The EAT Better Strategy:
If you were to design food to make you fat and sick, you would create ultra-processed food. Ultra-processed food is defined as “formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes” and containing minimal whole foods (Monteiro et al., 2018). In other words, food companies manufacture ultra-processed foods by combining substances extracted from whole foods with additives for taste, texture, shelf life and other factors that enhance the product’s profitability. Strip the food of fibre, load it with sugar and fat, then add salt for taste, and you have food that will
In other words, ultra-processed foods hack our appetite control mechanisms, making us fat in the process. In 2019 Dr. Kevin Hall demonstrated this effect of ultra-processed foods in a study showing that eating ultra-processed foods results in increased calories and weight gain. Hall took ten men and ten women into an in-patient metabolic ward where they were randomly assigned to receive an ultra-processed or unprocessed diet for 14 days followed by another 14 days on the other diet. The subjects were given three daily meals and could eat as much or as little as desired. The two diets matched total calories, energy density, macronutrients, fibre, sugar, and sodium but differed widely in the percentage of calories derived from ultra-processed versus unprocessed foods. Hall’s study found that subjects ate over 500 calories a day more and gained about two pounds of fat in 14 days on the ultra-processed diet. The overeating was almost evenly divided between excess fat and excess carbohydrates while protein intake was unchanged. Not only did subjects eat more ultra-processed foods, but they also ate faster, and bloodwork showed the effects of this diet on essential appetite control hormones. Compared to eating whole foods, subjects showed:
Now you may be thinking, “I get it - it’s junk food, but I don’t eat that much of it.” But collectively, we do: 50% of the calories Canadians consume comes from ultra-processed foods! A recent review found that increased ultra-processed food consumption correlates with higher risks of obesity, heart disease and stroke, diabetes, cancer, frailty, depression, and death.
No association between ultra-processed foods and beneficial health outcomes was found. Compounding these ill-effects is the fact that the more ultra-processed the diet, the less whole foods consumed. And eating lots of veggies, fruits, legumes, and whole grains has been associated with beneficial health outcomes. So how do you recognize ultra-processed foods - here we turn to Michael Pollan’s food rules:
What to eat? Check out these posts in our Eat Better strategy:
Need help applying this to your busy life? Get a personalized nutrition plan to gain clarity and improve your health: The TARGET Nutrition Plan takes a personalized, evidence-based approach to help you make better choices. Our nutritionists assess what you are currently doing and provide you with a personalized plan (including meal plans). Everything you need to transform your diet. The EAT Better Strategy:
Most people find fats confusing. They are technically challenging to understand, let alone keep straight:
And there is so much conflicting ‘information’:
Here is the real skinny on healthy fat, a way to cut through this confusion. Fats are an important part of what you eat. They are the most energy-dense food, providing taste and satiation to your meals. Fats also make hormones, modulate your immunity, support your nervous system, transport fat-soluble vitamins (A, D, E, and K), and form all of your cellular membranes. Some fats are essential (meaning your body cannot make them, so you have to eat them) - these are the Omega 3’s and 6’s. After over 30 years of demonizing fat, dietary recommendations now embrace the choice of healthy fats. So far, so good - but what are healthy fats? This may be the most conflicted question in all of nutrition. Here are some things that almost everyone agrees with:
Quick Technical Guide to Fats Here is our take - it is all about balance: 1. Balance your energy Think about fats and carbs as providing your energy, with protein for repair and maintenance. If you have followed the guide so far, you have built your meals around healthy protein packages and filled out your plates with healthy veggies, fruits, legumes, and whole grains. Now balance out your meal with healthy fats for taste, satiation, and of course, to meet your energy needs. High fat, low carb can work Low fat, high carb can work Medium fat, medium carb can work BUT High fat, high carb won’t work. 2. Balance your types of fats More than half of your fat should be monounsaturated.
Healthy fats come from whole food sources with minimal processing.
Think about the temperature you are cooking at - fats each have a smoke point at which they smoke and burn, yielding harmful free radicals and a burnt flavour. The more refined the oil, the higher the smoke point as the impurities that can burn at a lower temperature get removed. *for refined oils, choose products that explicitly state that they are cold-pressed or expeller-pressed. If the oil does not note how it was processed - assume that it was extracted using chemicals.
