Book Review: Forever Strong by Dr Gabrielle Lyon

Jan 7, 2024Oct 30, 2023 kaitiscotland3 Comments

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Forever Strong: A new science based strategy for aging well by Dr Gabrielle Lyon.

I read this book when it came out in October 2023. It costs £16.99 from Amazon in paperback.

Dr Lyon has worked in psychiatry, geriatrics and nutrition. She thinks that over fatness is less of a problem to being under muscled when it comes to general health, ageing and efforts to live longer in better shape.

She advocates a high protein diet of no less than 100g of protein a day for all adults. This can be more depending on a person’s ideal lean body weight. It is also a lot higher for those who aim to build more muscle.

She offers three different eating regimes. The first is for longevity. For this she recommends higher protein meals for breakfast and dinner and a lighter protein snack at lunch time. Carbohydrates are generally restricted to the same number of grams as the protein spread over the day. These can be increased for those engaged in more than one hour’s vigorous exercise a day. Fat is eaten according to the remaining calories available to maintain weight.

For those wanting to lose weight, she recommends that protein is spread evenly over three meals a day. Carbohydrate should be no more than 30g per meal. Fat intake should be low as the aim is to cut back by 10-20% of maintenance calories daily. She thinks that it is crucial to prioritise dietary protein as this reduces muscle loss and improves satiety. Carbohydrates should be low sugar fruit and low starch vegetables in order to minimise calories and insulin response.

For those who want to gain weight, protein intake is higher and usually needs to be spread over 4 meals. Carbohydrate and fat can be increased as the aim is to exceed maintenance caloric intake. A well planned exercise regime needs to be undertaken and this will usually require a personal trainer at a gym.

The exercise regime offered is based at the beginner in the book but she offers different programmes from her website. I wasn’t able to find these when I looked but perhaps they are still undergoing development.

The book covers the science behind her nutritional advice, a discussion of the mental roadblocks that stop people taking control of their diet and exercise regimes, baseline measurements that will help you figure out what exactly you should be eating and some recipes.

I exercise daily and have been weight training since the age of 27. I also have been low carbing for 20 years. Did I learn anything? YES.

I’ve been making several big mistakes regarding my diet and exercise regime.

Firstly, although I eat about double the protein that I see my friends eating, this is still not likely to be high enough for optimal muscle gain.

Secondly, I really should be eating a lot more protein first thing in the morning so that dietary leucine levels come up to the threshold that prevents muscle breakdown and ensures the best use of protein in the body and for muscle development.

Thirdly, like a lot of low carbers my fat intake is very high, and I pile it on oblivious of the caloric intake.

Fourthly, I do indulge in the odd sugar /starch item and during weight loss efforts these would be better cut out entirely. Same for alcohol.

Fifthly, my weight training regime needs altered. I used to do alternate days resistance training and something else but various injuries and back pain led me to experiment with more stretching and back exercises and this led to a definite improvement in my chronic back pain. I have altered my regime again to add in more resistance work. Dr Lyon thinks that three times a week is best. I’ll see how this goes but at my age I need to consider the injuries and degenerative problems that accumulate.

Overall this is a very helpful book for those who seek the best of physical health and contains information that I was not previously aware of.

Low carb diets have almost all the nutrients you need

Dec 22, 2023Oct 30, 2023 kaitiscotland1 Comment

Adapted from BMJ Open Access: Assessing the nutrient intake of a low carb high fat diet: a hypothetical case study design.

Abstract
Objective: The low-carbohydrate, high-fat (LCHF) diet
is becoming increasingly employed in clinical dietetic
practice as a means to manage many health-related
conditions. Yet, it continues to remain contentious in
nutrition circles due to a belief that the diet is devoid of
nutrients and concern around its saturated fat content.

This work aimed to assess the micronutrient intake of the
LCHF diet under two conditions of saturated fat thresholds.

Design: In this descriptive study, two LCHF meal plans
were designed for two hypothetical cases representing the
average Australian male and female weight-stable adult.

