Dispelling nutrition myths, ranting, and occasionally, raving


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To keto or not to keto

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I feel like there’s one thing missing from a lot of the discussion about the keto diet (and similar extreme diets, really). Everyone talks a lot about whether or not it “works” with proponents on both sides, research supporting both sides, arguing that it does or doesn’t work for weight loss. The problem with this is the assumption that weight loss is the most important feature of a good diet. It’s not. You can lose weight eating lots of things that are not going to provide you with the nutrients you need. Weight loss is not the most important thing for health, despite what the media, the “wellness” industry, society, and even many health care professionals have lead us to believe.

Just because you feel good on a ketogenic diet and are losing weight doesn’t mean that it’s a good idea. As a dietitian, this is something that I really struggle with. It’s our job to support people. We can tell them that keto is a difficult diet to follow, that it may not be advisable, but when it comes down to it, they decide if it’s something they want to pursue or not. And if they do decide to pursue it, we can’t say “well, good luck, I wash my hands of you”. We have to help them undertake it in as healthy a way as possible. Which kind of blows my mind (and makes me glad that I don’t work in a counselling role) because if someone came to us with an eating disorder we wouldn’t support them in that. How can it be ethical for us to support people in following a diet that may cause them harm?

A little history of keto: the ketogenic diet originated as a treatment for epilepsy in children in the 1920s. It was intended to mimic the effects of fasting through the generation of ketones. In recent years this concept has caught on with people desiring to lose weight. After all, if ketones are produced during fasting, then if a specific diet can promote the production of ketones, it may also lead to weight loss. Not illogical. In some children with epilepsy who do not experience a reduction in seizures with medications, the ketogenic diet can be an effective treatment. However, there are potential side-effects.

A few long-term studies (1, 2) have looked at the effects of the ketogenic diet in children and have found such side-effects as: kidney stones, slowed growth, dyslipidemia, and fractures. There are also short-term risks (2, 3, 4) associated with the diet in children with epilepsy including: acidosis, hypoglycemia, gastrointestinal distress (including vomiting, constipation, diarrhoea, and abdominal pain) dehydration, hypoproteinemia, and lethargy. All of these studies have found low long-term adherence among children. There are many reasons for this: some children see improvement in symptoms, even after discontinuing the diet, others find it difficult to adhere to the diet, for some it’s not effective.

Of course, adults who wish to lose weight are not the same as children who have epilepsy. It’s hard to say if slowed growth in children would have a similar counterpart in an adult. However, many of the short-term side effects may be seen in adults, as may some of the other long-term side effects. In addition, there is potential for nutrient deficiencies when following such a restricted diet. Unfortunately, we don’t have research into the long-term effects of a ketogenic diet on adults using it for weight loss. We have some short-term studies that primarily look at it from the standpoint of whether or not it’s an effective weight loss diet. Maybe it’s perfectly safe, but maybe it’s not. Given that the vast majority of people who lose weight on the diet end up regaining it, and often more, is it really worth taking that risk? By following a keto diet you’re basically enrolling yourself in an uncontrolled experiment.

I think it would be interesting to know what the long-term effects of a ketogenic diet for weight loss are in adults. What I’d really like to know though is why we have become so obsessed with being thin that we are willing to adopt disordered eating habits at the expense of other aspects of our health and well-being. Why is it when we talk about a diet “working” we de facto mean weight loss? Why have we come to value weight loss over every other indicator of health? Why can’t we just value ourselves enough to properly nourish our bodies?


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Do 6 amazing body changes really occur when you give-up carbs?

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This article is nearly two years old now but given that I just saw it shared on social media recently, and the number of evangelical LCHF preachers around, I think it’s worth talking about.

Can we start by discussing that headline? 6 Amazing Body Changes When You Give Up Carbs. Stated as if magical things will occur in your cells, transforming you into a superhuman. Stated as if it’s a given that giving up carbs is the miracle cure for the imperfect vessel of flesh in which you reside. Stated as if these six amazing changes are guaranteed to occur no matter who you are.

So, what are these six amazing changes?

  1. When You Give Up Carbs…You Start Burning Fat

This is not necessarily true. It depends on what you replace the carbs in your diet with. If you replace the carbs in your diet with protein, you’ll burn protein. If you replace the carbs in your diet with fat, you’ll burn fat. If you create a caloric deficit by giving up carbs then you’ll burn fat and probably muscle because you’ll need to get energy to function from somewhere.

2. When You Give Up Carbs…You Feel Less Hungry

If you are creating a caloric deficit by giving up carbs then, sorry, you are going to feel hungry. Reducing your food intake does not immediately result in a reduction in hunger. However, if you are able to maintain a low carb diet and enter into ketosis there is some research that shows you may experience some suppression of appetite.

3. When You Give Up Carbs…Your Belly Gets Flatter

Here the author is stating that your belly will become flatter if you replace simple carbs with high-fibre foods. This is not really a benefit of a low-carb diet, but a benefit of increased fibre intake (and their suggestion to swap white bread for whole grain is certainly not low-carb). However, for many people, increasing fibre can lead to gas and bloating, having the opposite effect of that claimed by the author. That being said, most people should consume more fibre, being sure to increase consumption gradually along with plenty of fluids to avoid blockages. With time, your body will adjust to increased fibre intake.

