The Lemonade Diet

The Lemonade Diet, also called the Master Cleanse, is a liquid-only diet consisting of three things: a lemonade-like beverage, salt-water drink, and herbal laxative tea.

Celebrities including Beyoncé have used this diet. But it’s far from the principles of healthy eating, and the results aren’t likely to last.

The claim is simple: Give it 10 days (or more) and you’ll drop pounds, “detox” your digestive system, and feel energetic, vital, happy, and healthy. You’ll also curb cravings for unhealthy food.

Does It Work ?

Because you’re getting so few calories, you’ll probably lose weight. You’ll also be losing muscle, bone, and water. And you’re likely to gain the weight right back.

It’s an unhealthy way to temporarily lose weight.

There’s no proof that detoxifying leads to long-term weight loss. Plus, you don’t need to detox your body — your liver takes care of that.

For lasting change, you’re better off eating a healthy diet of fruits, vegetables, whole grains, low-fat dairy, and lean proteins like fish, skinless chicken or turkey, and healthy fats like olive oil.

What You Can Eat and What You Can’t

You’re only allowed a salt-water drink, a “lemonade,” and an herbal laxative tea for the first 10 days. You can’t have any solid food, and you can’t drink alcohol.

After 10 days, you can gradually add back foods, but only a few at first, starting with juice and soup, and leading to raw fruits and vegetables. After this, the plan calls for eating very little meat and no dairy.

Conclusion: This is not a diet we recommend. If weight loss is the goal, it is better to lose weight gradually with a balanced diet that makes sure you get the nutrients you need. Cross this one off your list.

What is Detox ?

Before it was co-opted in the recent craze, the word “detox” referred chiefly to a medical procedure that rids the body of dangerous, often life-threatening, levels of alcohol, drugs, or poisons. Patients undergoing medical detoxification are usually treated in hospitals or clinics. The treatment generally involves the use of drugs and other therapies in a combination that depends on the type and severity of the toxicity. ¹

The detox programs now being promoted to the health-conscious public are a different matter. These are largely do-it-yourself procedures aimed at eliminating alleged toxins that are held responsible for a variety of symptoms, including headache, bloating, joint pain, fatigue, and depression. Detox products are not available by prescription; they are sold in retail stores, at spas, over the Internet, and by direct mail. Many are advertised as useful for detoxifying specific organs or systems; others are portrayed as “whole body” cleansers. Here is a review of some of the most widely promoted procedures and products.

Detox Diets

A seemingly infinite array of products and diets is available for detoxifying the entire body. One of the most popular is the Master Cleanse diet, favored by a number of Hollywood celebrities. Dieters take a quart of warm salt water in the morning; consume a 60-ounce concoction of water, lemon juice, maple syrup, and cayenne pepper throughout the day; and finish with a cup of laxative tea in the evening. Proponents of the Master Cleanse diet recommend adhering to it for at least 10 days.

Purpose : To restore energy, lose weight, and relieve symptoms of chronic conditions like arthritis and fibromyalgia.

Evidence of effectiveness : There are no data on this particular diet in the medical literature. But many studies have shown that fasts and extremely low-calorie diets invariably lower the body’s basal metabolic rate as it struggles to conserve energy. Once the dieter resumes normal eating, rapid weight gain follows. Much of the weight loss achieved through this diet results from fluid loss related to extremely low carbohydrate intake and frequent bowel movements or diarrhea produced by salt water and laxative tea. When the dieter resumes normal fluid intake, this weight is quickly regained.

Risks : The diet is lacking in protein, fatty acids, and other essential nutrients. Carbohydrates supply all the calories — an extremely low 600. The daily laxative regimen can cause dehydration, deplete electrolytes, and impair normal bowel function. It can also disrupt the native intestinal flora, microorganisms that perform useful digestive functions. A person who goes on this diet repeatedly may run the risk of developing metabolic acidosis, a disruption of the body’s acid-base balance, which results in excessive acidity in the blood. Severe metabolic acidosis can lead to coma and death.

Cost : The price of the book and a handful of food items.

Intestinal Cleansing

Numerous kits are marketed for this purpose, most of which include a high-fiber supplement, a “support” supplement containing herbs or enzymes, and a laxative tea, each to be used daily. Manufacturers of the herbal detox kits recommend continuing the regimen for several weeks. Such regimens may be accompanied by frequent enemas.

Purpose : The aim is to eradicate parasites and expel fecal matter that allegedly accumulates and adheres to the intestinal walls.

Evidence of effectiveness : Several studies suggest that milk thistle, which is often included as a supportive supplement, may improve liver function with few side effects. But there’s no medical evidence for the cleansing procedure as a whole. Promotional materials often include photographs of snake-like gelatinous substances expelled during cleansing. When these pictures are not faked, they are probably showing stool generated by large doses of the regimen’s fiber supplement. More important, the rationale for intestinal cleansing — to dislodge material adhering to the colon walls — is fundamentally mistaken. When fecal matter accumulates, it compacts into firm masses in the open interior of the colon; it does not adhere to the intestinal walls as the “sludge” depicted in the advertisements.

Risks : Like fasting, colonic cleansing carries a risk of dehydration, electrolyte imbalance, impaired bowel function, and disruption of intestinal flora.

Cost : A month’s supply of the supplements and laxatives sold on most Web sites is $20 to $70. The manufacturers recommend continuing the procedure for two to three months.

Foot detox

One method employs a special type of adhesive pad worn on the bottoms of the feet during sleep. Another approach is to immerse the feet for 30 minutes in a basin, sometimes referred to as an “ionic foot bath,” containing salt water and two electrodes that supply a low-voltage electric charge.

Purpose : Toxins are allegedly drawn out of the body through the soles of the feet.

