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One of my good friends and I occasionally discuss whether all calories are alike.

His perspective on losing weight involves eating less, full stop.

Mine involves eating the right kind of foods, which the body has to work harder to digest.

On Monday, June 20, 2022, an article appeared in the Daily Mail, ‘Counting calories is a waste of your time, says gut health guru Dr Megan Rossi’.

Here is the essential part of the article (emphases mine):

with highly processed foods, most of the food matrix has already been broken down for us by machines, making the calories more accessible (so the figures on the labels for ultra-processed foods are a more accurate measure of what our body absorbs).

Another reason for not focusing on calories is that not all calories are equal, because of food’s thermogenic effect. This is when you burn calories while eating and digesting. In other words, your body’s processing will counter some of the calories — and here’s the important bit — depending on the specific food.

Whole foods such as fruit, veg and nuts that need chewing, breaking down and more digesting have a higher thermogenic effect than ultra-processed foods.

And the calories from highly processed foods are much more readily available. For example, a KitKat and a banana might contain similar calories and your food-tracking app won’t treat them any differently — but your body will.

One study in particular (published in 2010 by Pomona College, Claremont, in the U.S.) found that the body burns nearly 50 per cent fewer calories digesting a meal of processed foods than after a whole-food meal, even if both contain the same total of carbs, fat and protein.

It might not sound enough to make a lot of difference, but over a month, a year, a lifetime, it certainly adds up.

Further research in the journal Cell Metabolism in 2019 found that people told to eat as much as they liked gained more weight when given ultra-processed foods than when having unprocessed options — again, even when the meals were matched for carbs, fat and protein.

This supports what I’ve seen in clinic: limiting processed foods is a better weight-management strategy than counting calories.

These sorts of findings are repeated time and time again, and explain why we often don’t experience a lasting feeling of fullness after eating processed foods. For instance you might feel stuffed after a fast-food meal, yet weirdly ready to eat more an hour later.

If a food has already been broken down for you, your body has less work to do and it’s less satisfying. An apple takes longer to eat and is way more filling than apple sauce, which itself is more satiating than a glass of apple juice. That’s because a whole fruit contains fibre and water bound up in that food matrix.

Unlike me, Dr Rossi is big on plant-based diets. However, she did have something interesting to say about gut bacteria, which she says is a:

secret weapon … These, and the chemicals they make when they digest plant fibre, can affect appetite.

These chemicals, such as short-chain fatty acids, tell our body we’ve had enough. This halts the production of hunger hormones such as ghrelin, and increases the ‘I’m full’ hormones such as leptin.

Other chemicals produced by our gut microbiota are thought to target the reward network in the brain, which influences our relationship with food and our tendency towards emotional eating.

Microbes and their by-products have also been linked with ‘turning on’ genes related to fat distribution. Added to the fact that our microbes may influence our taste receptors, it’s pretty clear that having a higher body weight is way more complex than simply eating too much and not exercising enough. So feed your gut microbes and it’s likely to keep everything else in check.

This is why it is important to prepare meals from scratch. Even at my busiest during my working years, which included being in the office at the weekends, I always made time to prepare two sets of dinners for the days ahead. I could take one portion out from the freezer every day and put it in the refrigerator. It was thawed by the time I got home that evening.

Ready meals never gave me as full a feeling, so to speak, as homemade dinners did.

The same goes for treats, such as cakes and biscuits. Baking with butter and sugar produces a more satisfying result than buying something off the shelf made with vegetable oil and corn syrup. Consequently, one eats less of a homemade sweet treat than an industrial product.

The answer to obesity is to eat fewer processed foods, especially carbohydrates, and to focus on natural fats and proteins instead.

The ketogenic diet is a way of eating, for life. It makes food more enjoyable and satisfying.

On Saturday, June 18, 2022, a group of Telegraph columnists shared the lessons they learned at the age of 40.

‘What I wish I had known at 40’ is a thought-provoking article and worth sharing with younger family members. I hope that Prince William, who is reaching this milestone on June 21, reads it.

Some of these columnists are well over 40 now, which makes their observations all the more worthwhile.

Excerpts follow, emphases mine.

Janet Daley had no choice but to leave her academic career abruptly, aged 40:

Not very long after my 40th birthday, I lost the career to which I had devoted my adult life. From the time I arrived at university – which seemed to me like heaven on earth – I had never wanted to be anything other than an academic …  But then came one of those brutal moves for which academic life is notorious: my department was closed down and I was out. It was like a bereavement. My family were for a time seriously worried about my emotional stability.

But there was, as you may have guessed, to be a whole new chapter. By an extraordinary stroke of luck, newspapers were at that time expanding exponentially. This was just after the Wapping revolution when the press was freed from the decline to which the domination of the print unions had once condemned it. This liberation also encompassed the old National Union of Journalists rule, which had made it very difficult for Fleet Street to hire writers who had not served years of apprenticeship on provincial newspapers. Those two factors combined to allow me to enter what would always have been a natural alternative profession. I started out as a commentator for The Times. Then The Independent – only recently launched and very fashionable – offered me a column. Then, a year later, The Times brought me in as a columnist. Five years after that, I joined The Telegraph, where I have had a happy home ever since.

So what do I wish I had known back in that period of grief and hopelessness in my 40s? That you can reinvent yourself at almost any point in your life, and that there is a world of possibilities out there if you refuse to be defeated by despair.

Bryony Gordon is still learning, every day:

It wasn’t that long ago that I turned 40 – I will be 42 in a couple of weeks – but two years in pandemic years is like 20 years in normal human years, so perhaps I have managed to gather some pieces of advice for my marginally younger self. Namely: don’t trust your Prime Minister, don’t imagine you’ll ever go abroad again, and don’t wait to get work done on the kitchen, because building materials are going to be more pricey than printer’s ink.

Practical matters aside, I wish I had known that I didn’t have to live in fear. Fear of failure, fear of not doing enough, fear of losing everyone I love. If I have learnt anything in the past two years, it’s that I have very little control over anything, so I might as well start enjoying life, instead of waiting anxiously for it to end. At 40, nothing is certain any more – not immortality, not oestrogen, not the 8.47 to Waterloo. You can sit around railing at the unfairness of it all, or you can start sucking the delicious juice out of what you do have. This is the option I have decided to take, but only after a fair bit of railing, flailing and pain.

But what do I wish I’d known most at 40? That I barely know anything at all, and if I’m lucky, I’ve got a whole lot of learning on the way. Bring it on, I say.

Christopher Howse recounts the mistakes of his his middle years and says:

At 40 I still hadn’t realised that almost everyone’s troubles were as big as mine. It took a few more years to swim along with other people cheerfully. The worst thing would have been to make my woes define me against a world that was to blame for my miseries. But now, like minnows in a stream lit up by the English sun, we swim one way, then swirl round in formation, then dart explosively apart. It’s better than solitary splashing, exhilarated one moment and towed under a dark wave the next. To me it looks like the Prince learnt to swim some time ago.

Judith Woods says that it is important to be oneself:

I wish I’d known at 40 that it’s not too late. To start a lifelong quest. To end a toxic friendship. To be reckless. To be careful. To be, in George Eliot’s immortal words, what you might have been. If only your inner critic could be silenced …

I spent my early life worrying, ruminating and second-guessing what “other people” thought of me, would think of me if I went blonde, brought supermarket wine to a dinner party or let my baby daughter have a dummy. Silly things. Stressful things.

Finally, at 40 I started to realise that unless anyone (by which I mean someone who mattered) explicitly said something to the contrary, it was safe to assume my dress wasn’t too short, my work was fine, I didn’t say anything unforgivably awful in the pub and I was not a high-functioning failure, in danger of being outed at any moment.

Do princes suffer from impostor syndrome? Apart from the one moonlighting as a pauper in Mark Twain’s classic novel, I suspect not. An heir to a throne is, of necessity, schooled in resilience as well as tireless public service.

Here in the cheap seats, I’m more than a decade ahead of the Duke of Cambridge and can joyfully report that not giving a monkey’s about other people’s (unvoiced and entirely putative) opinions of how dreadful I am is gloriously liberating. Curtailing the self-sabotage remains a work in progress of course. But it’s never too late to begin.

On a similar note, Michael Deacon points out that, at age 40, one can finally ditch the conformity that defined one’s youth:

We think of the young as rebels, but in reality the opposite is true. The young are conformists, desperate conformists. In everything they do they crave acceptance, perhaps not from their parents or teachers, but always from those their own age – and in particular from those they deem to be cooler or more attractive than they are.

And inevitably this frantic, fevered craving makes them unhappy, because it compels them to do things they don’t really want to, things they don’t actually enjoy. They force themselves to go to parties they’d been dreading, go clubbing even if they hate the music, buy clothes they know don’t suit them, pretend to love books they’ve never read – and all in a neurotic attempt to impress others, or at least to avert their contempt.

By 40, however, all that nonsense has dissolved. We go out when we want to, and stay in when we don’t. We choose the music, films and books we genuinely enjoy, rather than slog our way through unrelieved tedium in a miserable bid to seem clever and sophisticated. We lose all interest in the concept of cool, and accept our tastes and our views as they actually are. We allow ourselves to think what we really think, rather than what we think we should think. In short: we start being honest – both with others, and with ourselves.

No longer do we have time to worry about how we might look to people we don’t even know. This is the wonderful thing about middle age. Things that don’t matter don’t matter any more.

I couldn’t agree more. My 20s were miserable, especially as I was still trying to find my own identity as a person — and be accepted for my foibles.

I was so relieved to turn 30. It felt as if a shroud had been lifted from me.

