To Keto or Not to Keto

The ketogenic diet (KD) has gained lots of attention in recent years as a means to lose weight, reduce inflammation and improve metabolic markers. But is it right for you?

 The Facts

The ketogenic diet is a form of a very low carbohydrate diet where you deprive your body of carbohydrate so it learns to burn fat for energy. In this process ketones are formed. Ketones are then used as a source of fuel for the brain, heart and muscles.

There are various forms of the ketogenic diet ranging from the classic which recommends: 90% of diet from fat, 6% protein, 4% carbohydrates of total energy. Others are less restrictive and allow up to 50g of low glycemic load carbohydrates, 20% protein and 50-60% fat. However, even the less restrictive form will still require immense changes to your regular diet.

Why Are People Trying Keto?

The keto diet is not new, it has been around since the 1920s and is often prescribed to patients with specific type of epilepsy as it has been shown to be effective in reducing seizures.

Most people jump on the keto bandwagon in the hopes of reducing body weight. There are a number of studies that have found that following a KD can reduce one’s BMI and improve metabolic markers including increased HDL, decreased LDL, total cholesterol, triglycerides and glucose levels.

The KD or other low-carbohydrate diets may be most effective for those with insulin resistance. The key feature of insulin resistance is an impaired ability of muscle cells to absorb blood sugar (glucose) and convert it to energy. Instead, those with insulin resistance will divert the glucose to the liver to be converted into fat. If dietary carbohydrates are restricted to a level where they are not significantly converted to fat (a level which varies person to person) improvements in insulin resistance have been noted.

Metabolizing fats into ketones has been shown to reduce the generation of reactive oxygen species that increases inflammation and cause oxidative damage to our cells. KD may help reduce pain associated with inflammation and could potentially reduce the risk of cardiovascular disease due to improved metabolic markers and reduction in inflammation. However, read on to see the flip side of the coin.

Emerging Areas:

The Brain

Research is ongoing as to whether the KD has neuroprotective effects that could also help in the treatment of neurological diseases including Alzheimer’s, Parkinson’s, and even brain trauma. Early studies show some success in reducing the symptoms of these conditions; however, more research is needed to support the early findings.

Acne

Recent studies have shown that some food items can stimulate pathways that develop acne. Food with a high glycemic load and milk are two such culprits. More clinical trials are need to conclude this issue; however, some persuasive evidence exists that point to the benefits of a reduced high-glycemic carbohydrate diet on the severity and progression of acne.

PCOS

Polycystic Ovary Syndrome is characterized by obesity, insulin resistance, ovulatory dysfunction and high levels of androgen hormones (male sex hormones). Suggested treatments include those that target insulin resistance, such as, the KD diet. It has been shown that improvements in insulin resistance and a reduction in body weight may also be effective in reducing androgen hormone levels and normalizing ovulation. Results are preliminary but “watch this space” for further clarification in the future.

THE FLIP SIDE

Despite the fact that some early trials show benefits of the KD on various ailments, there is not concordance in the literature about their absolute effectiveness and doubts remain about their safety.

Low Compliance

I tell my clients “don’t start a diet you can’t stick to for the rest of your life”. One of the key downsides to the KD is that compliance is very low as it can be a very challenging pattern of eating to stick to for the long term. Optimizing adherence is the most important factor for long-term weight loss success.

Side-effects

Entering into a ketogenic diet can lead to a variety of symptoms colloquially termed “the keto-flu”. These include: head-aches, dehydration, shivers, foggy brain and nausea. Some people don’t get past this stage before they throw in the towel. Entering into ketosis slowly, that is, reducing carbohydrates and increasing fat intake over a period of time can reduce the symptoms of the keto-flu.

Rebound Weight Gain

The initial weight loss in a KD is due to the loss of water as your body burns through its water-filled carbohydrate (glycogen) stores. Further, as your body is deprived of energy from carbohydrate sources, it will look to, not only fat, but protein reserves to break down and convert to useable energy. It is possible, therefore, to lose lean tissue when following a KD. Preserving muscle mass while aging is key to injury prevention and mobility. Further, reduction in muscle mass can slow the metabolism and lead to rebound weight gain if/when normal eating resumes.

