60% of Canadian adults are overweight or obese. The diseases associated with obesity are epidemic & the list goes way beyond diabetes & heart disease. But our world is changing. Both health care professionals & patients are challenging traditional recommendations for how we eat, live, & manage illness.
Whole-foods, controlled carbohydrate eating has been extensively researched and repeatedly demonstrates safe and effective weight loss and lifestyle disease reduction. 1 2 3 4 There is a growing movement of health care professionals who are using nutrition to prevent and treat disease. 5 6 7 To read about this movement please view the endnotes at the bottom of this page or visit the Resources page of this website.
Below is a summary of the key components of whole-foods, controlled carbohydrate eating. For people who want to learn more, I recommend starting with the following resources:
Eat food that is as unrefined & unprocessed as possible. This means protein, vegetables, fruit, & natural fats close to their original form. Whole food also has little chemicals, additives, or preservatives and is full of the nutrients our bodies need. Generally, you can find whole food at the farmer's market or around the perimeter of grocery store - produce section, meat/fish/deli, & dairy.
Processed food is refined food that is generally packaged & has additives & should be avoided. Refined carbohydrates (e.g. bread, cereals, pasta) & sugar (e.g. candy, pop) are processed food. We've been told that some of these foods are a "healthy" part of all meals or can be "consumed in moderation". Unfortunately, that is the kind of advice that has fuelled the obesity epidemic in the last 40 years.
Eat vegetables in a variety of shapes, sizes, & colours. Emphasize veggies that grow above the ground. Two thirds of your plate should be filled with above-ground vegetables at every meal. Fruit is a whole food but is higher in natural sugars. Depending on what your goals are (see Individualization) you may wish to choose veggies over fruit or eat lower sugar fruit (e.g. berries) in controlled amounts.
Eat natural fats like butter, cream, avocados, olives, & naturally present fat in protein. Fat has had a bad rap & there are still people out there who are afraid to eat it. Low-fat food is full of processed carbohydrates, sugar, & chemicals - all of which fuel obesity & disease. There is lots of evidence now showing that our bodies need healthy fats to function both physically & mentally.
Eat meat, fish, seafood, poultry, eggs & full-fat dairy products that are nutrient dense with loads of vitamins, minerals, protein & useful fat (that includes chicken skin & egg yolks). Locally produced is better & grass-fed meats are ideal. Dairy products don't work for some people (see Individualization) but if you include dairy make sure you eat the whole-food, full-fat, unflavoured versions.
Drink a minimum of 8 (8oz) glasses a day (or 4 "large glasses" or 2 litres sounds easier). Most people I meet are chronically dehydrated & they have no idea that their complaints (fatigue, headache, muscle cramps, itchy skin, frequent colds or viruses, stomach ache, constipation) are all associated with dehydration. Please avoid bottled water to reduce the use of plastic & protect the health of our environment.
Any dietary changes that a person makes should be focused on changing behaviour and habits. Whatever your motivation for changing what you eat - weight loss, to lower medications, to have more energy, or to be healthier - results come from a lifestyle shift, not from a temporary diet.
In the primary care Nutrition Program that I run with Nutrition Coach Shelley Aggett, tailoring behavioural change & nutrition planning to each patient always produces the best results.
Every patient has a unique profile that determines the changes they make to their nutrition. Medical history, medications, age, gender, goals and patient choice all impact the program plan for that individual.
It's also really important to know what people have been eating before they join our program. For example, if someone has been drinking 5-6 cans of pop a day the first habit change we might recommend is replacing pop with water. Usually, this alone delivers great benefits (weight, blood sugars, energy, sleep).
So there is a huge range of options within nutrition change. What is best for you depends on your history and your goals.
Regardless of the nutrition changes you choose, the guiding question is always the same and Shelley & I ask every patient at every visit: Is what you are eating working for you?
We ask that guiding question because it encourages people to remain focussed on their goals. It also dissolves the rationalizations and excuses we tend to make when letting go of old habits.
Whether people are participating in our Nutrition Program or making changes by themselves, individualization and tweaking the plan for each person is always necessary to support good health & lifestyle change.
Want to know more? Read the next section on FAQs about Nutrition.
Isn't it dangerous to eat butter & fat? Won't I get fat or get heart disease?
It is not dangerous to eat healthy fat and in fact research shows that our bodies and brains need fat. Dr Eenfeldt has a very good summary page on the research to support low-carb high fat (LCHF) eating. Science journalist Nina Teicholz wrote bestselling book The Big Fat Surprise and Dr. David Perlmetter wrote bestseller Grain Brain. All of these resources provide evidence-based information on eating a diet with healthy fats versus eating the low-fat high carbohydrate diet that has fuelled the obesity epidemic.
Why are there no grains or bread products in your nutrition recommendations?
