Tag: weight loss
Diabetes and weight gain: has conventional wisdom got it all wrong?
It has been many years now since I was a new grad, yet I still remember with such clarity the first ever diabetic patient I saw.
This gentleman had poorly controlled diabetes and was also overweight, clearly holding most of it in his mid-section. He had seen a dietitian before, and according to him, he had “done everything he was told” and was therefore not entirely sure why he was sitting in my rooms that day. “The GP wants to make sure I am doing what I need to do I guess” was the best he could come up with.
I was so excited to see what I could do to help this gentleman. “I am going to be changing someone’s life!”
Channelling everything I had been taught up until that point, I went on to discuss his goals and look at his current intake so I could make some recommendations. I was adamant that losing weight will help improve his glycaemic control. So, in my head, I already had a few key things I wanted to address with him: I wanted to ensure that all his carb choices were low GI; I wanted to ensure all his food choices were lean and low fat; I wanted to make sure he ate regularly, without skipping any meals; and I wanted to make sure his meat were palm sized and that he controlled his total portions.
What caught me off guard was that his intake at the time was not far off that. He indeed was doing everything his previous dietitian had recommended. He chose Weetbix or oats for breakfast and had this with skinny milk and fruit. He snacked on fruit and low GI muesli bars (which also had a “Heart Tick”). His lunch was a salad sandwich with low GI brown bread, and he would seal the meal off with a piece of fruit. His dinner was lean meat with vegetables and some basmati rice, pasta or sweet potato. After dinner, he would have a low fat yoghurt, or some plain low fat crackers with some low fat cheese. He only ate when he was hungry and he rarely had chocolates, cakes or other indulgences.
So why was he not losing weight? Why did his sugar control get worse? I had no answers, except to tell him to continue with what he was doing, and to go back to his GP as he probably needed to increase his medication. “The diabetes is just getting worse and it isn’t anyone’s fault” I remember saying as I walked him out of my consult room, feeling sad that I couldn’t do anything, but knowing with confidence that he was doing everything right.
Well, fast-forward 7 years, and I am no longer so adamant I did the right thing. I am no longer so confident that he was doing everything right. Today’s me would have asked a lot more questions around his sleep, his work, his stressors. Today’s me would have requested to see a lot more blood tests to determine his hormone levels. Today’s me would have made dietary modifications to minimise insulin secretion so as to help him alleviate what was making him sick, what was making him fat.
Today’s me have successfully helped hundreds of clients go into “remission” from their diabetes just because I no longer believe what I used to believe.
You see, I no longer believe that diabetes is a disease that “only gets worse”. I no longer believe that weight gain causes diabetes. Instead, I know that weight gain does not cause diabetes, but is rather a symptom of the insulin resistance present in diabetics. Then when you add to that the fact that insulin resistance is not only found in those with diabetes, but also those with “normal” glucose readings, pre-diabetics and women with PCOS, it can become a lot harder to identify. But, once identified, it could be what prevents our current diabetes epidemic from continuing to spiral out of control, as well as end the frustration people have with their struggle to lose weight, despite their best efforts.
As the saying goes, “you live and you learn”.
Now at Metro Dietetics, we specialise in metabolic health and we thrive on seeing our clients achieve phenomenal results.
If only I could dial back 7 years so I could help that gentleman who sat in my rooms that day…
But hey, at least I can say that I did do the best I knew then, and now, I do the best I know now. At least I can say that I did live and I did learn and as a result, I am now actually helping change people’s lives for the better.
The Ketogenic Diet: Let’s Chew Through The Fat
I was recently approached to discuss the popular Ketogenic Diet. So let’s cut to the chase and chew through the fat.
When you ask your doctor about ketosis or when you type ketosis into Google search, the definition you will get is “a condition characterised by raised levels of ketone bodies in the blood, associated with abnormal fat metabolism and diabetes mellitus”.
However this definition is actually referring to a condition known as ketoacidosis which is a medical emergency signalled by raised ketone bodies in the absence of insulin. This is most common in the case of Type 1 diabetics who are not taking insulin correctly and not applicable to non-insulin requiring diabetics and the population at large, whose bodies are clearly able to produce insulin.