Lack of Nutrients

The KD diet is incredibly restrictive and many of the forbidden foods are colourful plants rich in fibre and phytonutrients. Although low-carb veggies are allowed and encouraged (such as leafy greens) most fruits, all grains and legumes as well as certain higher carb veggies like carrots and beets are prohibited.

The KD can end up being quite low in fibre which can lead to constipation and other lower gastro-intestinal disorders. Supplements are often recommended to those following a KD as deficiencies could occur in any or all of the following: B-vitamins, calcium, sodium, potassium, vitamin D and the antioxidant vitamins A, C and E. Further, there is also an increased risk of developing kidney stones. These are a couple of reasons why those prescribed a ketogenic diet (for example for epilepsy) are also monitored by an experienced nutritional professional.

Photo cred: @tlbvelo

Not For You

Those who should not go on a KD include children, teenagers, women who are pregnant, breastfeeding or trying to get pregnant, those suffering from adrenal fatigue, poor thyroid function or high -level athletes. As athletes know, carbohydrates are the primary source of fuel for high intensity training. Without them, athletes will have a marked- reduction in performance and increased levels of perceived exertion, that is, everything will feel very difficult and they won’t go as fast or be as strong.

Bottom Line

You can see there are potential benefits for some people in following a KD but many drawbacks and a fair amount of uncertainty. What is interesting to note is that exercise and fasting can evoke a similar physiological state to that triggered by the KD.

Further, being in the state of ketosis is not a requirement for weight loss or improved metabolic markers. There is ample evidence that those who suffer from metabolic syndrome* would see favourable changes in following a diet that moderately restricts carbohydrates to 26-44% of their daily diet. The emphasis would be to consume low-glycemic, high fibre, phytonutrient rich sources of carbohydrates. This dietary pattern would minimize many of the potential negatives associated with the more restrictive KD.

If you want more information or to discuss a diet that is right for you contact me for a consultation.

 * Metabolic syndrome: is a cluster of conditions that occur together including: high blood pressure, high blood sugar/ insulin resistance, excess abdominal fat and abnormal cholesterol and triglyceride levels that can increase your risk of heart disease, stroke and diabetes.

Resources 

Dashti HM1, et al. Long-term effects of a ketogenic diet in obese patients. Exp Clin Cardiol. 2004 Fall;9(3):200-5.

Smyl C1. Ketogenic Diet and Cancer-a Perspective. Recent Results Cancer Res. 2016;207:233-40. doi: 10.1007/978-3-319-42118-6_11.

Tinsley GM1, Willoughby DS. Fat-Free Mass Changes During Ketogenic Diets and the Potential Role of Resistance Training. Int J Sport Nutr Exerc Metab. 2016 Feb;26(1):78-92. doi: 10.1123/ijsnem.2015-0070. Epub 2015 Aug 12.

Tagliabue A1, Ferraris C2, Uggeri F3, Trentani C2, Bertoli S4, de Giorgis V5, Veggiotti P5, Elli M3. Short-term impact of a classical ketogenic diet on gut microbiota in GLUT1 Deficiency Syndrome: A 3-month prospective observational study. Clin Nutr ESPEN. 2017 Feb;17:33-37. doi: 10.1016/j.clnesp.2016.11.003. Epub 2016 Dec 18.

A Paoli1, A Rubini1, J S Volek2 and K A Grimaldi3 Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition (2013) 67, 789–796; doi:10.1038/ejcn.2013.116; published online 26 June 2013

Rietman A1, Schwarz J1, Tomé D2, Kok FJ1, Mensink M1. High dietary protein intake, reducing or eliciting insulin resistance? Eur J Clin Nutr. 2014 Sep;68(9):973-9. doi: 10.1038/ejcn.2014.123. Epub 2014 Jul 2.

Merino J1, Kones R2, Ferré R3, Plana N3, Girona J3, Aragonés G3, Ibarretxe D3, Heras M3, Masana L3. Low-carbohydrate, high-protein, high-fat diet alters small peripheral artery reactivity in metabolic syndrome patients. Clin Investig Arterioscler. 2014 Mar-Apr;26(2):58-65. doi: 10.1016/j.arteri.2013.11.004. Epub 2013 Dec 21.

