Saturated fat

Saturated fat is back and ketones are the new carbs…if you follow LCHF

Yes, a LCHF meal can look like this..... 

Yes, a LCHF meal can look like this..... 

I felt as though the Low Carb High Fat (LCHF) movement was taking over my life last week.  Along with everyone else in the country who has an interest in nutrition, I watched ABC’s Catalyst last Thursday night.  I then backed this up with the Low-Carb Downunder seminar in Melbourne on Saturday, so I was up-to-my ears in ketones and carbohydrate talk. My brain actually feels a bit overloaded and is experiencing a slight tug-of-war between my entrenched knowledge that has been accumulating over many years and this ‘new’ input that is being promoted by everyone from doctors, to scientists, to athletes and celebrity chefs. 

I am writing this post to provide an insight to some of the information presented at the Low Carb Downunder seminar for those who did not attend and may be interested.  There will also be the unavoidable mentions of Catalyst and associates, as well as a few interpretations of my own relating to all things LCHF.  Apolgies in advance about the length of this post, and there will be Part 2 to come, just so much to think about!

I arrived at the seminar and was greeted at St Kilda Town Hall by an unusual crowd, some sporty types, some middle-aged overweight men and women, mostly older vs younger people and I think more potential ‘users’ than health professionals.  There were also not as many people as I expected, from reports of the last Low Carb Downunder seminar that sounded like standing room only.  I was the only dietitian there (I will get to my concerns about that later….)

So I managed to find a comfortable seat amongst the believers, without being blown away by any ketone-related bad breath.  First line of the introduction by Dr Rod Tayler, anaethetist, was ‘How good was Catalyst?’ to which there was an almighty cheer.  Oh no, I was starting to think that maybe I really shouldn’t be there, but once the cheering had subsided I got out from under my chair and composed myself because I really wanted to hear what all the fuss over LCHF is about.  Well, the introduction was like nothing I had seen before – slide after slide of recommended reading. Actually not recommended reading, recommended purchasing!  It was a book sale….right up front, no warming us into it.  Not just books – there were DVD’s (including Cereal Killers of course), sponsors products, even ketone measurers!  All very strange for a so-called professional conference.  But I stuck it out, and I am glad I did, because things did get more interesting.

First presenter was Jimmy Moore, who also started off with visuals of his programs and books for sale, but then did get into more substantial content.  Throughout the entire day I found myself intrigued and amazed one minute, then finding it very hard to take things seriously the next.  The thing that seemed to get me off-side was that most of the information presented was based on anecdotes, case studies or articles written by journalists who had interviewed someone who has tried LCHF.  There was not a lot of original research or content (except for A/Prof Ken Sikaris, whose great presentation I will discuss in a future post).

One thing that quite surprised me, that was also very obvious during the Catalyst program, was the non-extreme approach.  Of course there was thorough discussion of the ketogenic diet, where carbohydrate intakes approaching less than 20g/day are all the rage, but there was also recognition that carbohydrates (albeit vegetable-based) can still make a valuable contribution as part of a LCHF approach.  From my perspective, it seems that the LCHF approach is not as anti-carbohydrate as Paleo, and there could be the potential to sneak in some fruit or grains here or there without feeling like you have betrayed the low-car fellowship.  There were no ‘carbs are poison’ or ‘sugar is toxic’ signs anywhere, and carbohydrates were in fact spoken of, at times, in a favourable light, particularly for active people.  I repeatedly heard the phrases ‘there is no one-size fits all’ and ‘what works for you’.  There was also an emphasis on the types of people that LCHF could work for and there was not necessarily a directive that everyone should be eating this way.  For example, it was highlighted both on Catalyst and at the conference that LCHF works best for individuals whose bodies have trouble 'managing or tolerating' carbohydrate and a major focus was people who are overweight and/or have diabetes.