At 40, I was even happier in myself. At 50 and 60, my personal happiness increased. Long may it continue.

I am closing with Philip Johnston’s warning about weight increase after the age of 40. Monitor it and get rid of it:

My advice is mundanely practical. Remember that just putting on a mere 1lb in weight a year can add two stone by the time you are in your 60s, so watch what you eat. I wish I’d taken a friend’s advice on reaching 40 to apply for MCC membership as I’d be in by now, just. I wish I’d taken up those Italian classes and properly learned the piano but didn’t. Do it. As Housman said, the land of lost content cannot come again.

But I also like the somewhat opaque observation of the American rock singer Bob Seger: I wish I didn’t know now what I didn’t know then.

On the subject of weight gain and loss, one of the greatest British success stories is that of Labour’s Tom Watson, who used to be the party’s deputy leader.

On Monday, June 20, 2022, The Telegraph interviewed him to find out his dieting secrets. The article has before and after pictures.

Excerpts follow:

In 2018 the former Labour deputy leader astounded everyone when he lost eight stone, going from 22st to 14st in two years and reversing his type 2 diabetes, going on to write the bestselling book Downsizing

Watson still admits to the occasional eating binge and has to resist temptation when he goes down the biscuit aisle in the supermarket:

Watson will never be free of the urge to eat sugar. The mere thought of a Hobnob can still have him salivating. If he finds himself needing to re-fuel on the go he’ll grab a packet of turkey slices from the likes of M&S. “But I could so easily go to the biscuit aisle and eat a packet there and then,” he says.

He has another book out about his weight loss:

Calling his new book Lose Weight 4 Life might at first seem a bit of a boast. As Watson says: “That’s a heavy and onerous responsibility I’ve given myself there”.

However, the title in fact refers to the cycle of small setbacks followed by resets that are inevitable.

Not every day will be a success, and those losing weight will have to adapt to good days and bad:

“You are losing weight for life because you’re going to have good days and bad days. You’re going to put a bit of weight on and have to learn how to put yourself in the mood to shift it. Whether it’s logging your food that week, or starting to take your measurements, as long as you’ve got a reset programme that brings you back to the journey, you’re going to be OK.”

Multiple times during our interview he tells me that weight loss is a “journey, not a destination”.

In Week One, he advocates:

  • creating and maintaining a log of food consumption along with one’s weight;
  • preparing oneself mentally;
  • avoiding getting down when one has not lost weight;
  • taking it one day at a time and reviewing the food log to see if any bad habits are apparent. If so, those are the ones on which to focus.

He makes it clear that what works for him might not work for someone else:

Not everything he did, he makes clear, will work for everyone else, but it’s a place to start.

His overall strategy is to adopt the keto way of eating:

Watson’s reset is to go keto, cutting back on the carbs.

If he was a minister now he’d be reengineering the British breakfast away from sugary cereals back to Fay Weldon’s ‘Go to work on an egg’, he says.

Cutting carbs also means cutting out beer:

he hasn’t had a beer in five years (“Too much sugar”), now favouring spirits such as vodka and gin.

Correct. Dry wine is also good with meals.

He also advocates the following:

  • not eating straight from the fridge; place your food on a plate and eat it with cutlery;
  • avoid snacking when going to parties;
  • don’t despair if your clothes suddenly feel tight; recalibrate and carry on;
  • pay attention to what is going on in your life and how it can affect your eating habits;
  • build a support group of friends who can help keep you on track;
  • get plenty of sleep; lack of it can cause people to gain weight.

I have a lot of posts about the ketogenic diet, which also improves mood, just the thing one needs at age 40 and beyond.

In closing, to my readers in the Northern Hemisphere, best wishes for the summer!

And many happy returns to Prince William on his special day.

Being a fan of the keto — low carb, high fat — diet, I was interested to read what an endocrinologist at Imperial College London’s Weight Centre discovered about weight loss and maintenance over the past six years, particularly during lockdown.

On March 28, 2022, The Telegraph featured Dr Saira Hameed’s findings: ‘How to lose weight — according to science’.

She developed the Imperial Satiety Protocol, the I-SatPro, six years ago. Her new book, The Full Diet, describes the protocol in detail. It involves more than food, delving into gut bacteria, sleep and exercise, too (emphases mine):

… she set up the I-SatPro (Imperial Satiety Protocol) six years ago, a fortnightly programme at her clinic, convinced that “if you share the science,” being able to “understand how your body works” could lead to lasting physical change. That programme is recreated in her new book, The Full Diet, which she believes can match the 14 per cent weight loss rate at her in-patient clinic.

The programme’s approach is both full and full-on: from food to movement, sleep, gut bacteria and exercise, all bases are covered. Like everything else in the world, I-SatPro went virtual when Covid hit – which was something of a blessing, Dr Hameed says, because the 14 fortnightly sessions, previously restricted to whatever room wasn’t booked up at Imperial, had their reach expanded significantly. There is no typical patient in each 15-strong cohort, though three-quarters are women (reflective of referrals generally for weight loss): their ages run from late teens to those in their 80s, from all walks of life, with a BMI upwards of 35. Dr Hameed says she stopped reading fiction two decades ago, when she became a doctor, because “my patients’ stories are more interesting”. 

It turns out that Dr Hameed’s findings on food are remarkably similar to the keto diet:

One of the reasons we have got fat, she thinks, is by cutting out fat (which is “delicious. Wouldn’t you rather eat the crispy skin as well as the roast chicken or sauté your vegetables in butter rather than eating them with a low-fat dressing?”), and “satisfying”. Eating creamy Greek yogurt, full of natural fats, both can’t be overdone and feels substantial; fullness being a key trait for stopping overeating.

Awareness of ghrelin, the hunger hormone, demonstrates the importance of the relationship between gut and brain – one modern ultra-processed foods are designed to derail even more. High sugar, high salt products with unrecognisable ingredient lists are the go-to for emotionally-driven eating – which Dr Hameed describes as “one of the biggest burdens” to all weight-loss treatments – and the fact it now makes up more than 50 per cent of our diets is a major cause for concern. Stick with one-ingredient foods, such as eggs, fish and nuts, and that issue goes away.

That said, she advocates eating only when hungry, because consuming anything too often — including protein — will lead to high insulin levels that convert fuel into fat storage:

Dr Hameed was on the Covid frontline until the summer of 2020 when she became pregnant with her fourth child: she believes most people “want to do the right thing” when it comes to protecting their health – particularly since the pandemic – but are often battling a tide of misinformation. One of the most common is around breakfast – which her patients routinely tell her they “know” is the most important meal of the day, and thus eat in spite of not being hungry. She tells them instead to wait until biology causes their hunger hormone to kick in, and to see each day’s food intake through the lens of an “eating window”.

Consuming anything – even the approved foods listed in the book – means sugar ending up in the blood, upping insulin levels that will convert fuel into fat storage; if we get up at 7am and are in bed by 11pm, that could mean 16 hours of food going in. Those following the programme can choose what their window looks like; either it opens or closes at a certain hour of the day, or lasts for a defined period of time. Not only does this keep insulin levels low – breaking down fat and assisting weight loss, as well as reducing the risk of insulin-driven diseases (such as type 2 diabetes)but it will “give your body the time to carry out essential repairs and resets”

That is so true. Being retired, I eat only once a day, in the evening. I have a normal one-course meal and rarely have dessert.

Hameed has a list of approved and forbidden foodstuffs. That said, there is enough variety for those following the protocol, preventing boredom:

the book’s “Choose Not to Eat List” includes offenders such as bananas, mangoes and grapes, “bread of any kind”, couscous and porridge. But Dr Hameed sees the book as a science-driven sum of parts; at the end of each chapter, like I-SatPro, “you get given a series of choices” which enable readers to decide what to do for themselves. “That element of choice is so, so, so important,” Dr Hameed, 43, says. People need “agency and ownership” over their health – and a plethora of rules “is probably counterproductiveif you give people information about anything, they should be free, then, to make choices about how they implement that in their everyday life. I think that’s the only way it can work, long-term.”

I agree.

However, I do disagree with the prohibition of ‘bread of any kind’. I am a keen bread baker and maintain my own sourdough mix. As long as the bread is fermented — allowed to rise once on the countertop, knocked back, then given time to rise again in the fridge (3°C) for one or two days — it will be fine. The result is a French-style, aerated artisan loaf, which is quite filling, given the holes. Weekend nights are sandwich nights in my house. I haven’t had any problem with weight control with fermented bread.

I do think that commercial bakery bread is a problem, though. That I would avoid.

So, the best bet is to learn how to bake bread at home. It’s cheaper and more satisfying.

But I digress.

Dr Hameed’s book includes simple exercise tips and her patients’ stories, which make it more interesting than a standard diet book:

She prescribes Neat or non-exercise activity thermogenesis; essentially, adding bits of movement to otherwise sedentary tasks. That can be standing on the train (even if there’s a seat); walking around when on a phone call, or offering to fetch something left elsewhere in the house. These are the kinds of small additions on which you can “build until it becomes just a natural part of how you’re living”.

Dr Hameed believes that where The Full Diet has the edge is that it features her patients’ stories. “These are real people with jobs, families, commitments, or with busy, busy lives, who have made it work. And I think that should really encourage the readers that if other real-life people can do it, then I can too”.

I would also recommend drinking three to four glasses of water a day to flush out the system. Incredibly, it will help with weight loss and maintenance.

Dr Hameed’s book goes on sale on March 31. I hope it is a great success.

Two recent studies on diet show that consumption of animal proteins and fats help young and old alike.