Need help applying this to your busy life? Get a personalized nutrition plan to gain clarity and improve your health: The TARGET Nutrition Plan takes a personalized, evidence-based approach to help you make better choices. Our nutritionists assess what you are currently doing and provide you with a personalized plan (including meal plans). Everything you need to transform your diet. The EAT Better Strategy:
Following the first step, "Start with a Healthy Protein Package” your next step in thinking about healthy meals is to load up on veggies, fruits, legumes and whole grains. I know, this might sound like your mother. “Eat your veggies - they are really good for you”, but there are some solid reasons why eating more fruits, veggies, legumes and whole grains makes good sense. Here are 7 reasons why loading up on veggies, fruits, legumes and whole grains makes sense: 1. They taste really good
2. They fill you up
3. They provide sustained energy
Convinced you need to up you improve your game when it comes to veggies, fruits, legumes and whole grains but not sure where to start? Here are 12 quick tips to get you started: 1. Have a fruit bowl
12. Have more plant-based meals
Need help applying this to your busy life? Get a personalized nutrition plan to gain clarity and improve your health: The TARGET Nutrition Plan takes a personalized, evidence-based approach to help you make better choices. Our nutritionists assess what you are currently doing and provide you with a personalized plan (including meal plans). Everything you need to transform your diet. The EAT Better Strategy:
When we eat food - it is broken down into 3 macronutrients:
When we eat proteins, they are broken down into amino acids - essentially the building blocks for new proteins. These amino acids are absorbed into the bloodstream and distributed around the body to tissues that need them. Dietary protein is predominantly used by our bodies for structure and function and not for fuel. The most important functional molecules of the body - hormones, neurotransmitters, enzymes and antibodies are proteins, as are our structural components - muscle, collagen, connective tissue, and even cartilage and bone. Our bodies need 20 amino acids to be able to create all the proteins that we need for life. Of these 9 are considered to be essential - meaning that we need to get them from our diets.
The body is very good at reutilizing amino acids, but is not fully efficient as some amino acids get damage and broken down. As a result, we always need a to eat some new protein just to maintain our existing proteins. Unlike fats and carbohydrates, we cannot store excess protein, so we are also dependent on our diets to provide enough protein for any growth and maintenance. Excess dietary protein, beyond levels required to restore amino acid balance, are degraded, the amino groups are broken down and excreted as urea, creatinine, uric acid or other nitrogenous metabolites. The remaining carbon skeleton which are keto acids are either utilized as fuel in the liver or converted into glucose or more likely fat. That’s right - excess protein will be turned into fat! This may seem surprising given the popularity of high protein diets for weight loss, but there are two other attributes of protein that may explain their benefit in a weight loss diet. First, of the macronutrients, protein is the most satiating. Meals with high protein feel more filling and decrease hunger for a longer period of time, and a result you will consume fewer calories overall. The other attribute of protein metabolism that helps with weight management is the fact that the process to convert protein into fat is inefficient and about a third of the energy in the protein is consumed in the process. A small percentage of protein is used to maintain blood glucose levels during fasted states. This process, gluconeogenesis, runs at a fairly constant rate throughout the day using multiple substrates including lactate (released from muscle glycogen) and glycerol (from fat breakdown). The amount of protein required for this is very small. Summary
How much protein do we need a day? The official answers from the Institute of Medicine are
0.8 g/kg is meant to be the minimum amount of protein we require without becoming deficient. This is the amount of extra protein our body needs for repair and maintenance or as we discussed above the amount of protein that is lost each day as we recycle our amino acids. As we are more active we need more protein - however the best evidence we have is that these requirements are still rather modest - with up to 1.6g/kg for strength/power athletes who are training to gain muscle mass. There is no evidence that we need beyond 2 g/kg per day. From these examples you can see that based on functional requirements the range of protein intake that we need is between 10-17% of our total calories. The average Canadian intake of protein is 17% Bottom Line: most people get enough protein. One interesting observation about how our bodies regulate protein comes from nutritional studies where subjects are allowed to eat as much food as they want. Overall, people tend towards overconsumption of fat or carbohydrates - especially if these come in refined and processed foods without fibre. When it comes to protein, most people will maintain a consistent protein intake of between 15-20% of their calorie consumption. So while our brains can struggle to regulate fat and carbohydrate intake well, we do self regulate on protein. The simple rule that can be taken from this observation is that when it comes to protein - listen to your body. If you feel like you need protein then be sure to increase your lean protein intake. Are there benefits to having more protein? As we have reviewed, extra dietary protein above and beyond our maintenance, growth and repair will predominantly get converted to fat. While this conversion consumes 33% of the caloric energy, if your overall caloric intake is excessive, you are still increasing your fat by consuming too much protein. The extra protein may however increase your satiation and result in the overall consumption of fewer calories in which case it will support weight loss or maintenance. One time where extra protein may be beneficial is your first meal of the day: break your fast with a meal containing at least 20-30 g of protein. This will signal your body that you have nutrients, increasing metabolic rate and will decrease ghrelin (your hunger hormone). If you are consuming more calories from protein than you require you must be careful and consider the package that comes with the protein - what fats, carbohydrates, vitamins, minerals, and other nutrients come along with protein? Eat protein that is low in saturated fat and processed carbohydrates and rich in many