In fact, when Dr Zeeshan Arain, a Melbourne based doctor who works in both general practice and sports, spoke about his experiences with LCHF and athletes, he openly discussed the potential detriment of inadequate carbohydrate for an athlete who is highly metabolically active. Young male athletes with a decent amount of muscle mass perhaps?  There is currently a lot of focus on athletes and LCHF, but again much of the ‘evidence’ is anecdotal.  Dr Trent Stellingwerf, regarded sports nutrition researcher from Canada https://twitter.com/TStellingwerff has recently been active on Twitter summarizing the published data on fat adaptation and ketogenic diets and performance and showed the majority of studies indicate no change or reduced performance with LCHF (see my Facebook page Lisa Middleton – Advanced Sports Dieititian for the shared post, thanks to Thinking Nutrition for sharing this also).  John Hawley and his team at RMIT, along with Louise Burke and other researchers have led the way in this area of sports nutrition, and it would have been great to get their perspective on Catalyst.  It was a shame that line-up of interviewees on Catalyst was basically the presenter list from the Low-Carb Downunder seminar earlier this year, no bias there at all.  How about a novel idea, get the world's best researchers together in the same room to present the evidence and sort it out and come to some type of consensus so we can all move on with our lives?

One thing that has frustrated me are the headlines about athletes who are using LCHF, without any description about when and how they are using it.  I think if we asked for more detail, it may become obvious that LCHF is often being used as a weight loss strategy in the off-season, when peak performance is not required.  In-season carbohydrate intake may be a different story.  I think the potential role of LCHF for weight loss is quite obvious…..if you cut out most of the carbohydrates and sugar from your weekly intake, you automatically reduce your total calorie intake, and how much fat can you really physically eat?  You eat less so you lose weight.  No problem with doing this in the short-term, with appropriate guidance from a dietitian to ensure you are doing it properly.  Another key message from the conference is that LCHF is not high protein, with the recommendation that protein intakes should be kept relatively low.

It was great to hear real athlete perspectives at the Low Carb Downunder seminar.  Tom McDonald, a player from Melbourne Football Club, spoke of his experience with LCHF, and one of his incentives to initially reduce carbohydrates was for his digestive system. He was not trying to lose weight, in fact he reported that he has always been underweight.  So he reduced his gluten and grain intake, but still maintains an estimated 100-200g carbohydrate per day, with much of this coming from sweet potato and bananas. Tom indicated his normal breakfast on training days would be bacon/sausage/eggs, occasionally with sweet potato and the night before games he would go for something like bolognaise sauce with cheese, vegetables and sweet potato.  So effectively he has reduced his wheat/gluten/processed carbohydrates but does not follow extremely low carbohydrate patterns.

Other anecdotal examples followed. Brian Rabinowitz, an experienced and successful triathlete and coach, who has been doing LCHF of late and says he has never trained better and can vouch for a number of the athletes he trains who are also flying with their training and performance, having changed from a gel-fuelled race to virtually water and oil.  Vicky Kuriel is a ‘LCHF dietitian’ who presented on the day (so there were in fact 2 dietitians at the conference!) and reported that her husband competes in ironman events with nothing more than water and nut butter, a significant change from his previous high-carb fuelling.  Apparently he is feeling and performing better than ever (he does eat carbs usually, ~150g/day although it varies day-to-day).

I know these personal accounts are not evidence-based science, but I find them quite powerful, especially when they come from credible sources.  That is another point, some of the outspoken experts on LCHF are very smart people….they are not just salespeople trying to boost their commission (although they may have a book or product on the side?).  I have spoken with many professional people who I know and trust who have great faith in the LCHF approach.

Saying that, I am certainly not sold on the concept of athletes becoming fat adapted by eating more fat, allowing fat to be more readily available as the main fuel to power elite performance.  Examples were presented of ultra-endurance athletes who train their bodies to burn fat as fuel and use ketones instead of carbs, but the thing with ultra-endurance is that it can be done at a steady-state pace.  If you need to put on a burst of speed to pass a competitor or at the finish line, carbohydrate will provide the rapid fuel to do this.  The question remains, that even though the bulk of science does not support the role of LCHF for performance, are there specific types of athletes, or individuals with a specific genetic make-up, who may benefit from the LCHF approach?

A great quote that I came across on Twitter from Professor Stuart Phillips, well-regarded sports nutrition researcher from Canada:

‘When it comes to LCHF and sport performance, I think it's important to remember that "Science is “the process of understanding the world through experimentation and observation,” whereas beliefs are “feelings that something is true.” Thus, the former represents an ideal of discovering truth that exists separate from the knower, whereas beliefs are internally held understandings filtered through one’s world view. By “unscientific belief,” something is held as generalizable fact without substantial scientific supporting evidence…" Brown et al. Adv. Nutr. 5: 563–565, 2014. So evidence trumps anecdotal experience and cognitive dissonance!’

