is that there is actually a much stronger correlation between sugar consumption in all of the countries! A possibility that Keys did not even consider.)

Although there might have been correlation between saturated fat consumption and heart disease (there was a relationship), it was not causal (didn’t actually cause the situation).

A further study on rabbits compounded Ancel Keys’ hypothesis: The rabbits were fed cholesterol (which doesn’t normally form a part of their 100% veggie diet) and went on to develop fatty deposits in their arteries. And then, guess what happened? Poor bunnies!

Governments (and their health care agencies) across the world began advocating a low fat diet on the basis of this flawed research.  They told us to fill up on bread, rice, cereals and pasta, and opt for low-fat or no-fat alternatives wherever we could. And we did. 

Soon, the food industry jumped on board to create products that better satisfied this new advice. They replaced saturated fats with ‘healthier’ vegetable oils, like margarine and shortening – ironically trans fats are now one of the few fats research shows are linked to heart disease. The biggest problem is that, when you remove the fat from foods, you need to replace it with something else to make those foods palatable – and this replacement is sugar. This was a really bad move.

We have been ‘good’! People around the world have listened to the low-fat recommendations since the 1970s and put them into practice. And it is from that point onwards that obesity, diabetes and heart disease really took off. Go figure!

Be the one who skips across the finish line

There's good news: Life expectancy is steadily increasing. Modern medicine is so good now that it is possible to keep us alive for longer than ever. The bad news is: Healthy life expectancy is not increasing.

According to data published by Public Health England in July 2017, life expectancy in the UK is now 79.5 for men and 83.1 for women. Healthy life expectancy however, is 63.1 and 64.4 respectively. 19.0 years less for men and 16.1 years less for women. As life expectancy is increasing, but healthy life expectancy is not, we are spending more and more time of our life sick.

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By the time we hit 65, 40% of us are going to have at least one chronic illness: heart disease, stroke, type 2 diabetes, hypothyroidism, depression, dementia, arthritis, and cancer are just the most common ones. How thrilling is it to know that we’re going to live longer, but that we’ll spend a significant chunk of that time in pain?

The human body is an amazing thing. It takes a lot (a lot!) of punishment without complaining and works hard day and night – particularly at night though – to repair the damage we do to it and at least maintain us on a reasonably healthy level. That works really well for many, many years. But there is a point when that repair and maintenance begins to slow down. It is usually only then that we start noticing, and from my own observation I would say that that is at around age 40.

Most of my clients are over 40 and it’s not as if I wouldn’t be happy to see younger clients, it’s just that their diet and lifestyle hasn’t caught up with them yet. When you’re young, you can cope with short nights – whether that time was spent studying, partying, looking after a baby or working long-hours in a stressful job. Our body takes it all: junk food, eating on the run, smoking, drinking and even recreational drugs barely leave a mark (that we can tell). Injuries, like broken bones and torn ligaments, heal quickly and we get back on our feet in no time.

But once we hit our late 30s or early 40s the cracks are beginning to show: Suddenly there is a spare tyre around our middle that didn’t used to be there. Where did that come from? We haven’t changed anything! Anxiety, depression, insomnia, tinnitus, thyroid malfunction, high blood pressure, achy joints, hormonal imbalances, fertility problems, sexual dysfunction, and constant, leaden tiredness suddenly appear.

We’re feeling like cr*p, but at this point we are still looking at a good 20 or 25 years of a working life that is not going to let up. We are still expected to turn up at the same time every day and work hard, be efficient, be brilliant, make a contribution for at least 8 hours a day – as we always have. Once we get home, there is still housework to do, kids – or at this stage parents – to look after, bills to pay, friends to be seen, and just stuff to do. We simply do not have time to collapse on the sofa or crawl into bed to recover for another day.

Meds will help us through: anti-depressants, acid blockers, statins, beta blockers, thyroid hormone, HRT, metformin – once we hit 45, most of us are on at least one or two of those. While prescription drugs may be necessary, they are not going to fix anything, they’ll merely tide us over. All drugs come with side effects, which sometimes require another drug to deal with.

At retirement age, we have finally paid off the mortgage, the children have their own families, we’re not responsible for anyone but ourselves anymore. This is the time to spend the day just the way you like it: socialising with friends, cycling, gardening, volunteering, heck, you could even downsize, buy a camper van and go travelling.

However, if we even make it to retirement, 40% of us merely limp across the finish line, only to then collapse (statistically) and succumb to at least one chronic illness. We might not have the inclination or be in good enough shape to do any of the stuff we had planned.

But that’s old age for you, right? That’s what happens. It’s to be expected that by age 45 we’ve got to be on two or three meds. It’s normal to lay down extra fat and be achy in the morning and tired in the evening. That’s what happens when you age.

Well, actually no, it isn’t. We have come to accept all this as normal, because it is so common. It’s not inevitable though. It is our diet and lifestyle choices that have brought us to this point, and diet and lifestyle are what is going to turn it around for us. Obviously, the sooner you get into healthy habits the better, but it’s never too late!

So, what is it that makes us sick and old?

1. Stress

More than anything else lifelong stress sets us up for chronic illness. Over the time of our lives, most of us are exposed to a lot of psychological and physiological stress. For many, this starts even in childhood and while humans have remarkable resilience, it can catch up with us in middle age.

2. Diet

We still treat diet as an optional factor in health. Yeah, healthy eating is all well and good, but who has time or money for that? We’re busy people and shoving a burger into our mouths during a 15-minute lunch break is just going  to have to do. Or it could be a bag of Wotsits, or a stack of digestives. Anything is sustenance, right? Wrong. Do this for 20 years and you’ll no longer be able to ignore the consequences.

3. Alcohol, smoking and recreational drugs

Obviously.

4. Overweight and obesity

The most damaging thing excess body fat does for us is that it fuels inflammation. Temporary inflammation is a good thing and vital. When the immune system finds something wrong, it springs into action and deals with the problem. There will be redness, swelling and pain for a few days, but then we’ll get better. Chronic inflammation is silent and much less noticeable, but unfortunately chronic: It doesn’t stop. Fat cells, and particularly visceral fat (the fat on the inside) promote chronic inflammation, which is at the root of most chronic illness we experience when we are older.

Address these issues now – whatever your age – and make sure that you are going to be one of those people who skip across the finish line into retirement, ready to face their freedom!

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