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Successful Weight Loss A Seminar by Robert Buist Copyright © 2012 International Academy of Nutrition ENTER THE LOW FAT DIETS 1950’s Ancel Keys - recommends low fat diet 1977 George McGovern - low fat dietary goals 1984 NIH - fat is a greasy killer 1985 to 2002 Five major studies- fat not linked to heart disease Profits drive food production We started to eat more starches and refined carbohydrates because these were the cheapest macro nutrients for the food industry to produce with the highest profits LOW FAT DIETS DIDN’T WORK Fat Protein & Carbs 9 calories /g 4 calories /g Reducing the fat calories didn’t cause weight loss because we ate more carbohydrates (refined grains, flours and corn syrup. Today we are hungrier than in the 70’s OBESITY EPIDEMIC Over 63% Australian men and 47% women are overweight or obese Aust. Bureau Stats. Nat. Nutr. Survey 1998 Beware low fat foods Low fat foods contain increased sugar to maintain calories eg. light beers, yogurts Failure of high carbs / low fat diets Lack of phytonutrients High glycaemic response foods Elevated triglycerides The wrong fats Exaggerated insulin response Importance of insulin control High GI carbohydrates High insulin Glucose stored as fat ( Obesity ) Insulin resistance ( Syndrome X ) Higher insulin levels Easier to store fat Harder to lose weight VISCERAL OBESITY and SYNDROME X Increased waist - hip ratio Abnormal glucose tolerance Insulin resistance Hypertension Hyperlipidaemia Chronic stress / Cushings Syndrome Insensitivity may be protective “Insulin resistance may actually be an adaptation to make it harder for the body to store fat as the body becomes more obese” WHY ARE YOU STILL HUNGRY AFTER A FULL MEAL High GI carbs cause an insulin spike Blood glucose drops below pre-meal levels High insulin prevents fat burning Low blood sugar causes craving Health ramifications of the GI “The GI concept implies that the primary cause of Syndrome X, Heart Disease, Type 2 diabetes and Obesity is the long term damage caused by repeated surges of insulin that come from eating high GI starches and sugars” The Glycaemic Index (GI) Describes the ability of carbohydrate in food to raise BLOOD GLUCOSE levels. Glucose GI 100 High GI > 70 Medium GI 56 - 69 Low GI < 55 FACTORS AFFECTING GI Starch gelatinisation (heating bursts grains) Fibrous coat / milling ( starch exposure) Amylose / amylopectun (enzyme access) Fibre viscosity (eg. legumes, apples, oats) Acidity (eg. grapefruit, lemons, salad dressing) Fat influence (reduces total meal GI) CHEMICAL STRUCTURE OF STARCH AMYLOSE Slower digestion Legumes, Basmati rice AMYLOPECTIN Rapid digestion, wheat flour, calrose rice ------ amylos e ------ amylop ectin The Role of Fibre SOLUBLE FIBRE is viscous, slows down digestion and harder for enzymes to attack e.g. apples, oats, legumes INSOLUBLE FIBRE is not viscous, doesn’t slow digestion but can delay access to enzymes and water to starch unless refined, then it doesn’t work. Olive oil and vinegar A side salad with a high GI meal lowers blood glucose and insulin response 30% HIGH GI FOODS White rice (86) Corn flakes ( 77) Dried dates (103) Rice Bubbles (87) Glucose (100) Calrose rice(83) Potato boiled (101) Watermelon (72) Baked potato (85) Roll-ups - fruit (99) LOW GI FOODS Raw cherries (22) Peas - dried (22) Cashews (22) Pearl barley (25) Chick peas (28) Prunes (29) Lentils (29) All Bran (30) Dried apricots (30) Oranges (33) Snacks between meals... ….must have low GI (because carbohydrates eaten alone have a