Stuart Phillips PhD Twitter - @mackinprof

I can certainly understand why scientists and health professionals, including dietitians, are having a hard time accepting this LCHF theory, and perhaps why I was the only dietitian at the seminar.  If your entire academic and working life has revolved around evidence-based practice, LCHF doesn’t quite fit as the bulk of evidence just is not there.  Health professionals are trained not to base their practice on case studies or something that worked for your neighbor down the road.  But I don’t think you can ignore emerging trends or turn a blind eye to what people are out there doing, even if it doesn’t fit the evidence-based practice model.    

Vicky Kuriel is a dietitian who was disillusioned about dietetics, and stopped working in nutrition for a period of time due to her frustration about the lack of results for her clients with traditional methods.  She is proud to be a LCHF dietitian and provided compelling reports of client success in the areas of weight loss and reduction of gastrointestinal symptoms.  Vicky also emphasized that the key is to find the right mix of nutrition for your individual needs and to listen to your body, so again it is not all about the lowest carbohydrate intake possible for everybody.  Vicky’s final slide said this, ‘The truth is transient in nutrition’ and her message was that we need to be open to new ideas and science.

Of course during the seminar there were a number of digs at ‘those nosy’ dietitians, although the speaker, knowing that I was the only dietitian in attendance, did kindly indicate that I was not one of those he was speaking negatively about!

I had been prepared for dietitians to be criticised at this conference, and to be honest, some of the comments were spot on.  As a young dietitian working at my first professional sporting club I was known as the carbohydrate queen.  My studies had taught me that carbohydrate and athletic performance, in the majority of sports, go hand-in-hand and that was my message for athletes…..carbs, carbs and more carbs.  Of course I still recommend carbohydrate to athletes, but my approach these days is somewhat more balanced with greater emphasis on overall nutrient balance and individualized nutrition strategies.  Another example where dietitians have a lot of work to do is in the hospital food service.  Admittedly I have never worked in a hospital, other than my placement at uni nearly 20 years ago, and I don’t have full comprehension of budgetary and other contstraints that may exist, but surely something can be done to improve on the rubbish food that is currently provided in many hospital settings.  During a short stay at hospital with my young son a couple of weeks ago, I was absolutely appalled at the breakfast tray that he was presented with.  A sachet of puffed rice cereal, a piece of white bread with margarine and jam and a tub of apple juice.  Absolutely terrible, and this is what hospitals are dishing up to our sickest members of the community whose bodies are crying out for nutrients (I am happy to be challenged on this one, as I am sure dietitians have made efforts to improve food service, with likely limitations.....please say this is the case?????). 

There has been outcry from dietitians around the world about the potential risks of LCHF.  Not enough fibre, not enough calcium, too much fat, not enough wholegrains….the list goes on.  With plenty of vegetables, fruit, nuts and seeds, a well balanced LCHF diet provides great potential to eat lots of fibre.  Especially for those following LCHF who are not following a super-low carbohydrate ketogenic plan, there is scope to eat many high fibre foods.

I can see the potential issues with calcium and this would need to be addressed for any person choosing a LCHF way of eating.  For someone who does choose to eat in a LCHF style, it is important to know what you are doing and it would be advisable to seek professional advice from a dietitian who can help to ensure you are getting all of the nutrients you need. 

In terms of fat intake, concerns about too much or the wrong type have mostly been driven by the impact on health and cholesterol levels, but the evidence is mounting that LCHF eating does not have a negative impact on blood cholesterol profile for everybody, and I will go into more detail about this in my next Thoughts post.

Most dietitians are anti-diet of any type, and there are warranted concerns about LCHF's restrictive nature and the potential impact on psychological well-being and a person's relationship with food.  I was very pleased to hear Dr Arain mention this issue in his presentation and address body image and societal pressures to be a certain shape/size.  He also mentioned body dysmorphia and disordered eating, and this highlights the fact that many people who recommend LCHF are also aware of the sensitivities associated with food, and the potential psychological impact of restriction and 'diets'. Although some LCHF advocates are not as aware....