This misinformation surrounding ketosis is the frustrating reason why ketogenic diets are under-utilised as a therapeutic approach for modern day diseases.
What is ketosis?
Ketosis is a state where the body converts fats to ketone bodies to use as a primary fuel source in the absence of sufficient glucose. Whilst many people will tell you that your body needs glucose for energy – or prefers glucose as energy – your body and brain can run perfectly on blood ketones.
This state of ketosis is achieved by restricting carbohydrates and compensating with an increase in total fat intake (and yes, that includes saturated fats too) so our bodies can switch over from relying on carbohydrates as fuel to using fats as fuel.
Now you might be worried about saturated fats and its effect on your heart, but rest assured that the theorised link between saturated fat intake and heart disease is well and truly crumbling in the face of new scientific development, but this is honestly a topic for another time!
A typical ketogenic macronutrient split of proteins, carbohydrates and fats would be: 70%-75% fat | 20% protein | 5%-10% carbs
Why Ketosis?
Ketosis is an approach to eating that is much more than just another fad. When the body adapts to using fats as a primary fuel source, many benefits arise. Some of the most common ones include:
• Reduced sugar cravings due to eliminating insulin spikes and therefore blood glucose spikes and crashes associated with carbohydrate intake
• Increased satiety and therefore a reduced need and desire to snack constantly
• Reversal or control of Type 2 Diabetes and Insulin Resistance from eliminating the burden placed on the pancreas to secrete insulin constantly
• Fat loss from allowing the body to tap into their fat stores for energy, instead of forever accumulating fat stores whilst only ever using glucose and stored glycogen for fuel
• Reduced inflammation and inflammatory markers, and therefore an improvement in inflammation within the body including joints
• Improved blood lipid profile by increasing good healthy HDL, reducing unhealthy Triglycerides and improving overall total cholesterol to HDL ratio (which is a much greater predictor of heart health than total cholesterol alone)
Is the Ketogenic Diet for you?
Just like all dietary approaches, there is no one size fits all. However the ketogenic diet plan is fast become an approach that is helping people achieve better health long term.
Whilst it does encourage bringing fats back into the diet (and in quite high percentages too), it’s important that anyone considering this diet plan doesn’t lose focus on the quality of the food they are eating.
This approach is not a green light to eat a lot of fatty takeaway and junk food. Instead, it is about going back to basics, back to real foods.
It is saying: instead of highly-processed vegetable oils and margarines; instead of grain-fed hormone-injected meats and chickens; instead of processed packaged foods filled with omega-6 rich oils and trans fatty acids: opt for organic butters, coconut oils, natural nuts and seeds, oily fish, avocados, olive oils, grass-fed meats, organic chickens, free-range eggs, and so forth.
Not everyone needs to go on a ketogenic diet to see health benefits, however, the ketogenic diet has certainly shown much scientific validity, much popularity and much promise in helping individuals achieve overall better health.
Weight Loss – Same Same But Different
Weight Loss is such a big part of what we as dietitians and nutritionists do every day. Whether people are trying to lose weight to improve health markers, fit back into old clothes, feel more confident, be at the correct weigh-in weight for a competition, achieve a certain percentage body fat in time for a physique competition, weight loss is the number one reason why clients come to see us at Metro Dietetics.
However, since there is more than one reason for weight loss, there needs to be more than one approach.
Over the years, we have heard clients come in saying that they have tried many things to lose weight in the past, but nothing has worked long term. We have also heard clients come in saying that they need to lose X kgs in body fat and improve energy levels and performance, and hopefully gain some lean mass in time for footy pre-season.
Should these two types of clients receive the same advice? Should they even be advised using the same approach? Of course not.
That is why at Metro Dietetics we think it is so important to recognise that even though someone’s reason for booking in is “weight loss”, how we go about it, and who is best for the job (so to speak) will be different.
At Metro Dietetics, we help our clients for weight loss utilising two distinctly different approaches. Let’s have a look at the two approaches we use side-by-side to see what differentiating traits they have:
There is no right or wrong approach – however, there is always an approach that is more or less suited to you and your needs. If you are unsure which approach best suits you, consult with a Metro Dietetics dietitian or nutritionist and we can help you figure that out.