National documented heights, a body mass index of 22.5
to establish weight and a 1.6 activity factor were used to
estimate total energy intake using the Schofield equation.

Carbohydrate was limited to <130 g, protein was set at
15%–25% of total energy and fat supplied the remaining
calories.

One version of the diet aligned with the national
saturated fat guideline threshold of <10% of total energy
and the other included saturated fat ad libitum.

Primary outcomes: The primary outcomes included all
micronutrients, which were assessed using FoodWorks
dietary analysis software against national Australian/New
Zealand nutrient reference value (NRV) thresholds.

Results: All of the meal plans exceeded the minimum NRV
thresholds, apart from iron in the female meal plans, which
achieved 86%–98% of the threshold.

Saturated fat intake was logistically unable to be reduced below the 10%
threshold for the male plan but exceeded the threshold by
2 g (0.6%).

Conclusion: Despite macronutrient proportions not
aligning with current national dietary guidelines, a wellplanned LCHF meal plan can be considered micronutrient replete.

This is an important finding for health
professionals, consumers and critics of LCHF nutrition, as
it dispels the myth that these diets are suboptimal in their
micronutrient supply. As with any diet, for optimal nutrient
achievement, meals need to be well formulated.

My comments: Achieving nutritional completeness is almost impossible on a high carb, low fat, low protein diet. Despite the nutritional superiority of a well formulated low carb diet, there are some take home notes from the dieticians involved. 1. Your requirements for Vitamin D cannot be met solely by diet. You either need year round sun exposure or nutritional supplementation with a Vitamin D/K2 supplement. 2. In women of childbearing age, they may need extra iron in the diet, even if they eat red meat regularly. This is due to the effects of menstruation and pregnancy. This may involve eating red meat with fruit juice, avoiding tea with meals, and taking extra iron supplements. Latest thinking is that iron supplementation on alternate days or even less often reduces the bowel problems such as constipation that are usually caused.

American Diabetes Association patient booklet for ketogenic and low carb diet for diabetes published

Oct 5, 2023Jul 22, 2023 kaitiscotland3 Comments

Here it is: the first ADA patient booklet about how to do a low carb or ketogenic diet if you have diabetes.

https://www.dropbox.com/s/582qeejjlmj1egu/ADA%20Low%20Carb%20patient%20guide.pdf?dl=0

My comment: My aim for the last 20 years has been that low carbing for diabetes becomes mainstream. It still isn’t being promoted as much as it should be, given the huge advantages that it confers over the usual dietary patterns in the western world, but well done the ADA in finally committing to publishing this document.

Binge eating: cause and cure

Jul 1, 2023May 11, 2023 kaitiscotland3 Comments

Adapted from: Ultra processed foods and binge eating: a retrospective observational study by Agnes Ayton MD et al. Nutrition 84 (2021) 111023 and Treating binge eating and food addiction symptoms with low-carbohydrate Ketogenic diets: a case series by Matthew Carmen et al. Journal of Eating Disorders (2020) 8:2.

In general ultra processed foods are high in sugars and fats and low in natural protein. They are considered to be not modified foods but formulations made mostly from substances derived from foods, many of them not normally used in culinary preparations, as well as additives. A series of processes are used to create the final product. Many ingredients including sugars are metabolically active and may have an addictive potential. Such foods include soft drinks, sweet or savoury packaged snacks, reconstituted meat products, pre-prepared frozen dishes and diet products.

Ultra processed foods have been gradually displacing unprocessed or minimally processed foods and freshly prepared meals. In the UK the percentage of foods eaten in this category ranges from 30-80% and the average is 56.8%. This has led to an increase in the amount of starches, sugars and fats, and a decrease in the amount of protein consumed. Increases in the amount of these foods consumed is linked to increasing rates of obesity and metabolic disorders. They seem to reduce satiety and stimulate overeating. People who are allowed to eat what they want end up eating more carbohydrate and fat but not protein. This results in widespread endocrine changes. Animal and human experiments show that ultra processed foods interact with various hormonal and neurobiological systems that affect food intake.