Finland: vegan diet ‘remodels metabolism’ in young children

A group of researchers conducted a study on vegan diets in small children attending Finnish nurseries:

They published their results in February 2021: ‘Vegan diet in young children remodels metabolism and challenges the statuses of essential nutrients’.

There is a lot to read, which is, nonetheless, very interesting.

I will cover only the highlights.

This is the top-line summary (emphases mine below):

Vegan diets are gaining popularity, also in families with young children. However, the effects of strict plant‐based diets on metabolism and micronutrient status of children are unknown. We recruited 40 Finnish children with a median age 3.5 years—vegans, vegetarians, or omnivores from same daycare centers—for a cross‐sectional study. They enjoyed nutritionist‐planned vegan or omnivore meals in daycare, and the full diets were analyzed with questionnaires and food records. Detailed analysis of serum metabolomics and biomarkers indicated vitamin A insufficiency and border‐line sufficient vitamin D in all vegan participants. Their serum total, HDL and LDL cholesterol, essential amino acid, and docosahexaenoic n‐3 fatty acid (DHA) levels were markedly low and primary bile acid biosynthesis, and phospholipid balance was distinct from omnivores. Possible combination of low vitamin A and DHA status raise concern for their visual health. Our evidence indicates that (i) vitamin A and D status of vegan children requires special attention; (ii) dietary recommendations for children cannot be extrapolated from adult vegan studies; and (iii) longitudinal studies on infant‐onset vegan diets are warranted.

More summarised points follow.

On metabolism and vitamin intake:

The children who followed the vegan diet from birth showed a metabolic profile and nutrient status distinct from those of lacto‐ovo‐vegetarians and omnivores, indicating that only relatively little animal source foods are enough to shift the metabolism of children. The main findings in vegan children included very low cholesterol concentrations and modified bile acid metabolism, as well as their markedly low fat‐soluble vitamin status despite their nutrient intakes matching current national recommendations fairly well. Despite of the adequate estimated vitamin A intake, the RBP results of vegan children in our sample indicated insufficient vitamin A status. Their vitamin D levels were low although the samples were taken during and after summer with expectedly high sunlight exposure and vitamin D storage. Our evidence indicates that special attention is needed to ensure adequate status of these important micronutrients for children on a vegan diet.

On cholesterol levels:

The low cholesterol levels resulting from adult vegan diet have mostly been linked to positive cardiovascular health effects (Appleby & Key, 2016; Elorinne et al, 2016), although a recent study also suggested an increased risk for stroke (Tong et al, 2019). The markedly low cholesterol in vegan infants and children in our study raises the question of whether such levels are healthy, as cholesterol is essential for cellular growth, division, and development of physiological systems due to its major role in the synthesis of cell membranes, steroid hormones, bile acids, and brain myelin.

A dysfunction with brain myelin means that the myelin sheaths, which cover our nerves, are not getting the fat necessary for healthy maintenance and function. Low-fat diets are thought to contribute to Alzheimer’s (see second study below).

On bile acids:

The main route of cholesterol excretion from the body is through bile acids, the biosynthesis of which occurs in the liver. Our metabolomics analysis indicated that bile acid biosynthesis was the pathway that differed most significantly between the diet groups. In vegans, direct measurement revealed higher primary bile acids, cholic acid, and chenodeoxycholic acid, which were previously reported to increase upon fasting in children (Barbara et al, 1980), and a lower taurine to glycine ratio in bile salt conjugation than omnivores. Vegan diets contain only little taurine, and the relatively low taurine‐conjugation compared to glycine conjugation of bile salts in vegan children is in accordance with previous adult studies (Ridlon et al, 2016). In addition to the role of bile acids in digestion and absorption of fat‐soluble components from the diet, recent studies have elucidated their diverse roles in endocrine and metabolic signaling and gut–microbiome–brain interactions (De Aguiar Vallim, 2013; Ridlon et al, 2016; Kiriyama & Nochi, 2019). What physiological consequences such findings indicate in children following a strict vegan diet remains to be studied. Our evidence indicates that vegan diet remarkably modifies bile acid homeostasis in young children.

The conclusion indicates that, in a vegan household, it might be a good idea to give small children some animal protein outside of meat:

The evidence indicates that even part‐time consumption of lacto‐ovo‐vegetarian products in an otherwise strict vegan diet may substantially alleviate the risk to nutrient deficiencies in children. Our data indicate the importance of studying vegan children to enable evidence‐based nutritional recommendations.

As this is the first time Western countries are seeing an increase in vegan children, more research is necessary.

With regard to Finland, the study says:

Our data of lower status of several biomarkers in vegan children compared to omnivores, in the relatively low number of study subjects, calls for larger studies before early‐life vegan diet can be recommended as a healthy and fully nourishing diet for young children, despite its many health‐promoting effects in adults. We suggest that the metabolic effects of vegan diet in adults cannot be generally extrapolated to children. Long‐term follow‐up studies are needed to clarify the causes and consequences of lower levels of vitamin D, RBP, transthyretin, essential amino acids, total cholesterol, and DHA in vegan children.

New Zealand: ketogenic diet can help some Alzheimer’s patients

Researchers in New Zealand found that a ketogenic diet might help patients with milder cases of Alzheimer’s:

I suspect that the lack of fat inhibits the proper maintenance and function of the myelin sheath. Our nerve coatings need fat. Well functioning connections to the brain are likely to lessen the possibility of Alzheimer’s.

The researchers published ‘Randomized crossover trial of a modified ketogenic diet in Alzheimer’s disease’ in February 2021.

Excerpts follow:

Brain energy metabolism is impaired in Alzheimer’s disease (AD), which may be mitigated by a ketogenic diet. We conducted a randomized crossover trial to determine whether a 12-week modified ketogenic diet improved cognition, daily function, or quality of life in a hospital clinic of AD patients …

This is the first randomized trial to investigate the impact of a ketogenic diet in patients with uniform diagnoses of AD. High rates of retention, adherence, and safety appear to be achievable in applying a 12-week modified ketogenic diet to AD patients. Compared with a usual diet supplemented with low-fat healthy-eating guidelines, patients on the ketogenic diet improved in daily function and quality of life, two factors of great importance to people living with dementia

Brain energy metabolism is impaired in AD. Compared with healthy controls, people with AD display lower levels of brain insulin signaling and fewer brain insulin receptors, culminating in brain insulin resistance [3, 4]. PET studies demonstrate a 20–25% deficiency in cerebral glucose metabolism [5]. AD neurons also exhibit diminished numbers of mitochondria, many of which show reduced citric acid cycle and respiratory chain activity, culminating in decreased energy production [6].

Ketogenic diets can theoretically mitigate impaired brain energy metabolism in AD, leading to improved cognition, daily function, or quality of life. Ketogenic diets are high-fat, low-carbohydrate diets that shift the body towards fat metabolism. Neurons cannot metabolize fats directly, but the liver converts fats into ketones, which can serve as a major neuron energy source [7]. During a typical western diet, the concentration of the primary blood ketone, beta-hydroxybutyrate, supplies less than 5% of brain energy requirements and its blood concentration rarely exceeds 0.5 mmol/L. By contrast, a ketogenic diet induces a state of “physiological ketosis” in which beta-hydroxybutyrate provides a greater contribution to brain energy metabolism and its blood concentration exceeds 0.5–0.6 mmol/L …

This was a single-phase, assessor-blinded, two-period randomized crossover trial conducted at Waikato Hospital, a tertiary hospital in Hamilton, New Zealand …

To our knowledge, this is the first randomized trial to investigate the impact of a ketogenic diet in patients with uniform diagnoses of AD. Our findings suggest that high rates of retention and adherence are achievable in applying a 12-week modified ketogenic diet to AD patients. Compared with a usual diet supplemented with low-fat healthy-eating guidelines, patients on the ketogenic diet improved in daily function and quality of life. Changes in cardiovascular risk factors were mostly favourable and adverse effects were mild …

Compared with usual diet, patients on the ketogenic diet improved in daily function. Given that a 2-point change on the ADCS-ADL is considered clinically meaningful [22], the observed increase of 3.13 points implies that the ketogenic diet imparted a meaningful benefit in our patients to a degree that rarely occurs with medications [33]. Since an ongoing decline in daily function is a core feature of AD [2], this finding may be potentially important. By contrast, the decline in function observed in patients on low-fat healthy-eating guidelines may raise questions as to whether this dietary advice should be provided in AD.

Compared with usual diet, patients on the ketogenic diet also improved in quality of life. Given that a 3-point change on the QOL-AD is considered clinically meaningful [23], the observed increase of 3.37 points again implies that the ketogenic diet may offer a substantial benefit. By comparison, cholinesterase inhibitors show inconsistent effects on quality of life [34].

Whether ketogenic diets offer benefits on cardiovascular risk factors remains controversial [35]. The changes observed in this trial were mostly favourable. Compared with usual diet, patients on the ketogenic diet lost 2.62 ± 3.29 kg. Weight loss has been associated with increased mortality in AD [36], but that observation may relate to appetite changes resulting in cachexia in later-stage disease. By contrast, our patients were generally overweight (and pleased with their weight loss). Moreover, patients on the ketogenic diet decreased their HbA1C, did not alter triglycerides, and increased their HDL. There were modest increases in LDL and total cholesterol, but the impact of these changes on cardiovascular health remains debated [37].

I have been saying for several years that keto is likely to help some Alzheimer’s patients, and I’m delighted that this group got funding to try it out in a properly randomised fashion.

I hope there are many more studies such as these. The simplest remedies are often the best. There is no cure for Alzheimer’s but those who are not in advanced stages can benefit from a modified — and tasty — diet.

Food notes

We receive so much propaganda about our food choices, that it is time to present the other side of the coin.