The Real Skinny on Low Carb Diets – A Critique.
This is a Critique of “The Skinny on Low Carb Diets” by Jenelle Croatto. The original article found here: https://www.12wbt.com/blog/nutrition/the-skinny-on-low-carb-diets/
Before I start, I want to preface this by saying that this article is not intended to “carb-shame”, but rather present the facts, which unfortunately is so often neglected when writing about carbohydrates and diet.
DEFINING THE UNDEFINED
So often we hear of the term “Low-Carb” – low carb bars, low-carb breakfast cereals, low-carb pastas, low-carb diets….so, my first question is: what exactly is LOW carb?
Unfortunately, in Australia and around the world, there is no clear definition. One source will claim that the MINIMUM we should consume a day is 130g of carbohydrates (hence implying that anything below that is technically low carb). Another source will state that low carb is less than 20% daily intake (which for someone on a 2000kcal a day diet means 100g of carb versus for someone on a 1300kcal a day diet means 65g of carb). The most extreme sources I have come across suggest 10% of total daily energy from carbs (which using the above example of 2000kcal and 1300kcal a day means 50g and 30g respectively of carbs). For the sake of this article, I am going to adopt a somewhat middle ground and say 50-65g of carb a day is “Low Carb”
However, I am yet to come across a single source that suggest we eat ZERO carbs. So the first point I want to make is: when we are talking low carb, a) the definition varies dramatically, and b) we do NOT imply no carbs.
WHY WE DON’T NEED CARBS
- It is not a premium energy source, nor is it the only energy source
Our body uses carbs as the first line of energy because it is readily available and accessible. In a modern Western diet, carbohydrates are very abundant, so the body adapts to using exogenous glucose from carbohydrate foods as fuel. So – what happens when we don’t have much carbs in our diet? Our body can produce glucose endogenously via gluconeogenesis, a process whereby the body creates glucose using non-carbohydrate derivatives such as amino acids (from proteins) and lipids (from fats). The body can also produce ketones for energy, running the body on fat as fuel as opposed to glucose as fuel.
- It does not help with sugar cravings
When our body is running on fats as fuel, insulin and blood glucose levels are low and stable, hence eliminating the normal issues with sugar cravings, post prandial slumps and strange energy spikes and dips throughout the day. Also a diet high in protein and healthy fats are much more satiating anyway! Who has ever had eggs for breakfast and noticed they don’t feel the need to snack mid morning?
- It is not involved in fat burning, let alone optimises fat burning
One thing I want to clear up before proceeding is: reducing carbs does NOT mean necessarily reducing total calories. Reducing carbs simply means reducing the quantity of carbs, but one can still increase fats and proteins for energy and satiety.
Now, in contrast to this unreferenced “population study” that apparently shows that those who include wholegrains in their diets tend to have smaller waistlines and be leaner, I have a referenced study that shows the striking contrast in FAT loss for those on a low-carb diet, versus a low-fat diet. Furthermore, this study also showed improvements in risk levels for heart disease in the low-carb group versus the low-fat group (Bazzano, LA, et al. Effects of low-carbohydrate and low-fat diets: a randomized trial. Ann Intern Med. 2014 Sep 2;161(5):309-18.). So – do carbs optimize fat burning? Apparently not.
As for the sensationalist journalism used to compare “soft white bread” to “steak” when describing their “eatability versus satiability” – I don’t think I really need to comment here.
A FINAL NOTE ON FIBRE
I believe that fibre is very important for bowel health. I also believe that fibre does not require eating pasta to obtain (100g of cooked pasta only giving us 2g of fibre) which is no more than what 100g of green beans, carrots, broccoli or eggplant would provide (100g of each would give you 2-3g of fibre). In a day, we are recommended 30g of fibre – so the question is: can we meet this on a “low-carb” diet (remember, we are using 50-65g carb a day as a guide)? Let’s find out:
| Food | Quantity | Net carb | Fibre |
| Raspberries | 50g | 2.5g | 4g |
| Chia seeds | 1 tbsp | 1g | 3g |
| Green beans (as an example) | 200g | 7g | 7g |
| Black rice | 125g cooked | 26g | 4g |
| Psyllium husk | 1 tbsp | 0g | 10g |
| TOTAL | 36.5g | 28g |
The answer is: Yes.