Responses to common foods vary from person to person and are influenced by such factors as insulin resistance, sleep, stress, exercise and the microbiome. These differences affect glucose tolerance and insulin sensitivity.

The detailed records of 73 people who had attended an eating disorders clinic in Oxford between 2017 and 2019 were examined retrospectively. Only 3 were men, the majority of patients being women.

Common ultra processed food items consumed included: breakfast cereals, diet yoghurt, diet drinks, biscuits, snack bars, cake, sandwiches, Quorn sausages, waffles, crisps, ready meals, pizza, ice cream, and doughnuts.

Eating patterns showed that while breakfast and snacks were commonly missed, most people ate lunch and dinner, and binge eating tended to occur more towards the evening. During the day most people chose foods low in fat and protein.

The foods consumed during binge eating were 100% ultra-processed such as chocolate, ice cream, crisps, sandwiches, biscuits, cakes, pizza, smoothies and doughnuts.

Meals were often missed during the day indicating that dietary restriction is shared between people with eating disorders regardless of the actual precise type.

A separate cross over study reported that patients did not notice a difference in palatability between normal and ultra processed foods, yet ate 500 k cals more a day on the ultra processed foods. The hunger hormone ghrelin, fasting glucose and insulin are all raised with ultra processed foods and the appetite suppressing hormone peptide tyrosine is reduced. Although fat and carbohydrate were increased in amount, protein intake remained the same suggesting that excess intake is driven by dilution of dietary protein.

Anorexia Nervosa is associated with increased insulin sensitivity while Bulimia Nervosa and Binge Eating Disorder are associated with insulin resistance. Indeed 30% of patients with BED had impaired glucose tolerance. It is possible that metabolic factors contribute to binge eating.

Overconsumption of food may also be driven by combinations of sugar and fat not found in nature and also non-nutritive sweeteners.

The nutrient sensing system plays a critical role in regulating striatal dopamine and reward. This is subconscious. The second conscious system influences food choices based on beliefs of healthfulness, cost and so on, which are heavily targeted by advertising and the food environment.

Patients with eating disorders choose diet products, which are actually often ultra processed, having the belief that these are healthier options, unaware of the metabolic and neurobiological effects that impair accurate sensing of nutrient content by the brain and result in uncontrollable eating during a binge episode.

The cavalry coming over the hill in all this could be the good old ketogenic diet.

Carmen et al from Stanford University reported on three patients aged 34, 54 and 63 whose average BMI was 43.5. They undertook a ketogenic diet consisting of 10% carbohydrate, 30% protein and 60% fat for 6 to 7 months. They all had binge eating and food addiction symptoms.

They were all pleased to report no major adverse effects on the diet and a significant reduction in binge eating episodes and food addiction symptoms such as cravings and lack of control. They also lost between 10 -24% of their body weight.

After the study finished, they all continued on the diet for 9-17 months and continued to have no recurrence of their original binge eating and cravings. In one patient with a pervasive low mood this also substantially improved.

Food addiction symptoms have been described as an addictive response to foods such as sweets and starches. These include much time spent obtaining food, feelings of withdrawal when off food, continued use despite adverse consequences, important activities reduced or given up, repeated unsuccessful attempts to stop, and eating more than intended.

Rates for food addiction are up to 42% for patients who are waiting on bariatric surgery. In people who have obesity the rates are 15 to 20%.

The ketogenic diet produces appetite suppression, lower hunger, greater satiety, greater fat burning, lower fat formation, more glucose being made in the liver and the increased thermic effect of proteins.

The patients were asked to keep to 20-30g of carbohydrate a day or less and to eat whole foods, not processed, including meat, seafood, nuts and eggs, 4 oz of hard cheese a day, 2 cups of assorted salad vegetables, cup of non starchy vegetables and low carb fruit. They were asked to not count calories and to eat till they felt full and then stop.