Eating meat is at the top of the list. With regard to beef, much depends on who is producing it and the target market. Brazil produces beef for China. That agribusiness cycle has nothing to do with Europeans or North Americans:

Traditionally processed meats are nutritious. People living in the countryside, especially in mountainous areas, have been curing meat for centuries. Here’s a comparison between veggie nuggets and proper Spanish ham:

Cheap, modest foods can help provide the nutrients we need.

Real cheese might help reverse diabetes:

It looks as if liver could also help put diabetes into remission:

A good friend of mine hears ‘liver’ and says ‘yecch’, but sautéed chicken livers are out of this world. So is chopped liver:

What about liver and bacon? A good quality liverwurst is excellent, too:

Plant-based diets, especially if they are low-fat, might not be all they are cracked up to be. Ancel Keys had a lot to answer for in recommending low-fat diets in preventing heart disease.

One of his contemporaries would have disagreed with him:

After 60+ years, low cholesterol diets are beginning to be questioned:

The truth hurts, especially in med school:

I have much more about the ketogenic diet on my Recipes / Health page. They are one-third of the way down the page. Search for ‘diet’ and ‘low-fat, high-carb diet’.

The other day, I responded to a comment on a conservative American website with regard to diet.

The context was in regard to the reform of Obamacare in the Trump administration. The initial comment referred to Speaker of the House Paul Ryan’s (R-Wisconsin) possible approval of a health auditor, a stranger, to visit someone’s house to assess a family’s lifestyle prior to their obtaining health insurance. Apparently, this is one health insurance idea that has been discussed before.

Ryan’s father died at an unexpectedly early age from heart disease. Consequently, Ryan focussed on diet and exercise to ensure he himself didn’t end up that way. It is thought that he also might well consider that a stranger going into someone’s home to assess their lifestyle — perhaps to check cupboards for snacks or alcohol and sniff walls for evidence of smoking — is entirely acceptable.

That is every bit as frightening as the Vault 7 Year Zero CIA document dump by WikiLeaks on March 7.

There are two things here.

The first is that, as a legislator, Paul Ryan will never have to be part of Obamacare or Trumpcare. He and his colleagues get a traditional health insurance plan.

The next thing is obesity, which Paul Ryan — a thin man — desperately opposes.

As I told the person on this particular conservative website, this notion of a healthcare audit is a plan for the ‘little people’. (They, in Ryan’s estimation, do not understand what their betters do. This, by the way, is Ryan’s ‘magnificent home’ in Janesville, Wisconsin. It has an extensive border fence around it.)

I further commented (same link):

To counter Ryan’s dictating to Americans on their health: my father also died of heart disease at an early age. So did his father, whom I never met. So have some of my friends in the present day. That doesn’t give the right to go around snooping in people’s homes as a precursor to getting health insurance!

Then, I discussed obesity:

Re obesity: severely limit or stop eating starch and sugar, eat more fat (including animal fat) and less protein. Watch the pounds roll off. It’s called the ketogenic diet, which is a permanent eating plan, not a fad diet. I’ve been on it for three years. I lost weight and stabilised. Cholesterol and triglycerides go down with keto.

As we know, there is a particular association between Americans and obesity. It is unclear whether this can be connected with the increase of obesity in other Western countries, because who knows how much corn syrup — rather than sugar — is in their food? Emphases mine below, not in the original comment:

Someone on here was talking about corn. It’s all the corn syrup used in place of sugar which also leads to obesity. Sugar makes you feel more sated than corn syrup. We owe the proliferation of corn syrup to the Nixon administration in the 1970s. Corn farmers, IIRC, had a glut of crop then, so were bailed out with companies producing corn syrup for commercial cake, cookie and candy manufacturers.

Note when obesity started to climb: the late 1970s to early 1980s. It was no big deal at the time. Most people attributed it to Americans giving up smoking. Although that was a factor, I would posit that the increase of sweet snacks and cakes made with corn syrup were a greater contributor — and continue to be today.

Yes, I know I should have said ‘was’ instead of ‘were’ in the last sentence, but only caught it now.

Regardless, that message got through. My sincere thanks to the moderators. I didn’t think anything of it until later. Now read on.

The commenter, with whom I was corresponding, replied:

Salty snacks like crackers and chips also contribute, along with soft drinks and the rest of our favorites (fast food, etc). Eat at home family meals with vegetables and salads have diminished with women working, divorces, unwed mothers with no Dad in the home, increase of addictions, etc.

I’m not in favor of a one-food group diet (animal fat/low carb) diet. Whole grains and vegetables/fruit contain important phytonutrients. Did you know heart attacks diminished in Britain, in WWII, despite the stress of the bombings, when sugar was rationed?

So, appreciating this reply, but differing because of my keto experience — and that of thousands of others — wrote back.

I retyped my reply twice. Both immediately went into spam. A subsequent message, on a different topic, went through, by the way.

The text below is similar to what was spammed. Once again, emphases mine below, not in the original comment. For the overweight:

All starch — whether salty or sweet, from carbohydrate to sugar — should be sharply curtailed or eliminated.

It should be noted that the ketogenic diet — a way of eating and not a fad diet — is not a one-food group diet. It works with a proportion (depending on the individual) of 50% fat, 35% protein and 15% carbohydrate per day. Vegetables should provide most of the 15% carbohydrate. The more you weigh, the more you lose.

Starch comprises bread, cereal, cakes, oatmeal, salty snacks (etc.). Sugars, including those in fruit, are also starches.

Corn syrup has replaced sugar in most sweet snacks. Corn syrup is less satisfying than pure sugar. Americans are eating more corn syrup in cakes, cookies and candies. Therefore, they are getting fatter because the corn syrup is less satisfying.

Eating more fat — including fat from cheese, eggs and dairy products, especially butter — will be more satisfying than eating starches or sugar.

I agree very much with your point on ready-made meals, however, another problem is that Americans — along with many other Westerners — eat five times a day.

I take your point that, during the Second World War, Britons got their nutrients from whole grain bread. However, they needed all the sustenance they could receive. They also had no central heating. They had to walk or ride bicycles to and from work. Rationing in the UK did not end until 1954.

Westerners live an entirely different lifestyle in the 21st century. They eat too many carbohydrates, including sugars — especially corn syrup products, which leave them less full than sugar would. They have heated homes and offices. They drive nearly everywhere.

Low fat foods are another problem. For a decent flavour profile, low fat needs to be offset with high sugar content, most often corn syrup.

My message must have had wording or syntax that instantly caused it to end up in spam — twice.

There is a political point about corn syrup that I want to make concerning the law of unintended consequences. No one could foresee in the Nixon administration that corn syrup would result in a national weight problem.

I know from experience. In the early 1960s, when I was five years old, I was a guest of a young friend at her house for Saturday dinner — pancake night. My mother always bought maple-flavoured syrup made with sugar. This family always bought corn syrup. I still remember eating a plateful of pancakes with syrup and feeling hungry before I went to bed that night. The hosts even told my parents that I had an incredible appetite for such a little tyke. Yet, that was the only time I was ever hungry after eating twice as many pancakes as I would have done at home. The only difference was the type of syrup.

Conclusion

If Americans were still eating sweets of any kind made with sugar, they would be of normal weight.

Corn syrup is making people fat. So are other starches. Anyone who wants to lose weight should try a low-carb high-fat — LCHF — eating plan.

For more information on the ketogenic diet, please read the following. If you are in any doubt or under regular care of a physician, seek medical advice first:

Does low animal fat intake increase hostility or depression? (a hypothesis)

Fat and a balanced mind (low-fat diets can imbalance serotonin and nerves)

Depression and anxiety: the perils of a low-fat, high-carb diet

High carbohydrate intake and depression

Depression and cancer: more evidence against a low-fat diet

High carbohydrate intake and depression (also epilepsy related [Dr Richard A Kunin’s paper])

High-carb, low-fat diets might cause Western diseases (cancer related)

Low-carb diet a migraine remedy

Low-carb, high-fat diets regulate testosterone, cholesterol levels

Ketogenic diet and gout risk — tips for success

Resources for the ketogenic diet

Low carb high fat diet primer

Dietary advice: the old ways are the best (my own story on the ketogenic diet)

High carb, low fat diets bad for brain health — and moods? (more testimonials for the ketogenic diet)

Whilst I cannot guarantee that my original correspondent on the conservative website will see this, I hope that others might find this of interest.

Churchmouse Altarmousefinal copyThis stuffed squid recipe is perfect for those on low carb high fat (LCHF) eating plans.

It goes very well with my prawn truffle sauce spooned on top.

My better half told me this was a ‘restaurant quality’ dinner. I hope you have a similar experience.

British readers can buy one of the seasonings, Old Bay, here.

Notes:

1/ Ask your fishmonger to prep the squid for you.

2/ Make half a recipe of prawn truffle sauce and reserve the rest of the stock as well as any squid juice (not ink) for poaching the squid.

3/ You can have two squid courses. Start with the tentacles and any flat pieces then serve the stuffed squid as a main course.

4/ If you want to serve the tentacles and odd pieces pan-fried, dunk everything in beaten egg white (or coat thinly with mayonnaise) then dredge in a few teaspoons of well seasoned flour. Let the squid pieces sit in the dredge for 45 minutes to 1 hour so that the coating sticks. In a small frying pan (slightly larger than an omelette pan), heat 2 – 3 tbsp of duck, goose or pork fat until hot (the fat should be bubbly on the bottom). Carefully place the squid pieces in the pan, working away from yourself to avoid grease splashes. Make sure there is adequate space between the pieces so that they fry evenly. Turn them over after 2 or 3 minutes to fry on the other side. Drain well and serve.