stronger effect on blood sugar) GI also applies to Diabetics Sugar doesn’t cause diabetes Sugar is not contraindicated (but also not recommended) The glycaemic response of the whole meal is what counts Glycaemic Load (GL) GL= (GI x amount carbs/serve) /100 GL(pumpkin) = (75 x 4)/ 100 = 3 Carrots, broccoli, tomatoes, peas, onions, plums, cherries and salad vegetables contain little carbohydrates but plenty of phytonutrients. Eat freely. LOW GI LUNCHES Fish, lean meats, chicken, eggs (0) Sushi (48), stuffed vine leaves (30) Thai noodles with vegetables (40), Torilla with beans and tomato (39), Ravioli (39), tabbouli (30), lentils & rice (24), pasta marinara (40), dhal (40), most noodle soups. GI of MIXED MEALS Adding a low GI food e.g. lentils (dahl) GI 30, to rice GI 80, will lower the glycaemic effect of rice (50% x 30) + (50% x 80) = 55. (Protein and fat also delay stomach emptying) A meal with a very low GI Example: beans lamb rice olive oil stringy vegetables Our Ancestors - Hunters/ Gatherers Ate more protein - small birds, fish, animals, shellfish, organs Ate less carbohydrate - fruit & vegetables, herbs, seeds, roots, berries Fat the same but different composition - more omega-3’s No cereals until 10,000 years ago High Fat, High Protein Diets Dr Atkins Diet Revolution (1972) Insulin was so low that muscles and tissues burned fat for energy, i.e. a ketogenic diet KETOSIS verses KETOACIDOSIS DIABETIC KETOACIDOSIS: blood glucose high, osmotic diuresis, NO INSULIN, increased respiration, vomiting, dehydration, electrolyte loss and hypotensive shock. MILD KETOSIS: Blood glucose low, no diuresis, no vomiting, no increased respiration as insulin still present but controlled. Acidosis is usually asymptomatic. Effect of Ketogenic Diet Reduces insulin levels Reduces glycogen stores Blocks glucose to fat Burns body fat Decreases addictive cravings The Role of Glucagon As insulin and glucose drops, glucagon causes glycogen breakdown… LIPOLYSIS in adipose tissue Ketogenesis Glycogenolysis Initial Wt Loss on Ketogenic Diet Depletion of 500g glycogen (total body reserves) leads to 2.0 kg water loss 1g carbohydrate binds 4g water (muscle and liver glycogen) Ketogenic Diets Almost universally effective in weight loss but have the following problems: constipation due to lack of fibre increase oxidized lipids (LDL) due to lack of phytonutrient antioxidants extra load on kidneys and liver mental judgment impaired on ketones compared to glucose strenuous exercise difficult without glycogen stores ATKINS DIET LONG TERM Bad breath Constant Constipation nausea Cancer risk Halitosis CHD disease risk Nervousness Kidney stones Irritability Osteoporosis Often the amazing effects of a ketogenic diet are due to .. …..THE REMOVAL OF FOOD ALLERGIES FOOD ADDICTIONS Allergy addictions to foods can be a hidden cause of obesity especially to wheat and dairy products Dairy products GI 30-50 but Insulin index is 3x higher ...possibly because milk proteins are insulinogenic (anabolic) - drives glucose, fatty acids and amino acids into cells for growth A Safer Ketogenic Diet Carbo’s low GI and high phytonutrients Safety depends on phytonutrients, minerals Protein trimmed of cutaneous fat Fats mono and omega-3 FAILURE TO DISTINGUISH BETWEEN FATS Margarine (trans isomers) Polyunsaturated (lowered immune function) Saturated fats (elevate HDL but contain oxidised cholesterol) Monounsaturated (more stable, marbled fat, less unsaturation Omega-3 oils (decreased inflammation, cardiovascular risk FISH OILS IN WEIGHT LOSS Omega-3 oils enrich