Evidence of effectiveness. Both methods claim to emit ions that stimulate the outflow of toxins through the feet. The pads contain tourmaline crystals, which are purported to emit ion-generating infrared rays. The foot baths allegedly generate ions by running an electric current through salt water. However, there is no scientific evidence that ionic changes in the environment can stimulate a discharge of toxins through pores in the feet — or any other part of the body, for that matter. Promoters assert that the success of the process can be monitored by a color change in the pad or in the water of the foot bath as impurities are leached from the body. But the pads, which are impregnated with wood vinegar, have been shown to turn the same dark color whether they absorb foot perspiration or are sprayed with tap water; and the color of the foot bath changes because the metal electrodes corrode.

Risks : No ill effects on health have been reported for either method.

Cost : Single-use pads average $1. Ionic foot bath sessions are available at spas for $40 to $50. Ionic foot bath devices are sold online at prices ranging from $85 to $2,000.

1. Harvard University – Harvard Health Publication May, 2008 : The dubious practice of detox – http://www.health.harvard.edu/staying-healthy/the-dubious-practice-of-detox

The Low Cholesterol Diet

Diet can play an important role in raising or lowering your cholesterol. We all know that butter, ice cream, and fatty meats raise cholesterol, but do you know which foods make up a low-cholesterol diet ?

A largely vegetarian “dietary portfolio of cholesterol-lowering foods” substantially lowered LDL, triglycerides, and blood pressure. The key dietary components are plenty of fruits and vegetables, whole grains instead of highly refined ones, and protein mostly from plants. Add margarine enriched with plant sterols; oats, barley, psyllium, okra, and eggplant, all rich in soluble fiber; soy protein; and whole almonds.Just as important, a diet that is heavy on fruits, vegetables, beans, and nuts is good for the body in ways beyond lowering cholesterol. It keeps blood pressure in check. It helps arteries stay flexible and responsive. It’s good for bones and digestive health, for vision and mental health ¹.

Here are the top foods to lower your cholesterol and protect your heart.

1) Oatmeal, oat bran and high-fiber foods

Current nutrition guidelines recommend getting 20 to 35 grams of fiber a day, with at least 5 to 10 grams coming from soluble fiber. The average American gets about half that amount. Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the “bad” cholesterol. Soluble fiber is also found in such foods as kidney beans, apples, pears, barley and prunes.

Soluble fiber can reduce the absorption of cholesterol into your bloodstream. Five to 10 grams or more of soluble fiber a day decreases your total and LDL cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you’ll add about 4 more grams of fiber. To mix it up a little, try steel-cut oatmeal or cold cereal made with oatmeal or oat bran.

2) Fish and omega-3 fatty acids

Eating fatty fish can be heart healthy because of its high levels of omega-3 fatty acids, which can reduce your blood pressure and risk of developing blood clots. In people who have already had heart attacks, fish oil — or omega-3 fatty acids — may reduce the risk of sudden death.

Although omega-3 fatty acids don’t affect LDL levels, because of their other heart benefits, the American Heart Association recommends eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in:

• Mackerel
• Lake trout
• Herring
• Sardines
• Albacore tuna
• Salmon
• Halibut

You should bake or grill the fish to avoid adding unhealthy fats. If you don’t like fish, you can also get small amounts of omega-3 fatty acids from foods such as ground flaxseed or canola oil.

You can take an omega-3 or fish oil supplement to get some of the benefits, but you won’t get other nutrients in fish, such as selenium. If you decide to take a supplement, talk to your doctor about how much you should take.

3) Walnuts, almonds and other nuts

Walnuts, almonds and other tree nuts can improve blood cholesterol. Rich in mono- and polyunsaturated fatty acids, walnuts also help keep blood vessels healthy.

Eating about a handful (1.5 ounces, or 42.5 grams) a day of most nuts, such as almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts and walnuts, may reduce your risk of heart disease. Make sure the nuts you eat aren’t salted or coated with sugar.

All nuts are high in calories, so a handful will do. To avoid eating too many nuts and gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds.

4) Avocados

Avocados are a potent source of nutrients as well as monounsaturated fatty acids (MUFAs). According to a recent study, adding an avocado a day to a heart-healthy diet can help improve LDL levels in people who are overweight or obese.

People tend to be most familiar with avocados in guacamole, which usually is eaten with high-fat corn chips. Try adding avocado slices to salads and sandwiches or eating them as a side dish. Also try guacamole with raw cut vegetables, such as cucumber slices.

Replacing saturated fats, such as those found in meats, with MUFAs are part of what makes the Mediterranean diet heart healthy.

5) Olive oil

Another good source of MUFAs is olive oil.

Try using about 2 tablespoons (23 grams) of olive oil a day in place of other fats in your diet to get its heart-healthy benefits. To add olive oil to your diet, you can saute vegetables in it, add it to a marinade or mix it with vinegar as a salad dressing. You can also use olive oil as a substitute for butter when basting meat or as a dip for bread.

Both avocados and olive oil are high in calories, so don’t eat more than the recommended amount.

6) Soy protein

Adding tofu to your stir-fry, soy milk to your morning bowl of oatmeal, or edamame as a snack can be a good move if you’re working on improving your cholesterol level.

Some studies suggest that soy protein may help, but the evidence isn’t strong, so you’ll definitely want to make other changes to your diet to help your cholesterol, too.

Eating soy foods may help lower your LDL (“bad”) cholesterol by about 3%. That’s very little, but when you’re trying to take advantage of everything you can do for your cholesterol, it’s worth considering.

Soy is also a good source of protein, fiber, and heart-healthy omega-3s (though not the same kind that you get in salmon or tuna). Plus, soy is naturally cholesterol-free and low in saturated fat.

Soy sauce and soybean oil don’t contain soy protein, even though “soy” is part of their name.