Dr Arain also mentioned another potential negative associated with LCHF eating - the development of commercial 'low-carb' products.  Similar to the proliferation of highly processed 'low-fat' products, these 'low-carb' products would not fit the 'real food' approach of LCHF but many people may use these frequently for convenience.

This leads on to probably the biggest problem that I see as a result of generalised LCHF guidelines - people don't do it properly.  The message that 'high-fat' is good could be interpreted as 'well, make that double bacon with my triple-decker cheeseburger then thanks'.  I can visualize this at take-away stores around the country, with this new message that saturated fat is a good guy.  Not that I think this is or was the intention of the low-carb, high-fat supporters, but this is the message that is coming across to the general public loud and clear.  And it creates the problem that people skip the low carb bit and just add in the fat, because fat is ‘good’.

The danger is that people choose selectively to include or omit the foods they wish.  A friend of mine who is a great GP put it perfectly ‘people just take the bits and pieces from different diets that they like’, which from my perspective creates a potential risk of even greater negative effects on their health.  Bacon is good, so must be good with everything, right??  Maybe on an extra piece of white toast, but is butter or margarine better with that?? 

Nutrition right now is confusing, but one thing that everyone does seem to agree on is that you need to find the best way of eating that works for you, based on real foods, that allows you to live and perform at your best.

In the next post I will give a summary of Associate Professor Ken Sikaris' presentation on the effect of LCHF on blood cholesterol profile, plus Ketogenic diets and Banting…. To make sure you keep up to date as new articles go up, 'Like' my Facebook page Lisa Middleton - Advanced Sports Dietitian and subscribe to my newsletter via the website home page.

 

This Thoughts post provides informational content only, and should not be substituted for individual nutrition prescription from a health professional.  For more specific nutrition guidance and recommendations tailored to your individual needs you should speak to an Accredited Practising Dietitian. 

 

 

 

Low-fat does not always mean high-sugar, but do we need low-fat anyway?

When we see 'low-fat' plastered over a food label, we often automatically assume that the fat has been replaced with sugar, salt, additives or something else that is worse for us than the actual fat that has been removed.  As a result, many people avoid low-fat products, but if you take a closer look you will find that not all foods with fat taken out have nasties added back in (although many do).  Some low-fat products are in fact higher in nutrients and lower in kilojoules than their full-fat relatives, but you need to read the labels carefully.  More importantly, do we even need to choose low-fat anyway or just stick to the full-fat versions?  I am asked this question all the time, and the answer is far from clear cut, so I thought I would write about it and try to clarify the best options for different individuals and circumstances . 

'Low-fat' can be a very deceiving label on a food.  Some foods are labelled low-fat when they are naturally low in fat to start with, so the food has not been altered in any way from it's natural state (eg. rice-based crackers).  Some foods can have the fat reduced, but nothing else is added to replace it (eg lean meats from which the fat has been trimmed).  Other foods named low-fat or "xx% fat free' have had fat removed, or are formulated to have a lower fat content, but to make the food palatable have a myriad of sugars added.  Sugar can be can be disguised within an ingredients list within a range of forms such as glucose, dextrose, fructose, corn syrup, fruit concentrate, brown rice syrup, honey, honey powder (!), maltodextrin, invert sugar, maltose, malt syrup and agave (which for some reason is often promoted as a healthy sweetener but is still high in sugar and super-high in fructose, reducing the glycemic index but big deal, it's still sugar).  Additives are also often plentiful in processed foods to maintain texture and shelf life.  An example of the types of foods that may be low in fat but higher in sugar and other additives include processed sweet and dry biscuits, fruit/muesli bars, breakfast cereals, flavoured milks and smoothies, sauces and dressings, ice-cream and flavoured yoghurts. 

Speaking of yoghurt, the dairy cabinet is one area of the supermarket that can be overwhelming when it comes to choice, and yoghurt is probably the main culprit when it comes to reducing fat content but adding sugar.  I don't read labels in the yoghurt aisle. I just try to keep it simple and stick to natural or Greek varieties, and most of the time avoid fruit flavoured yoghurts.  Whether sweetened with sugar or artificial sweetener (I am a little unsure to be honest which one is least preferable),  there is usually minimal fruit content and most of them don't even taste like real yoghurt.  Add your own fruit/nuts/seeds at home.