membrane phospholipids with EPA and improve insulin sensitivity and glucose control FISH PROTECTS KIDNEYS 109 Dialysis patients consumed fish 107 Dialysis patients consumed NO fish 50% less mortality in fish eaters over 3 years Kutner NG et al. Am J Kidney Dis. 39(5) 1018-1024 (2002) WARNING High fat and high protein have been associated with insulin resistance. Hence carbohydrate handling ability is decreased. ( blood glucose and insulin) Urine Ketone Test Use ketostick test before breakfast and after dinner SAFE LEVEL UNSAFE LEVEL (eat more low GI carbs) trace 0.5 - small 1.5mmol/l 4-6mmol/l (acidosis and low of electrolytes) Drink plenty of water - 8 glasses per day KETOGENIC DIET TIPS Get blood biochemistry prior No caffeine, fruits juices, alcohol, sugars No high GI foods but high phyto-nutrients Beware low fat products 150g biologically available protein daily 25-50g low GI carbohydrates Increase protein up to 25% as exercise increases Chronic Stress and Obesity Chronic stress, chronic corticosteroids & Cushing Syndrome (hypercortisolism) is associated with VISCERAL OBESITY INSULIN RESISTANCE HYPERTENSION ELEVATED CHOL & TRIGS SYNDROME X (increased urinary cortisol) CALORIC RESTRICTION Lowers free radical production in mitochondria The key to slowing the aging process Improved SOD, glutathione peroxidase, glutathione - transferase Better kidney, heart, liver and gastric function DIETARY RESTRICTION STOPS DNA DAMAGE (50yr old) Kcals/day 2000 1100 Body wt (lbs) 180 173 Thymidine glycol (nmol/kg/day) 0.26 0.11 8-hydroxydeoxy guanosine (nmol/kg/day) 0.35 0.09 Simic MG et al Mutat Res 250(1-2)17-24(1991) DIETARY CALORIC RESTRICTION (for 5 yrs) in RHESUS MONKEYS Normal Diet 688 cals/day Reduced Diet 477 cals/day Body Wt 31 lbs 21 lbs % Weight from fat 25% 10% Serum Glucose (mg/dl) 71 56 Serum Insulin (U/ml) 93 29 Serum Triglycerides (mg/dl) 169 67 Weindruch R. Sci Am 274 (1) 32-38 (1996) AVOID STARVATION DIETS Lower metabolic rate Induce fat storage Muscle is lost Mitochondria number decrease Low energy levels (Don’t skip meals metabolism slows down) MUSCLE IS HEAVIER THAN FAT As you exercise and look slimmer you may actually increase weight due to increased muscle mass. MUSCLE CRITICAL FOR Wt LOSS *(Aerobics and strength building vital) Fat has low metabolic activity Lean muscle mass = energy Muscle mitochondria = calorie burning units “Your lean body mass is you, your fat is on you” Biological Value of Protein Food Biological Value Whey protein isolate Eggs Milk Beef Fish / chicken Soya Rice 110 -159 100 91 80 79 74 59 WHEY (High protein powder) Whey (high biological value protein) (25g serve 2-3 times daily) Magnesium, calcium, potassium (electrolytes) Chromium polynicotinate (sugar control, decrease fat) L- or Acetyl Carnitine (fat burning, performance) ALPHA LIPOIC ACID (100mg) Mitochondrial Fn Lowers insulin and glucose levels Reduces insulin resistance Improves insulin sensitivity Neutralises free radicals Chromium 1,000 micrograms Reduces elevated insulin & glucose Reduces glycation Improves insulin resistance Reduce body fat Increases muscle mass Weight Loss - 2 Diets Low GI Diet 60% carbs (low GI) 35% protein (low fat) 15% fat (mono/omega-3) Ketogenic Diet 20% carbs (low GI) 50% protein (low fat) 30% fat (mono/omega 3) The Whey Diet Plan Breakfast: A Whey Smoothie or boiled egg, omelette, bacon&tomatoes, grated apple Lunch: Mediterranean Salad or chicken waldorf, salmon salad, bean & chicken, lentil soup Dinner: Stir-Fry or lamb fillet, chicken & almonds, pork & cabbage, poached salmon