7) Foods with added plant sterols or stanols

Plant sterols and stanols are substances that occur naturally in small amounts in many grains, vegetables, fruits, legumes, nuts, and seeds. Since they have powerful cholesterol-lowering properties, manufacturers have started adding them to foods. You can now get stanols or sterols in margarine spreads, orange juice, cereals, and even granola bars.

Plant stanol esters help block the absorption of cholesterol. They can prevent real cholesterol from being absorbed into your bloodstream.

Foods are available that have been fortified with sterols or stanols — substances found in plants that help block the absorption of cholesterol.

Some margarines, orange juice and yogurt drinks come with added plant sterols and can help reduce LDL cholesterol by 5 to 15 percent. The amount of daily plant sterols needed for results is at least 2 grams — which equals about two 8-ounce (237-milliliter) servings of plant sterol-fortified orange juice a day.

It’s not clear whether food with plant sterols or stanols reduce your risk of heart attack or stroke, although experts assume that foods that reduce cholesterol do reduce the risk. Plant sterols or stanols don’t appear to affect levels of triglycerides or of high-density lipoprotein (HDL), the “good” cholesterol.

8) Whey protein

Whey protein, which is one of two proteins in dairy products — the other is casein — may account for many of the health benefits attributed to dairy. Studies have shown that whey protein given as a supplement lowers both LDL and total cholesterol.

You can find whey protein powders in health food stores and some grocery stores. Follow the package directions for how to use them.

9) Beans and Legumes

Beans are especially rich in soluble fiber. They also take a while for the body to digest, meaning you feel full for longer after a meal. That’s one reason beans are a useful food for folks trying to lose weight. With so many choices — from navy and kidney beans to lentils, garbanzos, black-eyed peas, and beyond — and so many ways to prepare them, beans are a very versatile food.

9) Eggplant and okra

These two low-calorie vegetables are good sources of soluble fiber.

11) Other changes to your diet

For any of these foods to provide their benefit, you need to make other changes to your diet and lifestyle.

Although some fats are healthy, you need to limit the saturated and trans fats you eat. Saturated fats, like those in meat, butter, cheese and other full-fat dairy products, and some oils, raise your total cholesterol. Trans fats, often used in margarines and store-bought cookies, crackers and cakes, are particularly bad for your cholesterol levels. Trans fats raise LDL cholesterol, and lower high-density lipoprotein (HDL), the “good” cholesterol.

Food labels report the content of trans fats, but, unfortunately, only in foods that contain at least one gram per serving. That means you could be getting some trans fats in a number of foods, which could add up to enough trans fats in a day to be unhealthy and increase cholesterol. If a food label lists “partially hydrogenated oil,” it has trans fat, and it’s best to avoid it.

In addition to changing your diet, making other heart-healthy lifestyle changes is key to improving your cholesterol. Exercising, quitting smoking and maintaining a healthy weight will help keep your cholesterol at a healthy level.

To be smarter about what you eat, you’ll also need to pay more attention to food labels, if you don’t already read them.

12) Becoming more physically active

A sedentary lifestyle lowers HDL cholesterol. Less HDL cholesterol means there’s less good cholesterol to remove LDL (bad) cholesterol from arteries.

Physical activity is important. Just 40 minutes of aerobic exercise of moderate to vigorous intensity done three to four times a week is enough to lower both cholesterol and high blood pressure. Brisk walking, swimming, bicycling or a dance class are examples. Learn more about getting active.

13) Quitting smoking

Smokers can lower their cholesterol levels and help protect their arteries by quitting. Nonsmokers should avoid exposure to secondhand smoke.

Smoking lowers HDL cholesterol. When a person with high cholesterol also smokes, their risk of coronary heart disease increases more than it otherwise would. Smoking compounds risk from other risk factors for heart disease, too, such as high blood pressure and diabetes. Learn more about quitting smoking.

14) Losing weight

Being overweight or obese tends to raise LDL cholesterol and lower HDL cholesterol.

Losing excess weight can improve cholesterol levels. A weight loss of 10 percent can go a long way toward lowering your risk of high cholesterol — or reversing it.

1. Harvard University. Harvard Health Publications. 11 foods that lower cholesterol. http://www.health.harvard.edu/heart-health/11-foods-that-lower-cholesterol

What is Liquid Diet

A full liquid diet is made up only of fluids and foods that are normally liquid and foods that turn to liquid when they are at room temperature, like ice cream. It also includes:

• Strained creamy soups
• Tea
• Juice
• Jell-O
• Milkshakes
• Pudding
• Popsicles

Like the name suggests, liquid diets mean you’re getting all, or at least most, of your calories from drinks.

Some liquid diets are limited to fruit or vegetable juices, or shakes, that replace all of your meals, taken three or four times a day. You do some of these diets on your own. Others need medical supervision.

Other types of liquid diets replace just one or two meals (usually breakfast and lunch) with drinks, and then you eat a healthy dinner. You may also get snacks on some of these plans.

Clear liquid diet

A clear liquid diet consists of clear liquids — such as water, broth and plain gelatin — that are easily digested and leave no undigested residue in your intestinal tract ¹. Your doctor may prescribe a clear liquid diet before certain medical procedures or if you have certain digestive problems. Because a clear liquid diet can’t provide you with adequate calories and nutrients, it shouldn’t be continued for more than a few days.

Clear liquids and foods may be colored so long as you are able to see through them. Foods can be considered liquid if they are even partly liquid at room temperature. You can’t eat solid food while on a clear liquid diet.

• Purpose

A clear liquid diet is often used before tests, procedures or surgeries that require no food in your stomach or intestines, such as before colonoscopy. It may also be recommended as a short-term diet if you have certain digestive problems, such as nausea, vomiting or diarrhea, or after certain types of surgery.

