Week 9: Reminder of the Basics, Food Sensitivities, Cholesterol, LDL Particle Size, Sugar and Restaurants

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1 Week 9: Reminder of the Basics, Food Sensitivities, Cholesterol, LDL Particle Size, Sugar and Restaurants Understand that you don t need carbs. Since you ve been eating carbohydrates your whole life, you might be wondering if it s okay to cut them out more or less completely. Surprising as it may be, we don t need to get carbohydrates from our diet! It turns out that our bodies can make all the carbohydrate we need. This is not true of fats, protein, many vitamins, minerals, water or fiber. If we don t get those from our diet, we develop deficiency diseases. Don t be afraid of fat. If you are scared to eat fat you will not succeed on the ketogenic diet. This may be a challenge for some people, because dietary advice has discouraged fat for some time. This is unfortunate. Eating fat, especially healthy ones, will likely not give you heart disease or make you overweight (but eating carbohydrates very well might). Count your carbs. Do not assume that you know the carb content of any food. ALWAYS read the nutrition facts on packaged foods. The net carb content of a food is the amount of total carbohydrate minus the amount of fiber. Drink plenty of water. Ketogenic diets promote water loss, and dehydration can cause fatigue and general malaise. Pay attention to your thirst cues and be diligent about drinking water. Drink more if you re also consuming caffeine, sweating, or living in a hot climate. Supplement sodium and electrolytes. The kidneys excrete more sodium during ketosis. An imbalance of electrolytes can make you feel ill. Make an effort to add salt to foods, and drink high-quality broth when available. Eat when you re hungry and stop when you re full. The diet will get rid of your cravings and greatly diminish your hunger. Let it do its job! Ask for the ingredients in everything. If you re neither a food professional nor a big fan of cooking, then you may not know the ingredients in a lot of the foods you eat that are prepared by others. Just ask. You ll be surprised at how many sauces include flour or sugar or how often fish is lightly floured before being baked, etc. Do you have food allergies or sensitivities? By this week we hope you are feeling a lot better, healthwise. If not, it s possible that you re eating foods that you are allergic or sensitive to. For example, some people can't eat low carb tortillas (made with wheat and soy) or foods made with coconut flour without feeling pretty terrible. Even though they are low carb, they can make some people feel run down and give them an upset stomach. For other people, those foods are fine. Pay attention to your own body. You'll need to do a little tinkering to figure out what works for you. If you get extra gas or feel foggy and tired, take note of what you ve eaten. Is it a common allergen like wheat, soy, or corn? Is it a sugar alcohol? If so, try avoiding that food for a few days and see if you feel better. Week 9 Page 1 of 5

2 Week 9: Cholesterol and LDL Particle Size There are two types of cholesterol, HDL and LDL. Generally, HDL is known as "good cholesterol whereas LDL is bad. However, recent research shows that there are actually two types of LDL cholesterol particles, and only one is harmful to our health. Two types of LDL particles: LDL cholesterol actually consists of two different types of LDL particles: Small LDL particles are the harmful variety as they seem to raise the risk of cardiovascular disease considerably. Large LDL particles are more like HDL cholesterol, meaning they re healthier for you. Multiple studies show that LDL particle size is a more accurate predictor of cardiovascular risk than total amount of LDL (LDL-C), which is how we usually measure cholesterol. As one example, given the same amount of LDL-C, people with the smallest LDL particles (the bottom 25 th percentile for LDL size) had an over 30% higher risk of having health problems like a heart attack or stroke. 1 Cholesterol Testing: If LDL particle size is better than just measuring the total amount of LDL (LDL- C), why is LDL-C still used for clinical care? Measuring LDL particle size is more complicated and expensive than measuring LDL-C. It is now available from most large clinical laboratory testing services, but it costs several times as much as the traditional cholesterol test. LDL particle size is especially important with low carbohydrate diets. The main thing that influences LDL particle size in diet is the amount of carbohydrates you eat. More carbohydrate tends to decrease LDL particle size, creating unhealthier LDL in your body. On the other hand, decreasing carbohydrate intake and lowering insulin resistance tends to make LDL particle size bigger, creating healthier LDL. Therefore, even if total LDL level stay the same, LDL particle size (LDL-P) tends to go up (a good thing!) when you reduce carbohydrates in your diet. This varies from person to person--- so we are measuring LDL particle size to see how this diet affects LDL particle size for each of you. Delish Study cholesterol testing: We sent you lab test results so you can go over your LDL particle size results. There are a few numbers to understand when looking at these reports: LDL-P: Number of LDL particles per unit of blood o Higher LDL-P means you have more LDL particles which will tend to be small (i.e. harmful) o Lower LDL-P is desirable since you ll have fewer LDL particles, meaning they ll be larger in size and therefore healthier LDL Size: Average size of LDL particles o Bigger is healthier Small LDL-P: Amount of small particle LDL per unit of blood o Smaller is healthier We will be repeating this special cholesterol test when you come back for your 3 and 6 month visits, so you will be able to see if your LDL particle size changes with your changes in diet! References 1. Cromwell WC, Otvos JD, Keyes MJ, et al. LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study - Implications for LDL Management. J Clin Lipidol 2007;1: Week 9 Page 2 of 5