This small case series supports the feasibility of using a low carb ketogenic diet for patients presenting with obesity and self reported binge eating and food addiction symptoms.

Ketogenic diets can also be used for paediatric epilepsy, gastro oesophageal reflux, irritable bowel syndrome, and Crohn’s disease. Mental disorders such as bipolar disorder, psychosis and schizophrenia.

Dr David Ludwig: Childhood obesity the the crossroads of science and social justice

Jun 13, 2023May 2, 2023 kaitiscotland1 Comment

Adapted from paper by Dr David S Ludwig and Dr Jens J Holst published in JAMA May 1 2023

Treatment that focuses on the root cause of a disease has guided research and clinical practice for centuries. The American Academy of Pediatrics (AAP) published a clinical practice guideline for the evaluation and treatment of children with obesity earlier this year. This guideline emphasises the use of weight loss drugs and bariatic surgery. Diet received little attention apart from advising the USDA’s MyPlate recommendations and the limitation of sugar sweetened beverages.

The researchers are of course constrained by available evidence and the results on weight loss for drugs and surgery do seem superior to the changes achieved by diet. Yet, the physiological changes that occur on a carbohydrate restricted diet have many similarities to what occurs in the body with drugs such as GLP-1 receptor antagonists.

GLP-1 RAs improve beta cell sensitivity to glucose so that the same amount of insulin will be released at a lower glucose concentration. It also slows the rate that the stomach empties after eating food. Thus people feel fuller up after eating for longer, and the lower blood sugars released from the stomach over time result in lowering the total amount of insulin from the pancreas. The lower the rate that the stomach empties, the more weight is lost.

Slower digesting carbohydrate, for instance, must travel farther down the gut before being fully absorbed. This causes lower post meal blood sugars and insulin secretion. Protein and fat also digest more slowly and stimulate less insulin secretion than an equivalent amount of rapidly absorbed carbohydrate. Additional similarities between low glycaemic load diets and GLP-1 RAs include lower leptin levels, suggesting lower leptin resistance, lower ghrelin levels and higher adiponectin levels. This dietary strategy shares mechanisms with gastric bypass surgery which shifts nutrient absorption from a more proximal to a more distal location in the intestines. Of special relevance is that natural GLP-1 secretion is increased with a low glycaemic load diet, which slows gastric emptying thus improving satiety, and bariatric surgery.

Although in theory a low carb diet should be able to replicate the results of GLP-1 RAs (15% weight loss) results are usually disappointing, except where a ketogenic diet with intensive behavioural support (12% weight loss) is provided. In other words, the results can be almost replicated but the person must stick to the diet.

GLP-1 RAs cost $1,400 per adolescent per month. Treatment of all adults with obesity would cost $1 trillion and all adolescents $100 billion per year. Instead of spending this sort of money to solve the obesity crisis, it would be more worthwhile to enhance dietary quality and create environments that would encourage physical activities and outdoor play as an alternative to screen time and electronic gadgets. This would improve mental as well as physical health.

Unfortunately, once GLP-1 RAs are stopped, the weight is usually rapidly regained. Therefore we are really looking at potentially lifelong drug treatment for the obese population. We do not know the effects of prolonged drug treatment on other health factors. A low quality diet could still produce a raised lifetime risk of cardiovascular disease, cancer and other chronic conditions, independent of weight.

Perhaps low glycaemic load diets when given in conjunction with GLP-1 RAs would improve the therapeutic effect and thus allow drug use at lower dosages. This could reduce adverse effects.

To advance science and social justice we must fund research into new dietary treatments and overcome obstacles to the provision of intensive behavioural interventions. Especially for children, diet and lifestyle must remain at the forefront of obesity prevention and treatment.