Liebman M1. When and why carbohydrate restriction can be a viable option. Nutrition. 2014 Jul-Aug;30(7-8):748-54. doi: 10.1016/j.nut.2013.11.021. Epub 2013 Dec 4.

Thom G1, Lean M2. Is There an Optimal Diet for Weight Management and Metabolic Health? Gastroenterology. 2017 Feb 15. pii: S0016-5085(17)30158-0. doi: 10.1053/j.gastro.2017.01.056. [Epub ahead of print]

Ebbeling CB, Swain JF, Feldman HA, Wong WA, Hachey DL, Garcia-Logo E, and Ludwig DD. “Effects of dietary composition on energy expenditure during weight loss maintenance.” JAMA 307: 267-2634 (2012).

Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, and Ludwig DS. “Effects of a low–glycemic load vs. low-fat diet in obese young adults”. JAMA 297: 2092-2102 (2007).

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A New Year, A New You? Well….

A new year? A new you? Well, probably not, but maybe!

Research shows that by February most people have reverted to their previous year’s behaviour and resolutions are long forgotten, if not the lingering feeling of defeat. Although one study showed that 19% of resolution-makers were successful in sticking to their resolution after 2 years.

So what makes some of us successful while others fail? It has to do with:

 READINESS, MOTIVATION and SELF-EFFICACY

The first stage in changing a bad habit to a good one is readiness. There is no point putting a resolution on your list if you aren’t ready to tackle it. This is why I ask my clients to fill out a Readiness for Change Questionnaire so that I can ascertain their level of commitment and motivation. Behavioural change does not happen in a day. Psychologist outline between 3-6 discrete stages of change. The simplified version is:

  • pre-contemplation
  • contemplation
  • action

You need to be at the action stage in order to write that resolution down for 2017.

Ask yourself: is this goal truly important to me? You can’t put a resolution on your list because your spouse, mother, children, co-workers want you to do it. It has to resonate with you. Motivation is key and you must value the outcome that you are seeking in order to effectively execute the change. Ask yourself, “on a scale of 1-10 how motivated am I to follow through with this resolution?” Write down the number.

Next, you need to have sufficient self-efficacy to follow through with your resolution. Self-efficacy is simply a belief in yourself that you can execute a task, or simply put “I got this”. In order for you to feel confident about your ability to follow-through, ensure the resolution is not too large or cumbersome. It should be realistic and achievable. Ask yourself, “on a scale of 1-10 how confident am I that I can execute this change in behaviour successfully.”

Your motivation and self-efficacy scores should both be at 7 or higher in order for you to have a realistic chance of following through with your resolution.

Finally, notice I am using resolution in the singular, focus on one behavioural change at a time. A list of 5 resolutions is unlikely to be attainable. Once you have changed behaviour for a number of months so that an old habit has become a new healthy habit, then you can consider resolution number 2 and go through the same steps.

Good luck, Happy New Year and don’t forget:

You got this!. Believe in yourself.

References

Bandura, A., & Locke, E.A. (2003). Negative self-efficacy and goals revisited. Journal of Applied Psychology, 88, 87-99.

Norcross, J.C., Mrykalo, M.S., & Blagys, M.D. (2002). Auld lang syne: Success predictors, change processes, and self-reported outcomes of New Year’s resolvers and nonresolvers. Journal of Clinical Psychology, 58(4), 397-405.

Norcross, J.C., Ratzin, A.C., & Payne, D. (1989). Ringing in the new year: The change processes and reported outcomes of resolutions. Addictive Behaviors, 14(2), 205-212.

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A Better Resolution

 

It’s the end of January when resolution-fatigue often sets in. Wine has reappeared on Monday nights; sweet treats have replaced apples as the afternoon snack; and the 10 day extreme detox didn’t get past day 3 when fatigue and a relentless headache set in.

Some well-intentioned resolutions are just too tough to stick to for the long haul. Ideally, resolutions should be specific, realistic, achievable and, I would add, worth it. They should add some value or benefit to your life.