In Canada we tend to crowd our plates with both processed & unprocessed carbohydrates which means we are missing out on nutrient-dense foods like vegetables, protein & natural fats. Most of us are "carb-loading" like we are Olympic athletes. Unprocessed carbohydrates (starchy vegetables) & some whole grains (quinoa) have lots of nutritional value. But it all goes back to the guiding question: Is what you are eating working for you? If you are trying to lose weight or lower your blood sugars, for example, then decreasing your carbohydrate intake and insulin levels will help with that. Dr. Jason Fung has done extensive research on obesity, diabetes, and our hormone levels (in particular blood insulin levels) & you can learn about his research from his website, book, & podcast series.
What's wrong with eating fruit or starchy (below-ground) vegetables?
See above. It isn't that fruit or starchy vegetables are bad foods. They contain a lot of nutrients and fibre. However, it comes back to the guiding question. Is what you are eating working for you? If you are trying to lose weight or lower your blood sugars, for example, then decreasing your carbohydrate intake and insulin levels will help with that. Shelley & I meet a lot of people who are eating 4, 5, 6 servings of fruit a day and are frustrated because they are not able to lose weight.
If I achieve my goal can I go back to eating some of the foods I used to eat before?
This is pretty straightforward. If you go back to eating the foods that made you obese or gave you type two diabetes you are likely to go back to being obese or having diabetes. Whether or not you can have the occasional "treat", such as cake on your birthday, goes back once again to our guiding question: Is what you are eating working for you? If you have cake on your birthday and you are able to feel great and maintain your accomplishments (weight loss, disease control, medication reduction) that's fantastic. If you find that "carb creep" is happening - you are having cake on the birthday of all family members, everyone in your office, the dog, and your neighbour - and you aren't maintaining your accomplishments? Well.... you know the answer.
Do I have to eat a very low-carbohydrate or ketogenic diet?
No. Within controlled carbohydrate eating there is a range of carbohydrate intake - higher carbohydrate, moderate, and very low (keto or ketogenic). Tailor your carbohydrate intake to your individual history and needs and how your body and brain respond to what you are eating. Dr Eenfeldt describes the different levels of carbohydrate intake very well on his website. You will also see on his website that he recommends that you discuss any dietary changes with your health care provider (MD or NP) especially if you are taking certain medications (e.g. insulin). It is very important to keep your health care team in the loop.
I've heard about intermittent fasting. Do I have to do that?
No. Intermittent fasting is a well-researched strategy for weight loss and regulation of blood hormones, particularly insulin. For some people intermittent fasting is a good way to "flick the switch" and get weight loss and disease reversal happening. This might include people who have been obese for many years or who have hormonal issues that prevent weight loss. But for some people intermittent fasting is not necessary. Individualizing your nutrition plan is essential and again it is always best to speak to your health care provider about any lifestyle changes you are making. To read more about intermittent fasting check out Dr Eenfeldt's website (dietdoctor.com) or Dr Fung's website (idmprogram.com)
Is eating a whole foods diet safe?
Yes. As more people and health care practitioners move to whole foods controlled carbohydrate eating there is inevitably resistance from those who support traditional nutrition guidelines and recommendations (e.g. Canada Food Guide). So there are some concerns voiced that eating whole foods is not safe - it might cause kidney problems, blood sugar issues, or heart disease. There is now a large body of research to support both the safety and efficacy of whole-foods, controlled carbohydrate eating. I always recommend that patients read research from reliable sources and some of these are listed on the Resources page of this website. I have to admit that I am constantly amazed when anyone raises the alarm about people eating real food! Zero of my patients have had a poor outcome from eating more vegetables and whole foods. Zero. So as science journalist Gary Taubes says, always think about the study of one - yourself. In other words...Is what you are eating working for you?
I'm afraid to tell my MD/NP that I am changing what I eat. Should I keep it a secret?
Absolutely not. It is always best to communicate with your health care team and tell them what you are doing with lifestyle change - whether those are changes to what you are eating, exercise, alcohol and drug consumption or medication use. You might be pleasantly surprised - most clinicians who see their patients getting safe and effective results from lifestyle change will be supportive. There is also a growing number of health care providers who are developing expertise in whole-foods controlled-carbohydrate eating and will be supportive and may even have information for you.
I am a health care provider and want to learn more about preventing and treating disease with a whole-foods controlled-carbohydrate nutrition program. Where can I get more information?
Dr. Eenfeldt, Dr. Bourdua-Roy and Megan Ramos have an excellent page on the dietdoctor.com website for health care providers called Low-carb and Keto for Doctors (Nurse Practitioners and other health care providers can also view the presentations). I have a page on this website called Primary Care Provider Page that describes the primary care Nutrition Program offered at my clinic. There is also a network called Canadian Clinicians for Therapeutic Nutrition.
The information provided on npsam.ca is not intended to replace consultation with a qualified health care professional. You are encouraged to inform your nurse practitioner or physician of any changes you make to your lifestyle. If you have questions or concerns about any medical conditions please book an appointment with your nurse practitioner or physician.
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