Total mortality rates are improved when type two diabetics follow a low carb diet

Apr 20, 2023Mar 25, 2023 kaitiscotland3 Comments

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Adapted from Diabetes in Control March 24 2023

Mortality Reduced With Adherence to Low-Carb Diet in Type 2 Diabetes

Mar 24, 2023

Lower mortality seen with increases in total, vegetable, and healthy low-carbohydrate diet score

By Elana Gotkine HealthDay Reporter

FRIDAY, March 24, 2023 (HealthDay News) — For individuals with incident type 2 diabetes (T2D), a greater adherence to low-carbohydrate diet (LCD) patterns is associated with lower mortality, according to a study published online Feb. 14 in Diabetes Care.

Yang Hu, Ph.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues calculated an overall total LCD score (TLCDS) among participants with incident diabetes identified in the Nurses’ Health Study and Health Professionals Follow-up Study. Vegetable (VLCDS), animal (ALCDS), healthy (HLCDS), and unhealthy LCDS (ULCDS) were also derived.

The researchers documented 4,595 deaths, of which 1,389 cases were attributable to cardiovascular disease (CVD) and 881 to cancer among 10,101 incident T2D cases, contributing 139,407 person-years of follow-up. Per each 10-point increment of postdiagnosis LCDS, the pooled multivariable-adjusted hazard ratios for total mortality were 0.87, 0.76, and 0.78 for TLCDS, VLCDS, and HLCDS, respectively. Significantly lower CVD and cancer mortality was seen in association with VLCDS and HLCDS. From the prediagnosis to postdiagnosis period, each 10-point increase in TLCDS, VLCDS, and HLCDS correlated with 12, 25, and 25 percent lower total mortality, respectively. For ALCDS and ULCDS, no significant associations were seen.

“Our findings provide support for the current recommendations of carbohydrate restrictions for T2D management and highlight the importance of the quality and food sources of macronutrients when assessing the health benefits of LCD,” the authors write.

Worsening obesity in children can be reversed with a ketogenic diet

Mar 15, 2023Mar 8, 2023 kaitiscotland5 Comments

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Adapted from Independent Diabetes Trust Newsletter March 2023

The National Child Measurement Programme 16 March 2022

In the western world obesity rates continue to climb in children. In the UK when children start primary school at the age of 4-5 14.4% are obese and a further 13.3% are overweight. In Primary 6, at the age of 10-11 25.5% are obese and 15.4% are overweight.

My comment: from my own schooldays, there was only one overweight child in my primary class and she was on steroids and had a heart complaint that stopped her from participating in any exercise. In primary 7, there was one girl who was overweight and she had started puberty earlier than the rest of us.

In the USA in 2019 more than 30% of children were overweight or obese, similar to the UK figures. Physicians are reporting that since the Covid epidemic children are usually between 5 and 10 pounds heavier than they were at any given age, so these figures are likely to worsen even more.

Since 2006 Duke University has treated more than 15,000 children with a restricted carbohydrate diet which encourages the eating of vegetables, fatty fish, nuts and other features of the Mediterranean diet.

Meghan Pauley and colleagues from the Marshall University School of Medicine in Huntington West Virginia have cut the carbohydrate intake for children further to 30g or less a day and have been effective in short term weight loss in severely obese children and teenagers.

The ages of the subjects ranged from 5 years to 18 years. The study lasted 3-4 months. The children were otherwise told to eat as much fat and protein as desired with no limit on calories.

Two groups of analyses were done of different intakes into the programme in 2017 and 2018.

In Group A, 310 participants began the diet, 130 (42%) returned after 3-4 months. Group B had 14 enrollees who began the diet, and 8 followed up at 3-4 months (57%).

Girls compared with boys were more likely to complete the diet. Participants less than 12 years age were almost twice as likely to complete the diet compared with those 12-18 years, however, the older group subjects who completed the diet had the same percentage of weight loss compared with those under 12 years. Group A had reductions in weight of 5.1 kg , body mass index (BMI) 2.5 kg/m² , and percentage weight loss 6.9% .

Group B had reductions in weight 9.6 kg , BMI 4 kg/m² , and percentage weight loss 9% . In addition, participants had significant reductions of fasting serum insulin and triglycerides.