January is a banger month for detoxes or cleanse programs. But be aware that any program that severely limits caloric intake for a prolonged period of time could end up backfiring. Your body will react by putting the breaks on your metabolism in an effort to conserve energy.

Eliminating entire food groups could also lead to gaping holes in your nutritional intake. In particular, restricting protein while simultaneously reducing calories can lead to the loss of lean muscle, not fat. Reducing muscle mass will further suppress your waning metabolism and when normal eating resumes, fat, not lean tissue, will be gained.

I understand the desire to clean up one’s eating after the excesses of the holidays; however, extreme measures are unnecessary. Reducing sugars, alcohol, refined flours and processed foods while increasing your consumption of whole, fibre-rich vegetables is a realistic and achievable way to start.

It turns out we need to heed this advice as only 40 per cent of Canadians are eating at least five daily servings of fruits and vegetables, which falls well short of Canada’s Food Guide recommendation of 7-10 servings.

Soup’s the Solution

An easy way to increase your consumption of these super-foods is to get your soup on! Soup is not a trend. It has never been out of food fashion and there are plenty of reasons why. Research has shown that regular soup eaters consume more vegetables, fibre, protein and a variety of vitamins and minerals than those who don’t eat soup.

It’s not just the nutrients in soup that makes it a great go-to choice for those with health-focussed resolutions. Studies show that soup-eaters weigh less, have smaller waists and consume fewer daily calories compared to those who avoid this wonderful, warm meal. Soup induces fullness more quickly than solid food and can help reduce hunger throughout the day.

What I personally like about soup is that it forces you to slow down, sit down and enjoy your meal mindfully. You can’t eat soup on the run, or if you do, you may only do so once. Ouch.

Homemade or Close-To-Home-Made

Not all soups are created equal. Most canned soups are loaded with sodium so it is always better to make your own. Alternatively, choose high-quality, fresh products with a short list of ingredients all of which you would find in your own refrigerator.

Adding wholesome vegetable and fibre-rich soup to your daily diet is a resolution that ticks all the boxes: it’s specific, realistic, utterly achievable and is, most definitely, worth it.

 

ROASTED CARROT & PARSNIP SOUP

INGREDIENTS

  • 1 pound carrots, peeled and cut into 1/2-inch rounds
  • ½ pound parsnips, peeled and cut into 1/2-inch rounds
  • 1 yellow onion, quartered
  • 3 tablespoons olive oil
  • Salt and freshly ground pepper to taste
  • 3-4 cups vegetable stock
  • Optional: cilantro

 

DIRECTIONS

  1. Preheat oven to 400° F.
  2. In a large roasting pan, combine the carrots, parsnips, onion, 3 tablespoons of the oil, salt and pepper. Spread the vegetables in an even layer and roast, stirring occasionally, until tender and golden brown, about 45 minutes.
  3. Transfer the vegetables to a blender and purée with 3 cups of vegetable stock.       Blend. Add more stock as needed to achieve the right consistency. Reheat in a pot over medium-low heat.
  4. Serve with a drizzle of good quality olive oil and sprinkle of cilantro

 

Resources:

Clegg ME1, Ranawana V, Shafat A, Henry CJ. Soups increase satiety through delayed gastric emptying yet increased glycaemic response. Eur J Clin Nutr. 2013 Jan;67(1):8-11. doi: 10.1038/ejcn.2012.152. Epub 2012 Oct 24.

Flood JE, Rolls BJ. Soup preloads in a variety of forms reduce meal energy intake. Appetite. 2007 Nov;49(3):626-34. Epub 2007 Apr 14.

Statistics Canada. Canadian Consumer Health Survey. Fruit and Vegetable Consumption. 2012. http://www.statcan.gc.ca/pub/82-625-x/2013001/article/11837-eng.htm

Zhu Y, Hollis JH. Soup consumption is associated with a reduced risk of overweight and obesity but not metabolic syndrome in US adults: NHANES 2003-2006. PLoS One. 2013 Sep 30;8(9):e75630. doi: 10.1371/journal.pone.0075630. eCollection 2013.