• Clear Liquid Diet details

A clear liquid diet helps maintain adequate hydration, provides some important electrolytes, such as sodium and potassium, and gives some energy at a time when a full diet isn’t possible or recommended.

The following foods are allowed in a clear liquid diet:

• Water (plain, carbonated or flavored)
• Fruit juices without pulp, such as apple or white grape
• Fruit-flavored beverages, such as fruit punch or lemonade
• Carbonated drinks, including dark sodas (cola and root beer)
• Gelatin
• Tea or coffee without milk or cream
• Strained tomato or vegetable juice
• Sports drinks
• Clear, fat-free broth (bouillon or consomme)
• Honey or sugar
• Hard candy, such as lemon drops or peppermint rounds
• Ice pops without milk, bits of fruit, seeds or nuts

Any foods not on the above list should be avoided. Also, for certain tests, such as colon exams, your doctor may ask you to avoid liquids or gelatin with red coloring.

• A typical menu on the clear liquid diet may look like this.

Breakfast

• 1 glass pulp-free fruit juice
• 1 bowl gelatin
• 1 cup of coffee or tea, without dairy products
• Sugar or honey, if desired

Snack

• 1 glass fruit juice (pulp-free)
• 1 bowl gelatin

Lunch

• 1 glass pulp-free fruit juice
• 1 glass water
• 1 cup broth
• 1 bowl gelatin

Snack

• 1 pulp-free ice pop
• 1 cup coffee or tea, without dairy products, or a soft drink
• Sugar or honey if desired

Dinner

• 1 cup pulp-free juice or water
• 1 cup broth
• 1 bowl gelatin
• 1 cup coffee or tea, without dairy products
• Sugar or honey, if desired

• Results

Although the clear liquid diet may not be very exciting, it does fulfill its purpose. It’s designed to keep your stomach and intestines clear and to limit strain to your digestive system, while keeping your body hydrated as you prepare for or recover from a medical procedure.

• Risks

Because a clear liquid diet can’t provide you with adequate calories and nutrients, it shouldn’t be used for more than a few days. Only use the clear liquid diet as directed by your doctor.

If your doctor prescribes a clear liquid diet before a medical test, be sure to follow the diet instructions exactly. If you don’t follow the diet exactly, you risk an inaccurate test and may have to reschedule the procedure for another time.

If you have diabetes, talk with your doctor, dietitian or diabetes educator. A clear liquid diet should consist of clear liquids that provide approximately 200 grams of carbohydrate spread equally throughout the day to help manage blood sugar (blood glucose). Blood sugar levels should be monitored and the transition to solid foods should be done as quickly as possible.

Do Liquid Diets Work ?

Liquid diets can work, like any diet that gives you fewer calories than you use.

But the results may not last. When you drastically cut calories, your metabolism slows to save energy. Unless you change your eating habits, you’re likely to regain the weight you lost after you go off the liquid diet.

Some liquid diets work better over the long term than others. Diets that include both solid food and liquids can help overweight people control the number of calories they eat and help keep the weight off for several years.

How Safe Are Liquid Diets ?

Ideally, liquid diet drinks should give you a balance of nutrients you need throughout the day, but that isn’t always the case.

Very low-calorie diets (400-800 calories per day) in particular can be lacking in nutrients and should only be used under medical supervision.

Missing out on essential nutrients can lead to side effects such as fatigue, dizziness, hair loss, gallstones, and heart damage.

Also, if you don’t get enough fiber, because you’re not eating whole fruits and vegetables, you can get constipated.

You also can lose muscle if you don’t get enough protein in your diet.
A clear liquid diet is often used before tests, procedures or surgeries that require no food in your stomach or intestines, such as before colonoscopy. It may also be recommended as a short-term diet if you have certain digestive problems, such as nausea, vomiting or diarrhea, or after certain types of surgery.

How Can You Safely Get on a Liquid Diet ?

Pregnant or nursing women, and people who take insulin for diabetes, or anyone with a chronic illness shouldn’t go on a liquid diet.

If your doctor gives you the OK to go on a liquid diet, you should also see a registered dietitian, who can go over the diet with you and make sure you’re getting enough calories and nutrition. Your dietitian might recommend that you take a vitamin or nutritional supplement while you’re on the liquid diet.

Before you choose a liquid diet plan, know what you’re drinking. If you’re considering one of the commercial diets, look at the daily values on the nutrition facts label. Be sure you’re getting 100% of all the recommended vitamins and minerals.

You may also want to pick a diet that is not too low in calories and contains plenty of protein and fiber to keep you feeling full while you lose the weight gradually. Liquid diets that include a solid meal or two per day, or that teach you healthier eating habits, will be more likely to help you keep the weight off in the long run.

Liquid Supplemental Nutrition Drinks for People who struggle with a Loss of Appetite, or are Recovering from Surgery or an Illness

Nutrition in a bottle

Supplemental nutrition drinks can be helpful for people who struggle with a loss of appetite, have difficulty chewing, have trouble preparing balanced meals, or are recovering from surgery or an illness. You may be getting more sugar than any of the other ingredients. But if you can’t eat and that’s the only food that’s palatable, it’s better to get the calories. Experts warn that people who can still eat may be risking too many extra calories by consuming the drinks. They can lead to weight gain and a list of complications associated with obesity, such as high blood pressure and diabetes. It’s not okay to eat a full meal and then drink a liquid supplement, unless your goal is to gain weight or stop weight loss, because it has too many calories ².

Supplemental nutrition drinks provide a healthy balance of protein, carbohydrate, and fat. There are hundreds of varieties that fall into two general categories.