This study demonstrated that a carbohydrate-restricted diet, utilized short term, effectively reduced weight in a large percentage of severely obese youth, and can be replicated in a busy primary care office.

PHC: How low carbing can help the NHS, meeting in Edinburgh

Jan 24, 2023Jan 19, 2023 kaitiscotland2 Comments

The Public Health Collaboration is hosting a morning meeting on Saturday 18th March in Edinburgh from 9 am till 1pm.

The morning speakers will be explaining the role low carbing has on:

Improving mental health and particularly the results with bipolar disorder.

Improving weight and glycaemic control in type two diabetes.

Reducing the costs of managing type two diabetes.

Public education and group coaching initiatives in Scotland.

The PHC Ambassadors are having an afternoon meeting to discuss their projects.

The meeting is at the Quaker Meeting House in the old part of Edinburgh at the bottom of the castle and the fee is £15.

Please contact Sam Feltham at the Public Health Collaboration for more details and to register for the event.

Metabolic Multiplier: Help for type two diabetics who want to adopt a low carb diet

Jan 18, 2023Dec 27, 2022 kaitiscotland3 Comments

The site Metabolic Multiplier have compiled a toolkit that you can use to educate yourself about the low carb diet and have included information that you can give to your doctor or other health care professional so that they will be more likely to help you monitor your condition.

Your patient toolkit for prediabetes & type 2 diabetes

I was part of the development group last year.

The dietician Adele Hite was extremely active in the group and always seemed so full of energy and enthusiasm. She put in many hours into the project as well as her day job. Little did I know that she had a returning cancer and that she was to die from it in less than a year. In retrospect, I think that this is what drove her. She was determined to leave a legacy to help others.

If you know of any newly diagnosed diabetics or any who are experiencing friction with their GPs or health care providers, please let them know about the Metabolic Multiplier site. It is organised by the highly efficient and versatile Cecile Seth.

Low carb diets are beneficial for weight normalisation after childbirth

Jan 6, 2023Dec 26, 2022 kaitiscotland2 Comments

Everyone knows how hard it is to shift body fat after having a baby. A recent study suggests that adopting a low carb diet featuring plentiful meat/poultry/fish and animal fats was more successful than having a low carb diet based mainly around plant foods.

Readers who are keen to shed their post holiday season weight gain may also find this information useful.

Low-carbohydrate diets (LCD) have been considered a popular dietary strategy for weight loss. However, the association of the low-carbohydrate dietary pattern with postpartum weight retention (PPWR) in women remains unknown.

The present study involved 426 women from a prospective mother-infant cohort study.

Overall, animal or plant LCD scores, which represent adherence to different low-carbohydrate dietary patterns, were calculated using diet intake information assessed by three consecutive 24 h dietary surveys.

PPWR was assessed by the difference of weight at 1 year postpartum minus the pre-pregnancy weight. After adjusting for potential confounding variables, women in higher quartiles of total and animal-based LCD scores had a significantly lower body weight and weight retention at 1 year postpartum (P < 0.05). The multivariable-adjusted ORs of substantial PPWR (≥5 kg), comparing the highest with the lowest quartile, were 0.47 (95% confidence interval 0.23–0.96) for the total LCD score (P = 0.021 for trend) and 0.38 (95% confidence interval 0.19–0.77) for the animal-based LCD score (P = 0.019 for trend), while this association was significantly attenuated by rice, glycemic load, fish, poultry, animal fat and animal protein (P for trend <0.05).

A high score for plant-based LCD was not significantly associated with the risk of PPWR (P > 0.05). The findings suggested that a low-carbohydrate dietary pattern, particularly with high protein and fat intake from animal-source foods, is associated with a decreased risk of weight retention at 1 year postpartum. This association was mainly due to low intake of glycemic load and high intake of fish and poultry.

https://pubs.rsc.org/en/content/articlelanding/2021/fo/d1fo00935d