Churchmouse’s stuffed squid

(prep time: 15-20 minutes; cooking time: 10 minutes; serves 4)

Ingredients:

4 squid for stuffing

1/2 a recipe of prawn truffle sauce

1/2 pint (0.25 l) of prawn stock and any squid juices (not ink)

2 red bell peppers, finely diced

8 spring onions (scallions), finely sliced

1 tsp garlic paste or 1 clove crushed garlic

2 level tbsp flour

2 level tbsp butter

Salt, cayenne and Old Bay to season

1 – 2 tbsp double (heavy) cream

2 – 3 tsp baked panko-style breadcrumbs (optional, but they add crunch)

8 toothpicks

Method:

1/ In a small omelette pan, cook the butter and flour over medium heat. Stir it so it becomes a roux.

2/ Add the spring onion pieces to the roux. Stir and cook for 2 minutes.

3/ Add the garlic and diced red pepper to the onion roux. Stir well and cook for 4 – 5 minutes until al dente.

4/ Season the vegetable mix with salt, cayenne and Old Bay to taste and stir well. Add the cream and stir again. If the mix is too solid, add a teaspoon or two of the seafood stock and stir.

5/ Remove the vegetable mix from the heat and let cool for 15 – 20 minutes.

6/ Once the vegetable mix has reached room temperature, take a dessert spoon (larger than a teaspoon but smaller than a tablespoon), open the squid and carefully spoon in the mix. Using clean fingers, gently press the mix as far down the squid as possible.

7/ Take care not to tear the squid pockets when filling them. Also, do not overstuff, just ensure there is a decent amount from top to bottom so they are slightly rounded. Secure each squid at the top with two toothpicks. Set each aside on a plate or cutting board.

8/ Start heating the prawn truffle sauce in a separate saucepan.

9/ Put the prawn stock and any squid juice in a large, frying pan preheated over medium heat. Carefully place the squid in the pan. The liquid level should reach halfway up the squid.

10/ Poach the squid for 4 – 5 minutes on each side. Carefully turn the squid over with a large serving spoon to cook the other side.  In both cases, check after three minutes to make sure the squid have not split. (My first few squid split when I started stuffing them several years ago, but I keep a closer eye on them now and they are perfect.) In case of any splits, turn down the heat, either turn over to cook or quickly remove to a plate, split side up. A small split sometimes closes by itself.

11/ During the last few minutes of cooking the squid, make any seasoning adjustments to the prawn truffle sauce, if necessary.

12/ Carefully lift the squid out of the pan, allowing any excess liquid to drip off. Place the squid on the plates — one per person — and remove the toothpicks. Spoon the sauce over the squid. Top each one with a teaspoonful of warm, baked breadcrumbs for a bit of crunch.

13/ Long green beans drenched in garlic butter make an elegant accompaniment served on the other side of the plate.

(Graphics credit: Dr Gregory Jackson of Ichabod)

Yesterday’s post introduced the low carb high fat (LCHF) way of eating.

It is preferable to consider LCHF not as a short-term fix ‘diet’ but rather as a nutrition plan that you and your family can adopt — just as you might have adopted a high carb low fat one!

If you missed my previous posts over the past several days, it might be worth your time reading them to better understand the science behind it: debunking popular breakfast myths, why overweight individuals not to adopt an athlete’s diet, why we should not graze and a case against grazing.

The primer below is not exhaustive. Information comes from my own 18-month experience as well as insights from other LCHF followers and medical practitioners.

N.B.: In order to avoid fatigue or light-headedness from Day 1, you will need to consume around a litre of water a day and use good quality salt (e.g. sea salt) on your food. A potassium supplement, e.g. Lo Salt, is also highly recommended. I season everything with sea salt and Lo Salt.

Also, avoid falling into the trap of ‘gluten-free’ and soy-based foods (e.g. tofu). Most of these have large amounts of carbohydrate and are not on the LCHF plan.

1/ I’m afraid of fat, especially getting fatter by eating more of it.

Over the past few years, the medical establishment — which had previously advised against fat — now recognises it has a beneficial part to play in a healthful diet.

The problem Westerners have is eating a lot of carbohydrates which make us hungry a few hours later. This has made us fatter, not thinner, especially as more of us are obese and running the risk of Type 2 diabetes.

By turning the tables — eating more fat and far fewer carbs — we are actually helping to regulate insulin. Dr Mercola says (emphases mine):

Sugar (and foods that convert into sugar, such as grain carbohydrates) is the main culprit in causing you to become leptin-resistant and should clearly be avoided, especially if you’re struggling with excessive hunger.

Dr Lyle Macdonald explains:

insulin is a storage hormone released in response to eating with carbohydrates having the largest impact on insulin secretion, protein having the second greatest and fat having little to no impact on insulin secretion. Insulin sensitivity refers to how well or poorly the body responds to the hormone insulin. Individuals who are insulin resistant tend to have higher baseline insulin levels because the body is releasing more in response to try and overcome the resistance.

Note that fat has little to no impact on insulin secretion. This is why overweight people may well benefit from the LCHF.

On another practical level, fat increases satiety. Many LCHF followers find they consume fewer calories by increasing fat when compared with their former high carb low fat diets.

2/ How much weight can one lose on LCHF? Can you give me a real-life example?

The heavier one is, the more weight one will lose. The heaviest will also lose weight quicker than those who are in a normal weight range.

There are many examples that can be found by looking for LCHF successes in a search engine. A specific case is that of Tommy, a Scandinavian who has lost an incredible amount of weight — nearly 200 pounds in the first two years. The before and after pictures are amazing! His website, Eat Low Carb High Fat has many helpful posts on physiological markers and what he eats.

3/ How can I get a variety of fats?

Many LCHF followers rely a lot on butter. To it, one can add garlic, herbs and different kitchen seasonings (Old Bay, poultry seasoning). You can do this as you cook or make a compound butter in advance. Take a slightly softened stick or brick of butter, put it in a bowl and mix whatever you like into it so that you have it over the course of a few days. You can put it into a smaller container (with lid) or roll the butter into a sausage shape which you can then wrap in cling film (plastic wrap).

Clarified butter — known as ghee in the Subcontinent — is also an excellent cooking fat.

Cream is useful, especially in sauces or in a shot of coffee, known as ‘bullet-proof’. If you’re buying milk, make sure it is full-fat. Milk has a fair amount of carbs, so use it only in hot beverages and when thinning cream sauces.

Olive oil is great for salad dressings and light sautéing. It cannot withstand high temperatures, however.

Animal fats are highly recommended. I keep a variety of them in the refrigerator from our roasts and pan fried meats, e.g. duck. After cooking, I drain the fat into a glass jar (with lid) by type of fat. At any one time I have jars of the following fat: chicken, duck, goose, beef and pork. Chicken and duck fats are flavoursome to mix with butter when sautéing vegetables. Goose, beef and pork are for on the occasions when I make Yorkshire pudding, which needs fat that can withstand very high heat. To make light gravies to go with the roasts, keep a tablespoon of the fat in the roasting tin to make a roux (add a tablespoon of flour to mix and cook with the fat as a sauce base). Then add meat stock and seasoning gradually to the roux to make the sauce — a slightly thicker form of jus.

Pork crackling makes an excellent accompaniment to roast pork loin and a nice snack before dinner. I save chicken skin, salt it, flatten it and heat it in the oven for 10 minutes to crisp it. Served on the side with hot chicken, it melts in the mouth and is surprisingly filling! If I’m running low on chicken, I eat the skin with a small amount of meat and give the lion’s share of protein to my better half.

Full-fat mayonnaise is a must. Use it generously with tuna, chicken, egg or coleslaw.

Peanut and almond butters are great with vegetable sticks at lunch or as a daytime snack.

4/ How can I be sure I’m getting the right proportions of fat, protein and carbs?

Martina from the UK, author of The KetoDiet Blog, has a helpful calculator for macros — macronutrients — that are scaled to individual requirements. This determines the proportions you should be eating each day. The calculator page also has useful examples to illustrate how they work.

Most people with experience of this and similar calculators say to select ‘sedentary’ unless one has a daily workout regime.

You might have to rerun the calculator as you lose weight and reach a subsequent stall or plateau.

Initially, I was successful on a 60% fat, 35% protein, 5% vegetable with some flour (sauce) carb for the first few weeks. After my first month, I then had to recalculate my fat and protein amounts, so that I now eat 55% fat and 40% protein with 5% carb.

Weighing portions in the beginning will help to ensure that they are accurate. After 18 months, I no longer do this.

5/ It sounds as if you don’t count calories, then.

No. I weighed everything instead. Now I judge by eye. After a few months, you’ll see and feel (fullness) exactly what you need to eat to achieve satiety. Again, because of the dominance of fat, you’ll consume fewer calories.

6/ Did you throw out all the carbs in your house in the beginning?

No. I only threw our remaining pasta, rice and couscous a few weeks ago!

I went cold turkey whilst my better half continued to eat bread and potatoes for a few more months. We have both been on LCHF (ketogenic diet for us) for over a year, so it seemed a waste of space to keep these carbs around. As much as I dislike throwing food away, the opened packets were only taking up space. None of it appeals to us anymore!

I still make bread, but primarily for bread crumbs, used sparingly just to give crunch to soft vegetables. My better half needs a few more carbs than I do, so I make bread once every fortnight now on average. We have Yorkshire pudding much less often. For our birthdays, Christmas and Easter I make a fruit crumble or ground nut-based daquoise (e.g. Opéra, Yule Log).

7/ What sort of foods will provide both protein and fat?