• Shakes, such as Boost or Ensure, are intended for oral consumption. You can find them on a grocery store shelf. These are formulated to help you meet general nutrition goals such as increased calories and protein. Some drinks are designed to be compatible with health conditions such as diabetes (Glucerna). Shakes are usually fortified with vitamins and blended with sugar to improve taste.

• Formulas are designed for more specific disease states such as cancer, chronic obstructive pulmonary disease, and later-stage kidney disease. These drinks (Jevity, Osmolite) can be consumed orally but aren’t designed to taste good, and are often used in feeding tubes. Your doctor will have to supervise use of these.

You don’t need a doctor’s okay to try a shake, but it’s a good idea to ask your doctor if any of the ingredients will interfere with your medications. For example, some drinks contain vitamin K, and sudden changes in vitamin K intake may interfere with the effect of the blood thinner warfarin (Coumadin).

These examples offer the ratio of calories, protein, carbohydrate, and fat per serving recommended by dietitian Stacey Nelson of Harvard-affiliated Massachusetts General Hospital.

(Source ²).

The risks

Supplemental nutrition shakes contain more than just healthy ingredients. You may be getting more sugar than any of the other ingredients. But if you can’t eat and that’s the only food that’s palatable, it’s better to get the calories. In that case, substituting one meal a day with a drink won’t hurt. Experts warn that people who can still eat may be risking too many extra calories by consuming the drinks. That can lead to weight gain and a list of complications associated with obesity, such as high blood pressure and diabetes.

Equally concerning is that nutrition in a can isn’t the same as nutrition from food. Even if they’re fortified, they still won’t contain all of the nutrients a whole food source would, check the nutritional label to find out about the types of vitamins and dietary supplements in the drinks.

Alternative option

A potentially healthier option is a shake or fruit smoothie that is food-based and found in the refrigerated section of the grocery store. These tend to have minimum added sugars and are less processed, and they should not contain excessive amounts of vitamins and minerals, herbs, or other unnecessary supplemental ingredients. However, these tend to cost more than the shelf-stable shakes.

What to look for

No matter which drink you choose, look at the ingredients. Ideally the first few ingredients should be fruit or forms of protein (such as milk). If sugar is the first or second ingredient, choose another healthier option. Equally important are the calories. If you’re replacing a meal, look for about 400 calories per serving. Experts advise against using the drinks as snacks, but if you must, then don’t go above 200 calories.

As for nutritional ratios in an 8-ounce serving, look for 10 to 20 grams of protein, no more than 6 grams of fat, and no more than 40 grams of carbohydrate, including sugar.

1. Mayo Foundation for Medical Education and Research, MayoClinic. Clear liquid diet. http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/clear-liquid-diet/art-20048505?pg=1
2. Harvard University, Harvard Health Letter. Supplemental nutrition drinks: help or hype ? http://www.health.harvard.edu/staying-healthy/supplemental-nutrition-drinks-help-or-hype

What is the Diabetic Diet

The diabetes diet is simply a healthy-eating plan that will help you control your blood sugar. Diabetic diet usually contains low-glycaemic index food, with similar amount of protein, complex carbohydrates, fibres, and unsaturated fatty acids as in food for general public ¹. If you have diabetes, your body cannot make or properly use insulin. This leads to high blood glucose, or blood sugar, levels. What you eat is closely connected to the amount of sugar in your blood. The right food choices will help you control your blood sugar level and controlling your blood sugar can prevent the complications of diabetes ².

• Avoid foods labelled ‘diabetic’ or ‘suitable for diabetics’. These foods contain similar amounts of calories and fat, and they can affect your blood glucose levels. They are usually more expensive and can have a laxative effect. Stick to your usual foods. If you want to have an occasional treat, go for your normal treats and keep an eye on your portions.

There isn’t one specific “diabetes diet.” Healthy eating helps keep your blood sugar in your target range. It is a critical part of managing your diabetes, because controlling your blood sugar can prevent the complications of diabetes.

• The Centers for Disease Control and Prevention has a free recipes ebook for people and their families with diabetes, you download a free copy here ³.

A registered dietitian can also help you make an eating plan just for you. It should take into account your weight, medicines, lifestyle, and other health problems you have.

• To find out about your body mass index (BMI), you can use a FREE online BMI calculators from the Centers for Disease Control and Prevention (CDC) – for Adults ⁴ and for Children ⁵

• To find out What and How Much To Eat, you can use a FREE, award-winning, state-of-the-art, online diet and activity tracking tool called SuperTracker ⁶ from the United States Department of Agriculture Center for Nutrition Policy and Promotion ⁶. This free application empowers you to build a healthier diet, manage weight, and reduce your risk of chronic diet-related diseases. You can use SuperTracker ⁶ to determine what and how much to eat; track foods, physical activities, and weight; and personalize with goal setting, virtual coaching, and journaling.
  

SuperTracker website ⁶

• To find out about how many calories you should eat to lose weight according to your weight, age, sex, height and physical activity, you can use a FREE online app Body Weight Planner ⁷

• To find out about the 5 Food Groups you should have on your plate for a meal, you can use a FREE online app ChooseMyPlate ⁸
  

There is no one diet for all people with diabetes. There is, however, a “recipe” for eating healthfully that is similar to recommendations for heart health, cancer prevention and weight management.