4. When You Give Up Carbs…You Slash Your Risk of Diabetes

To date, there is no research to support this. While a low-carb diet may help some people with type 2 diabetes control their blood sugar, it doesn’t necessarily work for everyone and there is no data to show that a low-carb diet will prevent diabetes. A balanced diet with plenty of vegetables and regular exercise and physical activity are the best ways to prevent type 2 diabetes. There is no need to go to the extreme and cut out carbs to prevent disease. Also, depending what those carbs are replaced with, you may end-up increasing your risk of developing other chronic diseases.

5. When You Give Up Carbs…Your Muscles Get Stronger

This would only be the case if you were consuming insufficient protein (extremely uncommon in the Western world) before embarking on a low-carb diet. If you are consuming adequate protein, adding more protein will be of no benefit to your muscles. Also, without working your muscles they’re not going to get bigger. You can’t just sit around drinking protein shakes all day and expect to get swole.

6. When You Give Up Carbs…You Feel More Energized

Not all carbs are bad, of course. Your body needs carbohydrates to function properly, and they’re especially important for adequate brain and muscle function. By switching from simple carbs to more long-running fuel—fruits and vegetables, whole-wheat bread, oatmeal, brown rice, quinoa and other whole-grain options—you’ll ensure you have a steady flow of energy and avoid the ups and downs that simple carbs cause.

Way to stick this in the last bullet and undermine the entire premise of the article. This is not a benefit of a low-carb diet. If you are switching from refined simple carbs to complex carbs and whole grains you are simply following that lame old unsexy advice that we dietitians have been repeating for decades.

Let’s not even get into the fact that whole wheat bread has pretty much the same glycemic load as white bread per serving.

I think the author also missed a few other “amazing body changes” that happen when you “give-up” carbs such as, fatigue (which generally goes away after a few days or weeks), flatulence, bad breath, and irritability.

What it comes down to, is that the author is conflating low-carb diets with low-simple carb diets and mixing the claims about the two diets together in this list.

While some people can live happily and healthily on low-carb diets, most people can live (likely more) happily and just as healthily on diets that are not low in carbs.

 


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I guess some RDs are sexy

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Eat big meals… Fat goes quick! Photo by L’imaGiraphe (en travaux) on Flickr. Used under a Creative Commons LIcence.

Right on the heels of my post about we dietitians not being sexy, this article comes out in the Daily Mail, and I’m forced to eat my words (good thing there are no forbidden foods!). Dietitian Trudi Deakin is proclaiming a high-fat, low-carb diet to be the be all and end all, and she’s written the book to “prove” it. Sigh.

Now, as you (my regular readers) know, I’m certainly not one to shy away from fat. New readers, My original by line was “real dietitians eat butter”. However, I also subscribe to the school of thought that says too much of anything is bad for you. Be it fat, salt, sugar, or carrots. You can have too much of a good thing. According to Trudi, saturated fat is the key. While it’s become widely accepted that saturated fat is not the demon it was once believed to be, that doesn’t mean that it’s suddenly a dietary super hero.

Trudi claims that her diet is 82% fat, and she’s never felt healthier. She alleges that high-carb diets are fuelling the obesity epidemic. The gist is that low-fat was wrong so low-carb must be right. Why do we have to go from one extreme to another? I’ll say the same thing about this that I said about demonizing sugar: blaming one nutrient for obesity or chronic disease isn’t getting us anywhere. These are complex problems that aren’t going to be remedied with simple solutions.

This 82% fat has me curious though. What would a diet that’s 82% fat look like? According to Trudi:

BREAKFAST: Three eggs cooked in the microwave with butter and cheese, like a souffle, served with oily fish – smoked salmon or mackerel – or avocado.

LUNCH:A bowl of berries with double cream or a homemade walnut scone, made with ground almonds rather than flour, served with double cream

DINNER: Meat or fish with a serving of vegetables cooked in butter 

Just for fun, I entered this meal plan into my fitness pal to find out the breakdown. Obviously without quantities, it’s near impossible to say exactly what caloric and macronutrient totals would look like. Based on one serving of each of the items listed above, I would only be consuming 995 kcal, and fat would account for roughly 40% of these. If Trudi’s diet is being accurately reported, she’s obviously consuming greater quantities than I recorded, particularly of the high-fat foods. Regardless, it doesn’t sounds overly appealing to me. I’d rather be a few pounds heavier and die a couple of years earlier than never have cereal for breakfast, never snack, and put butter on everything (as much as I love butter).

While Trudi may be content with this restrictive diet for now, it will be interesting to see what will happen with time. Most people following low-carb diets find them to be extremely difficult to follow over the long-term and usually relinquish them. Aside from the difficulty adhering to these low-carb, high-fat diets, there are other risk factors to consider.

Children with epililepsy following ketogenic diets provide us with some insight into the long term effects of a ketogenic diet. A study of children following a ketogenic diet found that poor growth was common. Other side effects were kidney stones and bone fractures.

There’s some other misinformation in the article. Trudi states that she consumes 30 grams of protein at breakfast because “your body doesn’t store it.” Um… I don’t know where this is coming from. While 30 calories at breakfast is certainly reasonable, excess calories, regardless of macronutrient, will be stored as fat.

The unfortunate thing about most weight management research is that “long term” equals several months to a year. While someone might experience weight loss, and find a high-fat diet relatively easy to adhere to for a few months, years, or a lifetime, are a far different story. Trudi’s been following this diet for less than year. Let’s see the tune she’s singing in a decade. Until then, you might want to take her high-fat diet with a grain of salt, or better yet, a baked potato.