The Bottom Line?
I am not writing this to advocate carbs one way or another for the general population. I am simply presenting facts and figures, and obviously, disagreeing with the general tone of the original article I am critiquing.
As dietitians we are there to educate and present our clients with facts so they can decide whether a low carb approach is for them or not. We should not form pre-conceived stances on these things and attempt to sway our clients one way or another based on our own beliefs.
The Biggest Loser – A Critique
The Biggest Loser is a show that most people have watched and come to form strong views and opinions about.
Some people are fans and find the show “motivating”, “encouraging”, “successful” whilst others say that it is “unrealistic”, “unsafe”, “outrageous”.
For those who haven’t watched it – The Biggest Loser is a competition to see who can lose the most weight in a set time frame. The weight loss is calculated as a percentage weight loss based on the contestants’ starting weight.
Achieving high quality, client-centred outcomes is one of my passions. I recognise that in today’s society, there are many barriers to achieving good health and nutrition whether it relates to disease, lifestyle, work, financial or personal circumstances – and most importantly that everyone is different!
As a dietitian, I get asked all the time–
- “how does someone lose so much weight in a week?”,
- “is it safe to lose so much weight so quickly?”,
- “they don’t show a lot of their diet – what does it consist of, do you know?”,
- “they seem to be exercising a LOT – is that good for them?”
Since I had only seen bits and pieces of the show, I couldn’t really give a satisfactory answer.
So, I decided to sit and watch an entire episode – which turned into two episodes, and the finale as well.
Here are some of my thoughts on the show.
Pros:
A strong circle of support
A good and sturdy support network is important when making lifestyle changes of any calibre. On The Biggest Loser, each contestant had their trainers, team mates and fellow contestants to lean on when the going got tough. With the constant encouragement and push (and not-so-occasional kick up the backside), each contestant was well supported throughout their journey to lose weight.
Race to the finish line – $$$
Most people are, to varying degrees, competitive by nature. So, setting the show up as a competition, with such a large, beefy carrot dangled in front of the contestants, made the pain of the whip so worth the while! Of course, we cannot all be rewarded in tens of thousands of dollars in prize money for losing weight, but a reward based system definitely gives great incentive for us to do something that is fundamentally so difficult and mundane.
Cons:
Unrealistic expectations making the reality show not a reality at all
The sheer amount of weight contestants were losing was impressive, but outraging at the same time (especially when we are forever stressing to clients that a safe and realistic rate of weight loss is between 0.5 to 1kg a week).
Also, the focus became so centred on absolute weight loss that it lost sight of more important things like – a balance between diet, exercise and REST, quality of life, “weight” loss versus “fat” loss and so much more.
Needless to say, we don’t all have the luxury of being whipped into shape by a personal trainer all day every day, not needing to work, cook or do any housework. When taken out of the context of The Biggest Loser, the “lifestyle” that it portrays is simply not one that 99.9% of the population can mirror – yet, it is what a lot of people who watch the show would take as a fine example of “successful” weight loss.
Exercise, more exercise… what about the food?
Of course, the dietitian part of me is protesting that there was not a big focus on nutrition – but there really wasn’t! I have never been one to attribute successful long term weight loss to diet only, but The Biggest Loser made it seem like as long as you trained REALLY hard (to the point where most contestants were over trained and risking injury), you would be able to lose the weight and keep the weight off.
Whilst I am sure they had their diets taken care of, it would have been nice to see a bit more focus go into the importance of healthy eating and what it entails when it comes to weight loss, fuel for training, recovery and maintaining good energy levels throughout the day.
Finally the finale – but then what?
One of the biggest issues I found was that throughout the show, contestants were not taught real-life strategies to cope with the barriers that can pop up day-to-day, such as: emotional barriers (stress, for example), mechanical barriers (work, appointments, taking the kids to swimming) and knowledge barriers (not knowing the nutritional value of foods in order to make informed choices with meals and snacks). This meant that, when the contestants returned to the real world, they would likely revert back to their old ways and their old weight.