Zhu Y, Hollis JH. Soup consumption is associated with a lower dietary energy density and a better diet quality in US adults. Br J Nutr. 2014 Apr 28;111(8):1474-80. doi: 10.1017/S0007114513003954. Epub 2014 Jan 2.

 

 

 

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My Job? To Put Myself Out of a Job

pic me needs work

My goal is to put myself out of a job for every individual client. I want to empower my clients with knowledge, motivation and tools that they can use to move forward indefinitely with eating the right foods (most of the time), in the right amount, for the right reason. Simply put, to become and live as intuitive eaters.

One of the first things I tell my clients is that “I don’t do diets”. Diets are something you go on and then come off of – a recipe for disaster in my mind. I want each client to establish long-term changes in their eating habits and lifestyle that last a lifetime. There is no on again off again. This is life. Let’s get it right.

Many people suffer from some form of emotional eating. It doesn’t always relate to negative emotions either. Sure, stress, fatigue and anxiety can lead one to the Doritos, but so too can happiness, excitement, new love, and fun. We eat for many reasons, but really we should only eat for one. Any guesses? You got it: eat when you are hungry. Only. Period. Full Stop. The second half to that equation is: stop the moment you are satisfied. “Satisfied” means no longer hungry; not “stuffed to the gills”. Following these two simple maxims is the key to intuitive eating.

Overcoming emotional eating takes practice and perseverance. Recognition is the first step and then developing alternative coping skills away from food is essential. For some, it may require help in the form of professional counselling. However, for many, it can be achieved with a bit of motivation and a lot of mindfulness.

As we are approaching the holidays we will all be faced with multiple temptations throughout the day. Shortbread brought to work, cocktail party canapés, chocolate chocolate everywhere. Before you indulge, take a moment to ask yourself the following questions and guide yourself through the intuitive eating flow chart.

Intuitive eating chart_correctedIf you end up at “eat and enjoy without guilt” do so. However, keep in mind that one or two Purdy’s chocolate will satisfy that craving, but 10 will lead to remorse.

The question “will I be deprived if I don’t eat it?” is a key one. If you stop banning foods and give yourself permission to enjoy the odd treat, the answer to this question will become clear. A tray of store-bought Christmas cookies that has been sitting out on the kitchen table all day may elicit the answer “no, I will not be deprived if I don’t eat this”. However, you may choose to indulge in a piece of your grandma’s famous homemade fudge.

Santas Christmas Cookie Snack

Intuitive eating isn’t about throwing caution to the wind and eating anything you want, whenever you want. It involves mindful choices that allows you to find a balance between eating food you enjoy, when you are hungry, stopping when satisfied and then getting on with the rest of your life.

For more information or to kick-start your own path to intuitive eating contact me at haleybarton@nutritionsavvy.ca

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5 Slimming Summer Salads

Everyone wants to look their best in the summer. But how do you shed those extra pounds that snuck on since Christmas?

It can be hard reducing the amount of food we eat or changing our usual go-to choices.  But here is one quick tip that can help you along your way.

Fuel for the day, lighten at night.

You’ve heard the old adage: eat breakfast like a king, lunch like a prince and dinner like a pauper? It’s good advice, yet, culturally we tend to do the opposite. We need food to energize us through our busy day. But come evening time, activity levels reduce as we gear down for the night.

If you skip breakfast or eat small amounts through the day, your hunger will build and by the time 5pm rolls around, you are famished. You end up eating more than you would normally if you had a decent breakfast and lunch.

So start your day with a proper breakfast. Enjoy a lunch that satisfies you through the afternoon. If you are hungry at 4pm or so, have a healthy snack that will take the edge off your appetite. Prepare a lighter, vegetable-focussed dinner with a source of protein. When your plate is done, so are you. No second helpings.

Aim to eat about 3 hours before bed time so your body has a chance to digest your dinner and to reduce the chance of heart burn. Wake up hungry and ready to fuel for the next day.

Need some inspiration? Try these 5 Delicious Dinner Salads. One for each day of the work week.