Always buy fatty meats and eat the fat after cooking. When pan frying duck breasts, render the skin before flipping the breast over to cook on the lean side. Delicious.

Bacon and good quality sausages (85% meat minimum) are excellent sources of protein and fat. Premium hot dogs are perfectly keto.

Fatty fish — salmon, mackerel, sardines — provide a lot of Omega 3 and satiety.

Cheese is outstanding. Not only does it give you the excuse to eat different varieties but it is also very filling. A thin wedge of brie after dinner often suffices.

Don’t forget the versatile egg. Enjoy it scrambled, poached, hard boiled, devilled or in an omelette.

8/ What should I avoid?

Beware of eating too much dark (70%+) chocolate. It has carbohydrates, so only have a square or two now and then unless you are fully in maintenance.

Nuts are another potential downfall. Too many almonds or peanuts can cause a stall or weight gain. A handful — 15 whole nuts — really is the maximum one should have per day if one is not in maintenance. Nuts have a fair amount of carbohydrate. It is easy to underestimate how many we eat.

9/ Can I have a carb cheat day? If so, how soon?

If you’re really into carbs, cut down dramatically to begin with as you increase fat. If you can’t do without toast or breakfast cereal, have one or the other — and only a small portion. Give up every other carb.

If you’re not losing weight within the first fortnight, give up carbs altogether.

Most LCHF followers will experience a taste bud change once they go cold turkey. Carbs and sugars lose their appeal within a few weeks.

If you’re entering the LCHF plan anticipating your first cheat day, you’re unlikely to succeed long term. One way around this is to think of something fatty and appetising every time you want something carby. If you’re really hungry, have a fatty snack. Otherwise, imagine you’ve just eaten a fatty snack and you now feel full. Mind over matter.

10/ What are my chances of reaching a stall? What do I do?

Nearly everyone, reaches a stall — plateau — at some point on LCHF. This is especially common for those with the least to lose. However, this is common to every diet plan, which is why so many of us fail.

Considering LCHF as a long term way of eating helps to give us patience and endurance in reaching our goal.

LCHF is a gradual plan for those of normal weight. The heaviest have the most dramatic results. For everyone nearing their goal weight, the last several pounds take the most time to shift.

In general, it is essential to remember that after decades of an excess of carbs, the liver, pancreas, gall bladder and thyroid need time to readjust. This might take months or a few years.

Speaking personally, it was normal for us to have plateaus every few weeks. Sometimes we lost nothing. Sometimes we lost inches instead of pounds. Some pound loss came easier than others. There seems to be a step-change, including stall, every several weeks with progress at the end. Whilst my better half is now in maintenance thanks to a historically better metabolism and insulin sensitivity, I still have several more pounds to lose.

Those who are concerned can re-evaluate their macros, keep a food diary, weigh portions to guard against underestimating and increase gentle exercise. Some people find it helpful to reduce consumption of cream and milk.

Martina has an excellent précis of LCHF which serves as a useful reminder of what we should be doing. She also has an encouraging follow-up post. The readers’ comments and Martina’s responses are also enlightening.

Don’t give up! The benefits will come sooner or later! Internal clean-up is a big part of LCHF. Often, that stage has to be completed before the rest follows.

11/ You said ‘gentle exercise’.

LCHF does not work well for sedentary types who suddenly engage in intensive exercise to break a stall. Some actually gain water weight.

It is much better to get one’s exercise from moderate walking, cycling, housework, DIY or gardening.

That said, fitness enthusiasts who have already adopted their regime can do well if they choose to embark on LCHF.

12/ In what other ways can LCHF benefit us?

Diet Doctor has over 100 articles with case studies on the ways LCHF can benefit us. These cover a variety of health issues from acne to cancer to Parkinson’s.

I got interested in keto because it seemed that there should be a diet which can help with low moods and irritability. What I found amazed me. Related posts are on my Recipes/Health/History page under ‘Low-fat, high-carb diets increase depression‘:

Does low animal fat intake increase hostility or depression? (a hypothesis)

Fat and a balanced mind (low-fat diets can imbalance serotonin and nerves)

Depression and anxiety: the perils of a low-fat, high-carb diet

High carbohydrate intake and depression

Depression and cancer: more evidence against a low-fat diet

High carbohydrate intake and depression (also epilepsy related [Dr Richard A Kunin’s paper])

High-carb, low-fat diets might cause Western diseases (cancer related)

Low-carb diet a migraine remedy

Low-carb, high-fat diets regulate testosterone, cholesterol levels

Ketogenic diet and gout risk — tips for success

Resources for the ketogenic diet

Dietary advice: the old ways are the best (my own story on the ketogenic diet)

High carb, low fat diets bad for brain health — and moods? (more testimonials for the ketogenic diet)

In closing, best wishes to all those who are undertaking LCHF or are embarking on such a journey.

Final words from me before exploring recipes in future posts: low carb high fat eating is the most fun you’ll ever have with food!

Yesterday’s post made a case against grazing — consuming several small meals a day.

My previous posts on diet debunked popular breakfast myths, warned overweight individuals not to adopt an athlete’s diet and discussed why we should not graze.

As obesity and Type 2 diabetes have been at high levels in the West for 30 years and show no signs of abating, it is useful to find out why this phenomenon has been occurring.

With regard to diet, we wonder why our blood sugar levels aren’t going down whilst we feel hungry at the same time. This post will explore the subject in greater detail and what to do.

Insulin and leptin

Too few of us, especially those trying to lose weight pay enough attention to the role of insulin and leptin in the diet. That is because most of us do not realise how insulin affects each of us.

Dr Mercola’s article on frequent meals and metabolism has a good explanation of the role of insulin and leptin on metabolism. Excerpts follow. Emphases in bold are the original; those in purple are mine:

Consuming junk food and fast food that does not feed your body the nutrients it needs will often lead to eating far more calories than you need simply because your insulin- and other hormonal balances are out of whack …

Metabolism can be roughly defined as the chemistry that turns food into life, and therefore insulin and leptin are critical to health and disease.

Insulin works mostly at the individual cell level, telling the vast majority of cells whether to burn or store fat or sugar and whether to utilize that energy for maintenance and repair or reproduction.

Leptin, on the other hand, controls energy storage and utilization, allowing your body to communicate with your brain about how much energy (fat) the cells have stored, and whether it needs more, or should burn some off.

Controlling hunger is one way that leptin controls energy storage.

Hunger is a very powerful and deep-seated drive that, if stimulated long enough, will make you eat and store more energy. The only way to eat less in the long-term is to not be hungry.

It has been shown that as sugar gets metabolized in fat cells, fat releases surges in leptin. It is believed that those surges result in leptin-resistance, as well as insulin-resistance.

Once you become leptin-resistant, your body loses the ability to effectively and accurately convey hunger signals, resulting in feeling hungry much of the time, even though you’ve consumed sufficient amounts of calories.

Sugar (and foods that convert into sugar, such as grain carbohydrates) is the main culprit in causing you to become leptin-resistant and should clearly be avoided, especially if you’re struggling with excessive hunger.

The objective in changing diet is to become insulin- and leptin-sensitive. Many of us who have problems controlling hunger from an overload of carbohydrates — including sugar — are insulin- and leptin-resistant. We want to move from resistance to sensitivity.

Dr Lyle Macdonald at Body Recomposition explains more in his article ‘Insulin Sensitivity and Fat Loss’ (emphases mine):

insulin is a storage hormone released in response to eating with carbohydrates having the largest impact on insulin secretion, protein having the second greatest and fat having little to no impact on insulin secretion. Insulin sensitivity refers to how well or poorly the body responds to the hormone insulin. Individuals who are insulin resistant tend to have higher baseline insulin levels because the body is releasing more in response to try and overcome the resistance.

Becoming insulin-sensitive through diet

Note that Macdonald says carbohydrates cause the body to secrete the highest amount of insulin. Protein comes next. Fats, on the other hand, have no impact on insulin.

I cannot emphasise that enough.

Fats are the key to resolving insulin-resistance so that one becomes insulin-sensitive.

Granted, everyone is slightly different which means that insulin resistance and sensitivity vary, some of that being dependent on our genes. However, Macdonald says:

high insulin secretion tends to make people eat more.

This is why obesity and Type 2 diabetes are often discussed together — and why many of these diabetics are overweight.

Macdonald mentions two studies which showed that insulin-resistant women lost weight once they began reducing their carbohydrate intake.

Although the studies do not appear to mention a move from insulin resistance to sensitivity because that was not their objective, in time, if they maintained the eating plan, the dieters would probably have succeeded in regulating their insulin secretion.

It would be complicated and expensive to have all the blood tests necessary to diagnose insulin sensitivity or resistance, not to mention secretion. However, Macdonald offers these basic questions which can help us determine if we are sensitive or resistant:

  1. On high-carbohydrate intakes, do you find yourself getting pumped and full or sloppy and bloated? If the former, you have good insulin sensitivity; if the latter, you don’t.
  2. When you eat a large carbohydrate meal, do you find that you have steady and stable energy levels or do you get an energy crash/sleep and get hungry about an hour later? If the former, you probably have normal/low levels of insulin secretion; if the latter, you probably tend to over-secrete insulin which is causing blood glucose to crash which is making you sleepy and hungry.

Those who are insulin-resistant and often hungry would do well to adopt:

a diet lower in carbs and higher in fat (don’t forget that protein can raise insulin as well) …

What to do

The low carb high fat (LCHF) diet is what it says. Reduce intake of carbohydrates dramatically and replace that deficit with fat.