nutrients. Is there harm from eating too much protein? For many years, medical textbooks would caution against the harms of too much protein. Specifically the harmful effect of excessive nitrogen excretion from the kidneys. This harm was overstated - as a result the Institute of Medicine guidelines of 10 - 35%. From a longevity standpoint, there is a line of research from Dr. Valter Luongo suggests that high protein consumption is associated with higher rates of cancer, and diseases associated with inflammation. He specifically recommends that adults under age 65 consume no more than 0.7 g/kg and increase to 1 g/kg after age 65. What about protein for older adults? After age 50, we lose muscle mass through a process called sarcopenia, and as our muscle mass decreases we have less internal protein to recycle so the portion that we require from our diets increases. To help prevent, or at least decrease the rate of sarcopenia, the RDA for adults over 50 years is 1 g/kg. Most older adults easily reach this target, and for them the other key to maintaining muscle mass is resistance training. Regular exercise doing body weight exercises or weights has been shown to be the most effective strategy for sarcopenia. If you are like me these answers are hard to translate into our daily lives - what does this mean in terms of actual foods that I am going to eat? Are there differences in protein quality between plants and animal sources? Advocates of eating meat are quick to point out that animal sources are “complete” proteins, meaning that they contain all essential amino acids and fully meet protein requirements gram for gram. The problem with this line of thinking is that plants contain the same 20 amino acids, the origin of the amino acids in animals is originally from plants. Given that both animal and plant proteins are broken down into amino acids before absorption, there is NO fundamental difference between eating meat and eating a variety of vegetable sources of protein. (For more on this read Chana Davis’s excellent blog post: Busting the Myth of Incomplete Plant-Based Proteins. One factor in favour of plant protein over meat is that the plant packages have more micronutrients and fibre without the potentially harmful saturated fats found in meat. What about protein powder? The thing to ask yourself is why? Why are you taking protein powder instead of choosing a healthy whole food protein package? If it is to make your smoothie a satiating substitute for a meal that makes sense. If it is to get more protein into your body it is probably unnecessary. Remember that if you are consuming more calories than you need, that protein powder will get turned into fat! If you are going to choose a protein powder, the advice from Precision Nutrition is pretty good: Stick to the basics.
Summary
(That’s it - it really is that easy) Next - Add veggies, fruits, legumes, whole grains - (7 Reasons Why & 12 Tips How) Why is nutrition so hard to figure out? Why is it so confusing to know how to eat well and be healthy? When did eating become nutrition? This is our attempt to cut through the noise and help you learn foundational habits that will make eating better easier. The EAT Better Strategy:
This is not about diets. Diets do not work.
Diets are temporary, highly restrictive programs of eating to lose weight and are unfortunately damaging exercises in futility. (Diets are also about selling books!)
Inherent in the ‘diet’ approach is a reductionist mindset that the precise nutrient composition of one’s diet matters most. Since we cannot see nutrients, we as consumers have to rely on experts to tell us what to eat. These experts have wildly different views that lead to a dogmatic, almost religious element to food advice that divides food into good and bad, demonizing some foods and elevating others to superfood status. Michael Pollan calls this nutritionism, a term he popularized from the work of Gyorgy Scrinis. Nutritionism is an ideology, not science - a view that specific nutrients in food determine whether a food is healthy or not. “This focus on nutrients has come to dominate, to undermine, and to replace other ways of engaging with food and of contextualizing the relationship between food and the body," wrote Scinis in 2008. This ideology has even come to overtake nutritional science and government advice, easily co-opted by industry to market questionable food as healthy. “Twinkies now with Omega-3!” Nutritionism allows the food industry to market highly processed foods as healthy when they add specific nutrients back to the product and market accordingly - think of vitamin-fortified cereals. Nutritionism may even be one of the causes of the current rise of diabetes, obesity and chronic disease we see in the Western world. Specifically, the recommendations in the late 1970s and early 1980s for consumers to lower their intake of saturated fats led to profound shifts in Western diets with refined carbohydrates replacing fat in industrially produced food. This shift is thought by some to be the single most significant causal factor responsible for the epidemic of obesity in the world today. Pollan counters nutritionism with his simple advice (that we have borrowed): "Eat food, not too much, mostly plants. This simple advice is the antidote to nutritionism; a holistic counter strategy focused on whole foods. Ready for the EAT Better Strategy? EAT Better is our attempt to cut through the noise and help you learn foundational habits that will make eating better easier. The EAT Better Strategy:
Need help applying this to your busy life? Get a personalized nutrition plan to gain clarity and improve your health: The TARGET Nutrition Plan takes a personalized, evidence-based approach to help you make better choices. Our nutritionists assess what you are currently doing and provide you with a personalized plan (including meal plans). Everything you need to transform your diet. As humans, we are wired to be goal oriented. Have you ever watched an infant child learn to stand? They will scoot their way to a table or chair, grab on with all their strength, position their legs under their body and pull themselves up. If they fall while in the process, they will try again. . . .. and again. . . .. .and again, until they get it right! Whether it be a task as simple as learning to stand, or a more complicated task like applying for a job, planning a holiday or finally tackling spring cleaning the garage, goals push us forward and provide a constant reminder of what we want to achieve. Goals give us something to focus on and the energy to carry on, even when motivation is low. Academia has written much on the subject of goals. By far, though, the most well-known goal-setting technique comes from the world of business management - SMART Goals.