Healthy Diabetic Eating and Healthy Lifestyle ⁹ includes:

• Start by knowing how many calories you should be eating and drinking to maintain your weight.
• Limiting foods that are high in sugar.
• Eating smaller portions, spread out over the day.
• Being careful about when and how many carbohydrates you eat.
• Eating a variety of fiber rich whole-grain foods, fruits and vegetables every day.
• Choose poultry and fish without skin and prepare them in healthy ways without added saturated and trans fat. If you choose to eat meat, look for the leanest cuts available and prepare them in healthy and delicious ways.
• Eat a variety of fish at least twice a week, especially fish containing omega-3 fatty acids (for example, salmon, trout and herring).
• Eating less saturated fat and avoid trans fat and replace them with the better fats, monounsaturated and polyunsaturated.
• Limiting your use of alcohol. That means no more than one drink per day if you’re a woman and no more than two drinks per day if you’re a man.
• Lowering salt consumption to less than 1,500 mg day. To lower blood pressure, reducing daily intake to 1,500 mg is desirable because it can lower blood pressure even further. If you can’t meet these goals right now, even reducing sodium intake by 1,000 mg per day can benefit blood pressure.
• Lose excess weight and maintain a healthy weight
• Be physically active. Aim for at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity – or an equal combination of both – each week.
• Limit time with the TV, computer, and video.
• Also, don’t smoke tobacco — and avoid secondhand smoke.

In 8 randomised clinical trials ¹⁰ with 2241 participants randomised to exercise and diet intervention and 2509 participants to standard recommendation. Furthermore, 178 participants were randomised to an exercise only intervention and 167 participants to a diet only intervention. The duration of the interventions in the trials ranged from one year to six years. Interventions varied between studies but mainly consisted of caloric restriction if the person was overweight, low fat content (especially saturated fat), high carbohydrate content and the increase of fibre intake. Physical activity varied but on average at least 150 minutes each week of brisk walking or other activities such as cycling or jogging were recommended. Interventions were mainly delivered by frequent individual counselling by a physiotherapist, an exercise physiologist and a dietitian. Interventions aimed at increasing exercise combined with diet are able to decrease the incidence of type 2 diabetes mellitus in high risk groups (people with impaired glucose tolerance or the metabolic syndrome) by 37% with exercise and diet. This had favourable effects on body weight, waist circumference and blood pressure ¹⁰.

A more recent study to find out the health benefits of soluble dietary fiber on type 2 diabetes ¹¹. A total of 117 patients with type 2 diabetes between the ages of 40 and 70 were assessed. Patients were randomly assigned to one of two groups, and administered extra soluble dietary fiber (10 or 20 g/day), or to a control group (0 g/day) for one month. The 20 g/day soluble dietary fiber group exhibited significantly improved fasting blood glucose and low-density (LDL) lipoprotein “bad cholesterol” levels, as well as a significantly improved insulin resistance index. In addition, 10 and 20 g/day soluble dietary fiber significantly improved the waist and hip circumferences and levels of triglycerides and apolipoprotein A. The results of the present study suggested that increased and regular consumption of soluble dietary fiber led to significant improvements in blood glucose levels, insulin resistance and metabolic profiles ¹¹.

Soluble dietary fiber has been associated with lower postprandial glucose levels and increased insulin sensitivity in diabetic and healthy subjects; these effects were generally attributed to the viscous and/or gelling properties of soluble fiber ¹². Soluble dietary fiber exerts physiological effects on the stomach and small intestine that modulate postprandial glycemic responses, including delaying gastric emptying ¹³, which accounts for ~35% of the variance in peak glucose concentrations following the ingestion of oral glucose ¹⁴, modulating gastrointestinal myoelectrical activity and delaying small bowel transit ¹⁵, ¹⁶, reducing glucose diffusion through the unstirred water layer ¹⁷, and reducing the accessibility of α-amylase to its substrates due to the increased viscosity of gut contents ¹⁸. Notably, the increased viscosity and gel-forming properties of soluble fiber are predominantly responsible for its glycemic effect, since the hypoglycemic effect can be reversed by the hydrolysis of guar gum or following ultra-high heating and homogenization ¹³. In addition, the intestinal absorption of carbohydrates was prolonged by soluble dietary fiber, which was partially due to altered incretin levels, including increased glucagon-like peptide 1 levels ¹⁸. In experimental clamp studies, soluble dietary fiber also influenced peripheral glucose uptake mechanisms ¹⁹, ²⁰, including increasing skeletal muscle expression of the insulin-responsive glucose transporter type 4 (GLUT-4), which enhances skeletal muscle uptake, augments insulin sensitivity and normalizes blood glucose ²⁰. In humans, various fatty acids stimulate the expression of peroxisome proliferator-activated receptor-γ, which increases adipocyte GLUT-4 levels ²¹.

Increasing dietary fiber intake, which is one of the goals of nutritional counseling, deserves greater attention due to its ability to reduce total cholesterol levels and hyperglycemia in patients with impaired glucose tolerance and type 2 diabetes ²². In addition, increased fiber intake was shown to improve insulin sensitivity and reduce systemic inflammation ²³, ²⁴. Previous studies have demonstrated that high-fiber diets (30 g/day) altered biochemical parameters, reduced the severity of type 2 diabetes mellitus and decreased the occurrence of risk factors associated with cardiovascular disease ²³, ²⁵. According to Weickert et al ²³, nutritional educational studies involving dietary restrictions are typically met with poor treatment compliance. Participants in a previous study were encouraged to progressively alter their eating behaviors, including increasing the frequency of meals and increasing the intake of complex carbohydrates, dietary fiber, fruits, and vegetables, as well as polyunsaturated and monounsaturated fatty acids, including fish and olive oils, respectively ²³.

Portion Size Versus Serving Size

Sometimes the portion size and serving size are the same, but sometimes they are not. Over the past few years portions have grown significantly in restaurants, as has the frequency of Americans eating out. Learn how much to put on your plate to help control how much you eat ²⁶.

Here are a couple of important definitions from the National Institutes of Health:

• Portion is how much food you choose to eat at one time, whether in a restaurant, from a package or in your own kitchen. A portion is 100 percent under our control. Many foods that come as a single portion actually contain multiple servings.
• Serving Size is the amount of food listed on a product’s Nutrition Facts label. So all of the nutritional values you see on the label are for the serving size the manufacturer suggests on the package.