What to avoid

Carbohydrate-heavy foods to eliminate or reduce include potatoes, sweetcorn, chickpeas, lentils, rice, pasta, breads, pastry, oatmeal, breakfast cereal, breakfast bars, sugar, chocolate bars, sugary soft drinks, sweet smoothies and — crucially — fruit.

What to increase

Replace the carbohydrate deficit with fats: butter, olive oil, mayonnaise, cream, cheese and animal fat (chicken, duck, goose, pork and beef).

Exclude low-fat spreads and dressings as well as margarine.

With regard to coconut oil, be careful. Those who are unaccustomed to eating it and incorporate it in their diets might find it disagrees with them, resulting in a rush to the bathroom. Start with small amounts and adapt your body slowly.

Fatty proteins

Buy fatty meats, including well-marbled steaks and chicken with skin.

Bacon, pork sausages and quality hot dogs are excellent no-brainer meats.

Pork roasts with a good layer of fat are also highly recommended.

Oily fish, such as salmon, mackerel and trout, are excellent as is any other fish and seafood, particularly when combined with a buttery or creamy sauce.

Water and salt are vital

In order to avoid fatigue, especially in the beginning, you will need to consume around a litre of water a day and use good quality salt (e.g. sea salt) on your food. A potassium supplement, e.g. Lo Salt, is also highly recommended. I season everything with salt and Lo Salt.

Alcohol and soft drinks

Speaking of drinks, beer is out. Spirits, especially clear ones (gin and vodka), are fine. Dry wine is also good.

Diet soft drinks can be drunk in moderation. They are not a replacement for water.

Vitamin supplements

SpouseMouse and I have always taken a daily multi-vitamin and continue to do so.

Dr Mercola says that Vitamin D3/K2 supplements can also help to keep the body healthy. I take a D3/K2 supplement daily in liquid (drop) form. D3 and K2 are particularly necessary for people who have compromised immune systems.

Our household

I follow the ketogenic eating plan which calls for 20% or less of net carbohydrate intake a day. I try to keep it well below 20% altogether. SpouseMouse is more insulin-sensitive than I am and requires 30% to 40% in carbohydrates a day. Our protein intake is roughly 35% of our daily intake and fat comprises the rest — proportionally more for me and less for my better half.

The only starch we have in the house is T55 bread flour. I make bread for SpouseMouse once a week along with the occasional Yorkshire pudding.

I sauté vegetables in butter, duck fat or chicken fat. An alternative for the winter is to cook vegetables and top them with homemade cream sauces, often with cream cheese, which I top with grated cheese and bake at a low temperature (150° C or 325°F) for 15 minutes until the gratin melts.

Meal suggestions

The list below is hardly exhaustive but gives an idea of what LCHF followers eat.

Breakfast can be comprised of sliced ham, bacon and fatty (often smoked) fish, eggs (any way you like) as well as cheese.

Lunch can include the above as well as avocados, salad leaves, bell peppers and celery with a full-fat dressing. Some tomatoes and carrots are all right, but not too many as they are higher in carbs than green vegetables. Nut butters, particularly almond or peanut, or cream cheese with vegetable strips is a good combination. A cheese plate is a filling and tasty option. Fish and meat are superb proteins. Egg, chicken or tuna mixed with lots of mayonnaise are satisfying and easy to prepare options.

A small snack of a handful of almonds or peanuts is fine.

Dinner should be comprised of fatty meats or fish. Lean versions of either are also excellent sautéed in fat. Vegetables can include the aforementioned suggestions for lunch along with cooked ones such as green beans, broccoli, aubergines, courgettes (zucchini), cauliflower, brussels sprouts, all of which should be topped with butter or cream sauce.

A square or two of dark chocolate — 70%+ — makes a satisfying dessert substitute. A cheese plate is a better alternative and, for many, more filling.

These suggestions show how fat can be incorporated into the daily diet in place of carbohydrates.

Results

The LCHF is not an immediate silver bullet to combat insulin resistance, but, in time, the body corrects itself. Depending on the level of resistance, this can take six months to a year in most cases. Results will differ according to the individual.

Immediate effects

Within 24 hours, hunger pangs disappear. LCHF followers experience higher energy, calmer moods and better concentration. Sluggishness is gone.

After three to four days, the LCHF dieter will need to urinate copiously over a period of several hours. This will result in water weight loss of a few pounds. Heavier individuals will experience more loss than those of normal weight. Keep drinking water, however, as this is the time when fatigue or light-headedness can set in.

After one week, fat loss begins.

A fortnight later, pulse rates begin to normalise, clothes fit better and inches are lost.

After three weeks, skin becomes smoother and clearer. Dull roughness disappears. Expect compliments.

Intermediate results

As the body adapts, weight loss stalls can occur although inch loss continues.

Many people become frustrated after three to six months and think that nothing is happening when they get on the scale. However, tracking regular measurements of the waist, belly, hips and thighs will demonstrate that the body is reshaping itself into a slimmer, more attractive one. For this reason, a tape measure is more useful than a scale much of the time.

Men have an easier time losing weight than women. Post-menopausal women have the hardest time, although they, too, will still experience overall loss in inches and flatter tummies.

The longest and toughest battle is for internal organs such as the liver, pancreas and thyroid to start functioning properly after decades of abuse, illness or immune system issues. However, in time — depending on the condition — this can normally be resolved.

As an example, an article on Hashimoto’s disease states:

there is no doubt that what goes through your digestive system has a huge impact on your immune system. Huge.    

One Hashimoto’s sufferer, Carrie Vitt, regained her health with a gluten-free diet. It took her several years, but she is now symptom-free.

I digress, but this goes to show how a proper diet combined with patience and persistence can bring about lasting and beneficial physical improvement — without drugs!

Conclusion

Whilst this is not meant to constitute medical advice, overweight people with no serious health issues might wish to try an LCHF diet not only for weight loss but also for better overall health.

Starting now — well before the holiday season — will help to adapt the body and mind to a new way of eating, not meant for the short-term but the years ahead.

There’s a question mark in the title only because we have no significant proof yet from a majority of our experts in the medical community.

However, I have been on the ketogenic diet — eating plan — for well over a year now and am enjoying it. Even with an extremely stressful month-long episode six weeks into it, I still woke up feeling as if I could tackle what lay ahead of me on those days. Not perfectly, admittedly, but with much less emotional upset than expected.

Thank goodness.

The physician and author, Dr Michael R Eades, might be on some of your online reading lists. In a post from 2006, he explores reasons for the Western rise in obesity.

We are told we are fat because we don’t eat the right kind of foods and don’t exercise enough. Around the time Eades wrote this in the US, we in the UK were receiving constant announcements from the Labour government’s Health ministers saying we should be breaking out into a sweat every day. Gentle housework and 15-minute walks wouldn’t cut it, they told us.

With that in mind, it was interesting to read what Eades had to say nearly ten years ago:

What if cutting calories and running yourself ragged exercising don’t work because, well, you’re not overweight because you eat too much and don’t exercise enough?

He then cites a paper saying that any beneficial link between diet and exercise is ‘largely “circumstantial”‘ and cannot be applied to every person. Factors which also need to be studied include lack of sleep, smoking cessation, pesticides on fresh food which can harm our endocrine systems, demographics and so forth.

The one that caught my eye, and the only one Eades did not debunk, was the following one (emphases mine). It concerns the benefits of a high-fat diet on the brain whilst reducing carbohydrate consumption and prescription medicines. MD — mentioned below — is his wife, Mary Dan Eades, also a physician:

Factor # 5: Pharmaceutical iatrogenesis

Iatrogenesis, the causation of a state of ill health brought on by medical treatment, is indeed a cause of weight gain. Multiple drugs commonly given for a host of medical disorders have weight gain as a side effect. Antihistamines, antidepressants, anticonvulsants, blood pressure medicines, diabetic medicines, steroid hormones, mood elevators, birth control pills–all have been shown to cause weight gain to varying degrees. The authors make the case that there has been a huge increase in the number of people taking these drugs–especially the antidepressants and mood elevators–over the same time period as the obesity epidemic has been developing. Once again, I think there may be other factors afoot that cause both.

MD and I have always noticed that at the same time the bookstore shelves were laden with books on low-fat dieting they were also filled with books on depression. I don’t think this is a coincidence. The brain is a fat dependent organ composed primarily of fat. An enormous number of scientific studies have shown that people who don’t get enough fat nor enough cholesterol tend to develop depression and/or anxiety. MD and I have seen this first hand. Ten or so years ago we participated in a clinical study for an anti-obesity drug that worked by inhibiting fat uptake in the gut, thereby putting patients on a low-fat diet irrespective of how much fat they actually ate. One of the big problems we had was that the patients on the drug became depressed, anxious, or both, went to their regular doctors and were given prescriptions for antidepressants or anxiolytic medications. One of the guidelines of the study was than anyone who took one of these medicines was disqualified from continuing. We fought this problem continuously, so we know that low-fat diets cause mental problems. During the past 20 years the average fat consumption has fallen about 25%-30% as the obesity epidemic has surged, leading, I’m afraid, to a whole lot of antidepressant prescriptions. I would have to say that the increased drug use doesn’t cause obesity, but is, like the obesity epidemic, a consequence of a sea change in the American diet.

What about antihistamines, blood pressure medicines, anti-diabetic medicines? Same thing. When people get fat, they have more allergies, asthma, high blood pressure and diabetes. The dietary changes cause both the obesity and the attendant problems requiring drug treatment.

So, we have the real probability that high carb, low fat diets can affect our moods. We also know that our brains need fat in order to function properly. Lack of fat can produce moodiness and depression, which leads to prescription drugs that can also cause weight gain.