The acronym encourages us to make goals that are: specific, measurable, achievable (or attainable), realistic and time-bound. Below are some useful tips for setting Smart Goals. Make your goal Specific by describing it in detail. For example, say- “I will walk every week day for 20 minutes after dinner” versus “I will walk more.” Or- “I will be home by 6:00 pm to eat dinner with my family” versus “I will get home earlier from work to be with my family.” Make your goal Measurable by using metrics such as time or distance. “I will go to the gym and work out for an hour twice a week on Tuesday and Thursday mornings” versus “I will work out at the gym twice a week.” Using terms you can measure not only helps you to prioritize your goals but also keeps you honest with your progress. Make your goal Attainable by allowing yourself enough time and energy to achieve it. Most of us can recall a time when we took on too much, too soon with too little time. Deciding to crash diet in order to look good in your clothes for a big event in a week may sound like a good idea until ending up with nothing to wear the night before. Make your goal Realistic by building upon previous success and good habits. If you’ve never run before, it may be unrealistic to set out to run a marathon. However, if you have experience running and the time and ability to train, then a marathon or 10K (depending on your fitness level) may be a realistic goal for you. Make your goal Time Bound by setting a specific date to measure your progress. LIfe gets busy and it is all too easy to put off today what can be done tomorrow. Setting a date also improves accountability by allowing you to track progress over a given period of time. Apply what you have learned about goal setting across the Wellness Garage Six Pillars of Health:
Better yet - do a Precision Health Tune Up and create goals based on a personalized health plan. The 4+2 Diabetes Reversal Strategy programs are based on the research of Dr. Roy Taylor and his team in Newcastle over the past 20 years. Taylor has shown that Type II Diabetes is a disease of energy overload. Energy, from food, stored as fat, overwhelms our body’s healthy storage capabilities. Fat is then stored in places it shouldn’t be - within the cells of the liver, pancreas and muscle initially causing insulin resistance and eventually pancreatic beta cell dysfunction, abnormal blood sugars and diabetes. From cellular studies, to MRI imaging, all the way to a randomized controlled primary care study, Taylor developed the Twin Cycle Theory to explain the pathogenesis of Type II Diabetes and most importantly demonstrated the reversibility and potential for diabetes remission. Getting rid of the fat in the liver and pancreas, restores insulin sensitivity and improves beta cell function. The amount of fat in each organ is relatively small - 400g in the liver and only 5g in the pancreas. However to achieve these reversals most people need to lose significant weight. In the DiRECT study, Taylor and his colleagues showed that 86% of people who lost > 15kg of weight were able to achieve reversal of their diabetes. At Wellness Garage, we have taken these insights and combined them with other evidence to develop the 4+2 Diabetes Reversal Strategy with a goal of helping people reverse their Type II Diabetes. The 4+2 Diabetes Reversal Strategy consists of four key and two secondary behaviours: Our programs for patients have three phases:
Research References: Taylor and team demonstrated that metabolic vicious cycles operating in the liver and pancreas (Twin Cycle) cause insulin resistance and beta cell dysfunction that results in Type II Diabetes AND that these processes can be reversed. They have systematically tested and confirmed each step of the hypothesis.
For people trying to maintain optimal health, there is a central paradox when it comes to heart disease:
The only logical resolution for this paradox is that we all need to develop a strategy to manage the 9 risk factors that account for 90% of the risk. But what about genetics? We have known for many years (at least since 1938) that there are familial risk factors and evidence from twins and large prospective trials confirmed that genetic risk for heart disease is significant.