3 Week 9: Facts About Sugar About Sugar This week we have several articles about sugar. Here are some excerpts from the National Geographic article: A doctor asked - Why is it that one-third of adults [worldwide] have high blood pressure, when in 1900 only 5 percent had high blood pressure? Why did 153 million people have diabetes in 1980, and now we re up to 347 million? Why are more and more Americans obese? Sugar, we believe, is one of the culprits, if not the major culprit. "... in the 1960s the British nutrition expert John Yudkin conducted a series of experiments on animals and people showing that high amounts of sugar in the diet led to high levels of fat and insulin in the blood risk factors for heart disease and diabetes. But Yudkin s message was drowned out by a chorus of other scientists blaming the rising rates of obesity and heart disease instead on cholesterol caused by too much saturated fat in the diet." It has nothing to do with its calories, says endocrinologist Robert Lustig of the University of California, San Francisco. Sugar is a poison by itself when consumed at high doses. [The conventional wisdom is that] Americans are fat because they eat too much and exercise too little. But they eat too much and exercise too little because they re addicted to sugar, which not only makes them fatter but, after the initial sugar rush, also saps their energy, benching them on the couch. The reason you re watching TV is not because TV is so good, he said, but because you have no energy to exercise, because you re eating too much sugar. The solution? Stop eating so much sugar. When people cut back, many of the ill effects disappear. The trouble is, in today s world it s extremely difficult to avoid sugar, which is one reason for the spike in consumption. Manufacturers use sugar to replace taste in foods bled of fat so that they seem more healthful, such as fat-free baked goods, which often contain large quantities of added sugar." The take away: Stay away from sugar! Luckily, you ve already figured out how! Be aware of sugars hidden in healthy foods (i.e. yogurt, some vegetables). At first you may feel foggy, but once that clears you'll find the food/sugar cravings disappear, as well as the severity of the afternoon energy slump, so stick with it! Week 9 Page 3 of 5

4 Week 9: Navigating Restaurants and Restaurant Menus Restaurants Navigating restaurants can be especially tricky. Different establishments and cuisines prepare foods differently. As a result, a dish from one restaurant may contain few carbs and be safe to eat while the same dish at a different restaurant may be full of carbs and should be avoided. How can you know? Ask! When eating out, here are some tips to help you stay keto: 1. Ask what is in a dish and how it s prepared a. Is that made with any flour or thickener like corn starch or potato? Is the fish breaded? 2. If you re not sure if a sauce has sugar, ask for it on the side that way if it tastes sweet you can still eat the rest of the meal 3. Ask for substitutions a. If you want the chicken or steak that comes with potatoes and broccoli, ask for no potatoes, just broccoli or say I can t eat potatoes, can I have a little salad instead? 1. Note that some restaurants don t do substitutions, but if you say hold the potatoes, just broccoli for me they ll usually be happy to give you extra broccoli, even if they won t substitute a salad or different veggies in the dish b. If you want more variety on your plate, see what veggies come with the other dishes. 1. I ll have the Roasted Chicken but I can t eat potatoes. I see that you have sautéed spinach on the menu; can I have sautéed spinach instead of potatoes? c. Some restaurants might even substitute broccoli for pasta doesn t hurt to ask! 4. Put together a meal from a couple of starters e.g. meat skewers, salad and roasted Brussels sprouts 5. Some restaurants might try to make dishes heart healthy by using little butter or oil in the cooking. If that s the case, consider asking for a side of butter or avocado, or ask them to cook in butter/olive oil so you can get the fat you need Week 9 Page 4 of 5

5 Week 9: Goal Week 9 Goal Keep measuring blood ketones 3 times/week on alternating day in late afternoon or early evening/before dinner. Recommit yourself to staying low carb. When you eat out, practice asking questions about ingredients and making requests for substitutions it gets easier with practice! If you re starting to feel bored with your diet, pick 1-2 new low-carb meals or recipes to try. Check out the Delish website we will be posting some interesting articles. Week 9 Page 5 of 5