I agree with mechanical engineer Lori Miller who has also been on the low carb, high fat diet for a year when she wrote a post about it in 2011, ‘Lousy Mood? It Could Be the Food’, excerpted below. Details about the book cited can be found here:

Since I started my low-carb, saturated fat fest almost a year ago, the old problems evaporated. I can’t remember the last time I needed to stop and regroup. I believe the high-fat diet has had everything to do with that.

Psychotherapist Julia Ross says in her book The Mood Cure, “… much of our increasing emotional distress stems from easily correctable malfunctions in our brain and body chemistry–malfunctions that are primarily the result of critical, unmet nutritional needs.”(2) She recommends, among other things, eating plenty of good fats and protein. “Our clients generally love the way they can come alive on their omega-3 foods and supplements.” (3) Saturated fat, Ross explains, is needed for vitamin and mineral absorption, skin health, blood sugar control, brain health, and cancer prevention, to name a few things. It’s an important part of her cure for patients with eating disorders(4), something Dr. Robert Atkins had been doing for years.(5) Ross also recommends eating enough food and including vegetables.(6) (I noticed years ago that eating a salad improved my mood.)

Sweets and white flour starches tie for bad mood foods #1 and #2 in Ross’s book.(7) (Remember my Coke & bagel diet?) Dishonorable mentions go to skipping meals, low-calorie dieting, low-fat diets (“firmly associated with depression”), low-protein diets (“low energy and low-mood”), and pre-packaged food.(8)

So far, everyone offline — bar SpouseMouse — thinks a high fat, low carb eating plan goes against common sense and, more importantly, received wisdom. ‘I need my breakfast cereal,’ ‘Bread is very important for a nutritional profile,’ ‘We need to eat pulses’, ‘I always feel better after cake’ and so on. All of this is rubbish. A small amount of carbohydrate from green and cruciferous vegetables will suffice.

In February 2015, Time magazine came out with another article — they published two in 2014 — saying that low-fat guidelines should never have been issued or encouraged in the 1970s.

Alice Park’s article explores a study done in Scotland which states:

Reporting in the journal OpenHeart, Zoe Harcombe, a researcher and Ph.D. candidate at University of the West of Scotland, and her colleagues say that the data decisionmakers had in 1977, when the first U.S. guidelines on dietary fat were made, did not provide any support for the idea that eating less fat would translate to fewer cases of heart disease, or that it would save lives

The problem, as Harcombe notes in her study, is that advice was “arbitrary. The 30% wasn’t tested, let alone proven,” she says. In fact, some data even contradicted the idea that the fat we took in from food had anything at all to do with the artery-clogging plaques that caused heart disease. In one study, men who were fed copious amounts of high-fat foods (butter, eggs, portions of cream and the like) did not show higher levels of blood cholesterol, suggesting that the fat from food had little to do with the cholesterol circulating in the body and produced by the liver

The American Heart Association, fortunately, is taking this on board for their own revised recommendations.

The most important thing is to eat whole foods, not necessarily organic, but helpings of fatty meats and oily fish that you need to prepare at home. Cook a selection of vegetables or prepare a salad to accompany them. Leave out the potato, pasta, rice, couscous. Add plenty of butter or cheese and cream to sauces. Sauté in duck or goose fat, lard or beef dripping.

Also: Drink lots of water during the day — three or four large glasses. Salt your food, and supplement potassium with Lo Salt or Lite Salt. Otherwise, you might well end up feeling weak and faint.

Not only will your hunger pangs disappear for hours on end, but your mood and outlook will improve immensely.

As for exercise? Only the gentlest will do, as a hard workout may cause the body to retain water. In any event, when there is no weight loss, one will lose inches.

Disclaimer: This is not intended as blanket medical advice. When in doubt, check with your doctor.

More of my posts on the ketogenic diet can be found on my Recipes / Health / History page:

Low-fat, high-carb diets increase depression

Does low animal fat intake increase hostility or depression? (a hypothesis)

Fat and a balanced mind (low-fat diets can imbalance serotonin and nerves)

Depression and anxiety: the perils of a low-fat, high-carb diet

High carbohydrate intake and depression

Depression and cancer: more evidence against a low-fat diet

High carbohydrate intake and depression (also epilepsy related [Dr Richard A Kunin’s paper])

High-carb, low-fat diets might cause Western diseases (cancer related)

Low-carb diet a migraine remedy

Low-carb, high-fat diets regulate testosterone, cholesterol levels

Ketogenic diet and gout risk — tips for success

Resources for the ketogenic diet

Dietary advice: the old ways are the best (my own story on the ketogenic diet)

In breezing through The New York Times, a few health headlines from the past month caught my eye.

Allergies connected to dishwashers?

A study published in the journal Pediatrics shows a correlation between allergy prevalence and dishwasher use.

Washing by hand, the researchers say, could be better.

As always, check the readers’ comments which proved to be a mixed bag. Some who grew up in homes where Mum washed the dishes by hand still had allergies. Some who grew up with dishwashers were allergy-free.

SpouseMouse and I did not grow up with dishwashers in our parental households nor do we have one now. Neither of us has allergies, but who knows?

Possible things to check out with regard to dishwashers — thanks, NYT readers — are filters which need to be replaced, too much detergent and film on plates or glasses. Any one of these, or a combination thereof, might trigger allergies or skin conditions.

Feed peanut butter to infants?

Speaking of allergies, should mothers feed their infants small amounts of peanut butter in order to prevent a possible nut intolerance?

An editorial in the New England Journal of Medicine says they should. Dr. Rebecca S. Gruchalla of the University of Texas Southwestern Medical Center and Dr. Hugh A. Sampson of the Icahn School of Medicine at Mount Sinai in New York City point to a study done in London in 2008 among Israeli and British Jewish infants. The Israeli children ended up with fewer cases of peanut allergies because their mothers fed them small amounts of a local peanut product when they were only a few months old.

A more recent study based on this looked at infant reactions to peanut protein. Some mothers were told to give their infants a peanut product and other mothers were told to avoid it. The children were tested weekly for an allergic response.

Of those consuming a prescribed peanut product, only 10.6% developed an allergy by the age of five. By contrast, 35.3% of children not eating the peanut product were allergic to it.

However, as ever, this is not intended as being a conclusive debate on the matter. More research needs to be done.

NYT readers debated the matter heatedly.

Parents should check with their paediatrician first. However, a small amount of peanut butter mixed in now and then with appropriate baby food might accustom the body to handling it. It won’t work for every baby, but a consultation with the doctor and an allergy test beforehand will confirm if this is the right way forward.

Older generations never had nut allergies. I’d never heard of such a thing until the 1990s. Why is this now such an increasingly common disorder?

Should athletes turn to a high-fat instead of a high-carb diet?

This story is about the ketogenic diet, which my regular readers over the past ten months will recognise from my posts on the subject.

When I was growing up in the 1970s, many athletes were still eating plenty of steak and eggs to build muscle and stamina. That changed during the 1980s. Today, pasta and rice are daily staples.

However, new advice from the Dietary Guidelines Advisory Committee suggests that athletes should also be consuming a certain portion of fatty foods for their metabolism.

Professor Jeff Volek of Ohio State University in Columbus is a co-author of the paper in question. Anyone who is following a ketogenic eating plan will recognise his name as one of the diet’s biggest supporters.

In the opposing corner is Louise Burke, the head of sports nutrition at the Australian Sports Commission. She says there is no proof that a high-fat diet is better than a carbohydrate-based one.

However, both agree that there is no firm definition of a high-fat, low-carb diet.

In reality — and what the article doesn’t say — is that this will vary amongst individuals. Those who are in a normal weight range will need a closer balance between fat and protein whilst severely restricting carbs. Those who are overweight to obese will need much more fat than protein whilst also keeping carbs to 10 – 15g a day.

Clicking on my ketogenic diet link reveals the physical and mental benefits as well as the resources where one can go to calculate specific daily macros — gram ratios — for fat, protein and carbohydrate.

My complaints with the article are twofold. First, it says that ketogenic followers experience days or weeks of sluggishness when adapting. That happens only with inadequate salt and water intake. The condition is known as ‘keto flu’ and can be potentially dangerous. The remedy from Day 1 is more salt (and possibly potassium) on a daily basis, possibly 1.5 to 2x what one was consuming previously. Cups of bouillon are helpful. With regard to water, even a sedentary person on this eating plan must drink one litre per day. Athletes will probably need around three to four litres a day.

I never had keto flu nor has SpouseMouse. My year’s anniversary is coming up in April. SpouseMouse has been on the eating plan for six months.

Secondly, the reporter says that the food is boring. Not at all. In fact, it is the most fun anyone can have with food: all the tastiest things, including fatty meats, are allowed. Nearly everyone also ends up craving more vegetables and salads, too. How can that be a bad thing?

My suggestion is to copy Italian and Indian restaurants by making one basic sauce — cream-based, in my case — and varying it according to vegetable or protein (especially fish). We have creamy leeks, courgettes, onions and spinach nearly every week. With fatty steak, I sauté onions and mushrooms in butter and animal fat (goose, beef dripping or lard). We eat poached eggs in hollandaise sauce without a worry.  Bread, potatoes, pasta — who needs it? We’re quite satisfied — and keto-adapted.

It seems our media do not wish to divert too much from the received Ancel Keys dietary advice dating from the 1950s.

Yes, there are parts of the world where populations do rely heavily on carbohydrates. However, they are surviving on a subsistence diet and working strenuously during the day. Most Westerners do not fit that category. Most of us are sedentary. Even athletes can balance out their diets quite comfortably.

With any of these headline stories, concerned readers should check with their doctors first. This post is not intended as medical advice.

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