The next dairy option to consider is milk.  LOW-FAT MILK IS NOT HIGHER IN SUGAR THAN FULL-CREAM!  Back to my fridge for some nutrition comparisons, per 100ml:

                                       Full-cream milk                Reduced fat milk

Energy                          64 calories                       46 calories   

Protein                          3.4g                                  3.5g

Fat                                 3.4g                                  1.4g

Saturated fat                 2.3g                                  0.9g

Carbohydrate                4.8g                                  4.9g

Sugars                            4.8g                                  4.9g

Sodium                           44mg                                44mg

Calcium                          128mg                               132mg

Similarly with yoghurt, low-fat natural or Greek varieties DO NOT have more sugar than full fat. 

Milk and natural yoghurts do not contain extra sugar when the fat is removed, but do we really need to choose the low-fat versions anyway?  I am asked almost daily whether low-fat or full-fat milk is better and my answer always varies depending on who I am talking to.  I have both reduced fat (not skim) and full cream milk in my fridge. I give my two young growing boys full-cream milk.  You can offer low-fat milk once little ones reach 2 years of age, but my boys are bundles of energy and the additional calories are useful for them.  We also have low-fat milk, mostly for my husband who is a large consumer of milk as part of milkshakes and protein drinks.  The benefit of low-fat is the reduction in calorie intake with larger volumes.  Myself I vary it, going for full cream milk usually, but sometimes low-fat if I seem to be having a bigger dairy day.  My preferred dairy option is yoghurt, and again, sometimes I choose full-fat, but probably more often low-fat as I eat a fair bit of it.   So it comes down to the amount of dairy food you eat, as to whether or not you need low-fat dairy options, with consideration also of health and body composition goals.  Many people are concerned about saturated fat intake with regard to specific medical conditions and this is also an area for discussion based on individual circumstances.  A great article for an update on the debate over saturated vs. unsaturated fats from Harvard School of Public Health, 'Is butter really back?'.  It is long, but well worth a read http://www.hsph.harvard.edu/magazine-features/is-butter-really-back/ and outlines the positive aspects of unsaturated fats for good health rather than trying to solely reduce total or saturated fat.

It is interesting to also compare the carbohydrate and sugar contents of non-dairy milk options also.  Looking at the full fat varieties, soy milk generally has a slightly higher carbohydrate content than dairy milk (5-6g/100ml vs. 4.8g/100ml). Oat milk (>8g/100ml) and almond milk (4.8-9g/100ml) are generally higher in carbohydrate than dairy milk, and rice milk usually twice as high (10-13+g/100ml), depending on the brand....rice milk is a terrific base for protein powders for athletes!  Regular coconut milk is not that much lower in carbohydrate (4g/100ml) than dairy milk but significantly higher in fat (the brand I looked at was ~24% fat, so 6x the fat of regular milk) and almost 4x as many calories. *Note, these values were taken from a range of supermarket products, some milk varieties may be higher, or lower in carbohydrate (particularly unsweetened varieties).

Above all, it is important to remember that most foods with a low-fat claim are highly processed.  If you are eating mostly fresh foods in as close to their natural state as possible then you don't have to worry too much about labelling, or ingredients, or the numbers in the nutrition information panel.  By eating less-processed and including fresh vegetables, lean proteins, fish, dairy, nuts, seeds, fruits and wholegrains you are likely to automatically reduce your intake of fat and sugar.  Fat is not the bad guy.  Healthy fats are good for you and should be eaten daily.  Whether you choose low-fat varieties of foods may relate more to your overall energy and calorie needs than anything.  But the other thing to remember is that even though reducing fat intake may reduce calories, you may end up hungry and disappointed.  The full-fat alternative may leave you feeling fuller so you may in fact eat less overall, and feel more satisfied if you prefer the taste.  Also remember that full-fat yoghurt is still only ~4% fat, or 96% fat-free, it's not like you are eating half a cheesecake for breakfast! 

If you are an athlete you may not want to reduce your calories necessarily, but instead focus on optimal carbohydrate and protein intakes for training and performance, so low-fat varieties of certain products may be useful to manipulate macronutrient intake for fuelling, recovery or body composition goals. 