Once you understand the difference, it’s easier to determine how much to serve and easier to teach kids the difference between the two. Learn some suggested servings from each food groups you and your kids can eat at mealtime or between meals.

Do you know how much you’re really eating ? Sometimes it’s hard to tell if the portions you are eating are the right serving size for your nutritional needs. Portion sizes have increased drastically over the years, contributing to the rising obesity rate.

Consider these statistics from the American Heart Association and the Robert Woods Johnson Foundation study “A Nation at Risk: Obesity in the United States”:

• Adults today consume an average of 300 more calories per day than they did in 1985.
• Portion sizes have grown dramatically over the last 40 years.
• Americans eat out much more than they used to.

How much carbohydrate do you need each day ?

The daily amount of carbohydrate, protein, and fat for people with diabetes has not been defined—what is best for one person may not be best for another. Everyone needs to get enough carbohydrate to meet the body’s needs for energy, vitamins and minerals, and fiber ²⁷.

• Experts suggest that carbohydrate intake for most people should be between 45 and 65 percent of total calories. People on low-calorie diets and people who are physically inactive may want to aim for the lower end of that range.

One gram of carbohydrate provides about 4 calories, so you’ll have to divide the number of calories you want to get from carbohydrates by 4 to get the number of grams. For example, if you want to eat 1,800 total calories per day and get 45 percent of your calories from carbohydrates, you would aim for about 200 grams of carbohydrate daily. You would calculate that amount as follows:

• 0.45 x 1,800 calories = 810 calories
• 810 ÷ 4 = 202.5 grams of carbohydrate

You’ll need to spread out your carbohydrate intake throughout the day. A dietitian or diabetes educator can help you learn what foods to eat, how much to eat, and when to eat based on your weight, activity level, medicines, and blood glucose targets.

How can you find out how much carbohydrate is in the foods you eat ?

You will need to learn to estimate the amount of carbohydrate in foods you typically eat. For example, the following amounts of carbohydrate-rich foods each contain about 15 grams of carbohydrate ²⁷:

• one slice of bread
• one 6-inch tortilla
• 1/3 cup of pasta
• 1/3 cup of rice
• 1/2 cup of canned or fresh fruit or fruit juice or one small piece of fresh fruit, such as a small apple or orange
• 1/2 cup of pinto beans
• 1/2 cup of starchy vegetables such as mashed potatoes, cooked corn, peas, or lima beans
• 3/4 cup of dry cereal or 1/2 cup cooked cereal
• 1 tablespoon of jelly

Some foods are so low in carbohydrates that you may not have to count them unless you eat large amounts. For example, most nonstarchy vegetables are low in carbohydrates. A 1/2-cup serving of cooked nonstarchy vegetables or a cup of raw vegetables has only about 5 grams of carbohydrate.

As you become familiar with which foods contain carbohydrates and how many grams of carbohydrate are in food you eat, carbohydrate counting will be easier.

Nutrition Labels

Nutrition labels tell you the total grams of carbohydrate per serving, along with other nutrition information.

Nutrition labels tell you:

• the food’s serving size––such as one slice or 1/2 cup
• the total grams of carbohydrate per serving
• other nutrition information, including calories and the amount of protein and fat per serving

If you have two servings instead of one, such as one cup of pinto beans instead of 1/2 cup, you multiply the number of grams of carbohydrate in one serving—for example, 15—by two to get the total number of grams of carbohydrate—30.

• 15 x 2 = 30

You can find out how many grams of carbohydrate are in the foods you eat by checking the nutrition labels on food packages. Following is an example of a nutrition label:

What is carbohydrate counting ?

Carbohydrate counting, also called carb counting, is a meal planning tool for people with type 1 or type 2 diabetes. Carbohydrate counting involves keeping track of the amount of carbohydrate in the foods you eat each day ²⁷.

The Internet has carbohydrate counting tools that let you enter a type of food and find out what nutrients the food contains, including carbohydrates. Try visiting these sites:

• A calorie and carbohydrate counting tool from the American Diabetes Association ²⁸
• An online database from the U.S. Department of Agriculture Nutrient Data Lab ²⁹

Carbohydrates are one of the main nutrients found in food and drinks. Protein and fat are the other main nutrients. Carbohydrates include sugars, starches, and fiber. Carbohydrate counting can help you control your blood glucose, also called blood sugar, levels because carbohydrates affect your blood glucose more than other nutrients.

The right amount of carbohydrates varies by how you manage your diabetes, including how physically active you are and what medicines you take, if any. Your health care team can help you create a personal eating plan based on carbohydrate counting.

• Healthy carbohydrates, such as whole grains, fruits, and vegetables, are an important part of a healthy eating plan because they can provide both energy and nutrients, such as vitamins and minerals, and fiber. Fiber can help you prevent constipation, lower your cholesterol levels, and control your weight.

• Unhealthy carbohydrates are often food and drinks with added sugars. Although unhealthy carbohydrates can also provide energy, they have little to no nutrients.

The amount of carbohydrate in foods is measured in grams. To count grams of carbohydrate in foods you eat, you’ll need to

• know which foods contain carbohydrates
• learn to estimate the number of grams of carbohydrate in the foods you eat
• add up the number of grams of carbohydrate from each food you eat to get your total for the day

How can carbohydrate counting help you ?

Carbohydrate counting can help keep your blood glucose levels close to normal. Keeping your blood glucose levels as close to normal as possible may help you

• stay healthy longer
• prevent or delay diabetes problems such as kidney disease, blindness, nerve damage, and blood vessel disease that can lead to heart attacks, strokes, and amputations—surgery to remove a body part
• feel better and more energetic

Which foods contain carbohydrates ?