Since 2007 - more than 50 independent genetic variations have been identified as being associated with the risk of coronary artery disease. These risk alleles, when aggregated into a polygenic risk score, are predictive of incident coronary events and provide a continuous and quantitative measure of genetic susceptibility. Many observers assume that a genetic predisposition to coronary artery disease is deterministic. However, a recent study in the NEJM shows that genetic risk is modified by a favorable lifestyle. This study compared a polygenic risk score across 50 different genetic variations (SNP’s) with a lifestyle behaviour score across four different healthy lifestyle metrics: no current smoking, no obesity (BMI<30), physical activity at least once per week and a healthy diet pattern. They made this comparison across four different populations:
In total 55,685 were studied across these four populations. Here is what they found, when comparing genetic risk and lifestyle factors:
This last point really drives home why everyone should work to modify these risks - everyone can reduce their risk of heart disease. Like many complex chronic diseases coronary artery disease involves an interplay between genetics and lifestyle and while we cannot yet change our genes, we absolutely can change our lifestyle. Adopting a strategy to reduce risk of heart disease starts with an assessment of your current lifestyle and risk. Our Precision Health Tune Up’s start with a Comprehensive Lifestyle Medical Assessment, where we review your key biomarkers, medical history and lifestyle behaviours known to impact health. Included in this is a full cardiovascular risk assessment, along with recommendations for change, additional investigations and or follow-up. From the medical assessment, our team can help you implement the recommendations through a TARGET Nutrition Plan, a TARGET Fitness Plan or a Comprehensive Plan encompassing both nutrition and fitness. Finally a plan is only as good as its implementation, and here our six month digital coaching program (myhealthjourney.ca) and team-based support will help you get started, make the changes and fine tune your strategy. When it comes to improving your vital longevity it is essential that you have a strategy to avoid the complications of atherosclerosis, the underlying disease process that causes heart disease and stroke. Heart disease and stroke are the second and third leading causes of death behind cancer accounting for approximately 25% of all deaths in Canada. Worse heart disease alone is the number one cause of life years lost. It is estimated that 50% of middle age men and 33% of middle age women will develop some manifestations of heart disease in their lifetimes. The INTERHEART study found that the top nine risk factors account for 90% of the related risk:
What is notable is that all of these risk factors are potentially modifiable - in other words 90% of heart disease risk is preventable. The challenge is that only 1 in 10 Canadians are in ideal heart health and over 90% of Canadians have at least one risk factor. Digging further, smoking and high cholesterol account for almost two thirds of the risk - and their importance is highlighted by correlation of declining smoking rates and improved cholesterol management with decreasing incidence of diagnosed heart disease as well as a decreasing incidence of first heart attack observed over the past 30 years. Atherosclerosis is a chronic disease that begins at birth and progresses throughout life (fatty streaks, the earliest sign of developing fatty plaques are seen in fetal autopsies). As a result the single greatest risk factor is age. The longer you live the more likely you are to develop complications of atherosclerosis. Here is the paradox of heart disease:
If you want to live a long and heart disease free life, you need to have an active strategy to avoid or manage these risk factors. The place to start is to assess your risk:
Once you have this information, put the data into one of the cardiovascular risk calculators like Framingham. This will give you the % risk of having a cardiac event in the next 10 years, as well as comparisons between your age/gender average and optimal (all risk factors optimally managed). The process of doing this will help you get started in taking control of your your health:
If you need help doing this assessment and developing your strategy, we can help. Our Precision Health Tune Up’s start with a Comprehensive Lifestyle Medical Assessment, where we review your key biomarkers, medical history and lifestyle behaviours known to impact health. Included in this is a full cardiovascular risk assessment, along with recommendations for change, additional investigations and or follow-up. From the medical assessment, our team can help you implement the recommendations through a TARGET Nutrition Plan, a TARGET Fitness Plan or a Comprehensive Plan encompassing both nutrition and fitness. Finally a plan is only as good as its implementation, and here our six month digital coaching program (myhealthjourney.ca) and team-based support will help you get started, make the changes and fine tune your strategy. Other Posts on Heart Disease: One of our defining beliefs at Wellness Garage is that when it comes to your health you have to consider ALL of the six pillars of health. Over the years, we have provided the clinical evidence to support each lifestyle behaviour individually: In our coaching programs, we have always stressed that the power of these behaviours lie in the fact that they are interconnected. Our clinical health counsellor Noral recently created an internal guide for our team showing just how each behavior is impacted by, and impacts each other behaviour. Take a moment to go through this grid and assess yourself. (Apologies, but this grid needs to be viewed from a desktop or tablet - it's worth the effort!)
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