I feel like I am making things more complicated than they really are, but the best choices in nutrition are very individual based on a range of personal factors - lucky there are so many options out there to choose from, the challenge is choosing from these the best one for you. 

 

What I love about eating like a cavemen

CavemanClipArt.jpg

Perhaps like you, I have been quite fascinated at the to-and-fro in the media between various individuals about the merits, or otherwise, of following a Paleo style of eating.  I love a bit of healthy debate, and I think everyone has a right to their opinion, but the thing that disappoints me most is the tone of recent discussions and the use of blatant or insinuated negativity directed towards individuals and their opinions.  Present your arguments, based on science and fact, but please don't ridicule others to promote your own opinions.  Credibility is built on honesty, transparency and results, not by personal attacks to try and make your opinions appear superior.  At least the fiery debate has put nutrition into the spotlight and inspired many of us to think about, and discuss, how, what and why we eat.

So what is 'Paleo' anyway?  I think there is plenty of confusion about Paleo, low-carb, gluten-free, clean eating, etc.  The Paleo approach promotes gluten-free, but is not completely carbohydrate free, and is based on the eating patterns of our caveman ancestors from Paleolithic times.

The brief in a nutshell:

Include - fresh meat, poultry, fish/seafood, eggs, nuts, seeds, vegetables, herbs, occasional fruit

Avoid - everything else, including dairy, grains (especially wheat apparently), legumes and all processed foods.

Things I love about Paleo:

- food in as close to natural state as possible

- high quality protein from meats, poultry, fish/seafood, eggs, nuts and seeds

- plenty of fresh seasonal vegetables 

- use of herbs and spices

- not much sugar

- no additives

- sustainability

Things I don't love about Paleo:

- avoiding dairy and grains completely, even minimally processed varieties

- not  much fruit 

- unlimited type and amount of fat

- potential expense

- preparation time

- not family friendly, inappropriate for children with regard to nutrient inadequacy and restrictive nature 

I seem to have  more positives on my list than negatives BUT the negatives are deal-breakers.  A positive relationship with food involves flexibility with choices, and the option to incorporate any type of food (obviously some more regularly than others).  It also is important to enjoy food without guilt, and I think this could be challenging with any style of eating that prescribes long-term rules and restrictions.  

How about 'partial-Paleo' or even 'lacto-graino-Paleo' as an alternative to full-on Paleo?  Just like there are various options for vegetarians (eg. lacto-ovo-vegetarian follow a vegetarian style of eating, and don't eat meat but include dairy and eggs), there could be different options for Paleo, which allow for our modern lifestyles, preferences, cooking options and nutrition needs?  Lacto-graino-Paleo could include some nutritious options within the dairy, grain and legume families.  Perhaps some A2 milk, some natural/Greek style yoghurt, a delicious tasty cheese, and some nutrient-packed oats or rye products.  Or even sometimes, shockingly, enjoying delicious fresh-baked white bread or a crunchy and gooey chocolate brownie! 

I am certainly not endorsing a Paleo style of eating, or any other specific style of eating,  across the board, because everyone is different and different things work for different people.  I do believe that it is everyone's individual choice as to what, how and why you eat and how you live your life in general.  Food serves a purpose in keeping your body energised and healthy, but is also a big part of our lives to be shared, appreciated and enjoyed.  Many of our most wonderful food memories involve foods that would not be considered to be 'healthy'.  I can still smell the home-made sausage rolls, an infrequent but much loved and anticipated lunch order from the local general store next to my old primary school.  Or Mum giving my brothers and I a few coins (no doubt silver ones, that we often pooled together for maximum value) to spend at the supermarket on snacks to take into the movies.  We weren't in the fresh produce section that is for sure.  Who would want to deny children these experiences and memories?  Being a dietitian I am obviously interested in health and eating well, but I also love to enjoy special food occasions.

If you like the idea of Paleo, or any other particular style of eating, make sure it is right for YOU.  Think about how it fits your lifestyle, the demands, pressures and costs involved, whether there is good nutrient balance for your particular health needs, potential for nutrient inadequacies and if it really makes you feel good.....you may have to make some modifications to come up with something that suits your unique needs.  Above all, work towards eating choices that you can live with long-term and that allow you to eat well, widely and without ongoing deprivation or guilt.