For more info check out my segment on CTV Morning Live on Slimming Summer Salads:  http://bc.ctvnews.ca/recipes/five-healthy-summer-salads-1.2391902

Asian Shredded Chicken SaladIMG_5250

  • 3 ounces rotisserie chicken
  • 1 cup shredded napa cabbage
  • 1 carrot, grated
  • ½ red pepper julienned
  • small handful snow peas, cut on diagonal
  • cilantro – torn
  • 1 tablespoon black and white sesame seeds
  • 1 tablespoon slivered almonds

Dressing

  • 2 teaspoons rice vinegar
  • 2 teaspoon low-sodium soy sauce
  • 1 teaspoon dark sesame oil
  • ½ teaspoon honey

Combine all ingredients and toss with dressing. Can use pre-cut and washed broccoli slaw to save time! Serves 1.

Fava Bean & Asparagus SaladIMG_5249

  • ½ cup fava beans (about 10 pods), blanched for 1 minute and de-skinned
  • 5 asparagus spears
  • 2 cups arugula
  • 1 tablespoon torn fresh mint
  • 1 tablespoon shaved pecorino cheese
  • 1 egg

Dressing:

  • 1 tsp olive oil
  • 2 tbsp fresh lemon juice
  • 1 tsp Dijon mustard
  • Salt and pepper to taste

Prepare fava beans. Steam asparagus for 1 minute. In the meantime poach egg. Combine all ingredients for dressing and whisk together with a fork. Assemble salad by laying down arugula, top with asparagus, fava beans, mint and toss gently with lemon vinaigrette. Top with shaved pecorino cheese and poached egg. Season to taste with salt and pepper. Serves 1.

Grilled Prawns & Corn Summer SaladIMG_5247

  • 3-4 raw prawns, deveined, on skewer.
  • 1 tsp olive oil
  • 1 clove garlic minced
  • Juice of 1 lemon
  • 1 cob of corn
  • Small head of butter lettuce
  • Handful of grape tomatoes
  • 1/3 of an avocado

Lemon Vinaigrette (recipe above)

Preheat BBQ and place cob of corn on hot grill. Turn regularly so each side turns golden brown and caramelized. Remove from heat to cool. Combine olive oil, garlic and lemon juice and brush onto prawns. Place prawns on grill and cook about 3 minutes a side depending on size. Continue to brush with garlic marinade.

Assemble salad by laying down butter lettuce, chopped tomatoes and avocadoes. Cut kernels off the cob of corn and sprinkled on top of lettuce. Toss gently with lemon vinaigrette. Add cooked skewered prawns to top. Season to taste with salt and pepper. Serves 1.

 

Spelt Salad with Strawberries, Mint & FetaIMG_5246

  • ½ cup of pre-cooked spelt (option to use quinoa)
  • ½ cup sliced strawberries
  • 1 tablespoon torn mint
  • 2 radishes sliced
  • 1 ounce crumbled feta
  • 1 green onion, sliced
  • 2 cups spinach
  • Dressing: 2 teaspoons olive oil + drizzle (1 teaspoon or so) of balsamic vinegar

Combine first 6 ingredients and toss with ½ the amount of dressing. Assemble spinach on plate and place grain salad on top. Drizzle remaining dressing on top and season with salt and pepper to taste. Serves 1.

Thai Beef SaladIMG_5245

  • 3-4 ounce strip loin steak
  • 1 Thai chili, julienned
  • ¼ red onion, sliced
  • ½ cup cucumber, julienned
  • 2 cups spring mix lettuce
  • 1/3 cup grape tomatoes, sliced in half or quarters
  • 4 leafs Thai basil, torn
  • ¼ cup torn cilantro
  • 1 tablespoon

Dressing:

  • 2 tablespoons lime juice
  • 1 tablespoon Thai fish sauce
  • 2 teaspoons low sodium soy sauce
  • 1 teaspoon honey
  • 1 clove of garlic, minced

Grill steak on BBQ until cooked to your liking. Make dressing by combining all ingredients and whisking together. Assemble salad by laying down spring mix lettuce, toping with cucumbers, tomatoes and onions. Lay sliced steak on top and drizzle dressing over top. Garnish with Thai basil, cilantro and peanuts.  Serves 1.

Enjoy!

 

 

 

 

 

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