Foods that contain carbohydrates include :

• grains, such as bread, noodles, pasta, crackers, cereals, and rice
• fruits, such as apples, bananas, berries, mangoes, melons, and oranges
• dairy products, such as milk and yogurt
• legumes, including dried beans, lentils, and peas
• snack foods and sweets, such as cakes, cookies, candy, and other desserts
• juices, soft drinks, fruit drinks, sports drinks, and energy drinks that contain sugars
• vegetables, especially “starchy” vegetables such as potatoes, corn, and peas

Potatoes, peas, and corn are called starchy vegetables because they are high in starch. These vegetables have more carbohydrates per serving than nonstarchy vegetables.

Examples of nonstarchy vegetables are asparagus, broccoli, carrots, celery, green beans, lettuce and other salad greens, peppers, spinach, tomatoes, and zucchini.

Foods that do not contain carbohydrates include meat, fish, and poultry; most types of cheese; nuts; and oils and other fats.

What foods and drinks should you limit if you have diabetes ?

Foods and drinks to limit ³⁰ include:

• Fried foods and other foods high in saturated fat and trans fat
• Foods high in salt, also called sodium
• Reduce intake of chips, cookies, cakes, full-fat ice cream, etc.
• Cut back on high calorie snack foods and desserts.
• Sweets, such as baked goods, candy, and ice cream
• Beverages with added sugars, such as juice, regular soda, and regular sports or energy drinks
• Eating too much of even healthful foods can lead to weight gain.
• If you choose to drink alcohol, do so in moderation. (Two or less drinks per day for men and one or less drinks per day for women.)
• Watch your portion sizes.

Drink water instead of sweetened beverages. Consider using a sugar substitute in your coffee or tea.

If you drink alcohol, drink moderately—no more than one drink a day if you’re a woman or two drinks a day if you’re a man. If you use insulin or diabetes medicines that increase the amount of insulin your body makes, alcohol can make your blood glucose level drop too low. This is especially true if you haven’t eaten in a while. It’s best to eat some food when you drink alcohol.

What are added sugars ?

Added sugars are various forms of sugar added to foods or drinks during processing or preparation. Naturally occurring sugars such as those in milk and fruits are not added sugars but are carbohydrates. The most common sources of added sugars for Americans are:

• sugar-sweetened soft drinks, fruit drinks, sports drinks, and energy drinks
• grain-based desserts, such as cakes, cookies, and doughnuts
• milk-based desserts and products, such as ice cream, sweetened yogurt, and sweetened milk
• candy

Reading the list of ingredients for foods and drinks can help you find added sugars, such as

• sugar, raw sugar, brown sugar, and invert sugar—a mixture of fructose and glucose
• corn syrup and malt syrup
• high-fructose corn syrup, often used in soft drinks and juices
• honey, molasses, and agave nectar
• dextrose, fructose, glucose, lactose, and sucrose

For a healthier eating plan, limit foods and drinks with added sugars.

Healthy diabetic eating includes:

• Limiting foods that are high in sugar
• Eating smaller portions, spread out over the day
• Choose healthful foods to support a healthy weight and heart
• Being careful about when and how many carbohydrates you eat
• Eating a variety of whole-grain foods, fruits and vegetables every day
• Limiting your use of alcohol
• Using less salt

To successfully manage diabetes, you need to understand how foods and nutrition affect your body. Food portions and food choices are important. Carbohydrates, fat and protein need to be balanced to ensure blood sugar levels stay as stable as possible. (This is particularly important for people with Type 1 diabetes.)

The key to eating with diabetes is to eat a variety of healthy foods from all food groups, in the amounts your meal plan outlines. For that reason the American Diabetes Association has created:

• The Diabetic Diet Meal Plans ³¹ and
• A online tool called Create Your Plate ³². With Create Your Plate method, you fill your plate with more non-starchy veggies and smaller portions of starchy foods and protein—no special tools or counting required. You can practice with this interactive tool ³².

The American Diabetes Association’s Create Your Plate online interactive meal planning tool

The American Diabetes Association’s Create Your Plate online interactive meal planning tool divides your daily food requirements according to the percentage daily requirement for each major food groups: 25 percent Protein, 25 percent Grains and Starchy Foods and 50 percent Non-starchy Vegetables ³². Creating your plate lets you still choose the foods you want, but changes the portion sizes so you are getting larger portions of non-starchy vegetables and a smaller portion of starchy foods. The healthy meal combinations are endless.

Using the 7 simple steps to Create Your Plate ³² you can simply and effectively manage your diabetes and lose weight at the same time. When you are ready, you can try new foods within each food category.

Try these seven steps to get started:

1. Using your dinner plate, put a line down the middle of the plate. Then on one side, cut it again so you will have three sections on your plate.
2. Fill the largest section with non-starchy vegetables.
3. Now in one of the small sections, put grains and starchy foods.
4. And then in the other small section, put your protein.
5. Add a serving of fruit, a serving of dairy or both as your meal plan allows.
6. Choose healthy fats in small amounts. For cooking, use oils. For salads, some healthy additions are nuts, seeds, avocado and vinaigrettes.
7. To complete your meal, add a low-calorie drink like water, unsweetened tea or coffee.

The food groups are :

Vegetables

• Non-starchy Vegetables ³³
  

The following is a list of common non-starchy vegetables:

• Amaranth or Chinese spinach
• Artichoke
• Artichoke hearts
• Asparagus
• Baby corn
• Bamboo shoots
• Beans (green, wax, Italian)
• Bean sprouts
• Beets
• Brussels sprouts
• Broccoli
• Cabbage (green, bok choy, Chinese)
• Carrots
• Cauliflower
• Celery
• Chayote
• Coleslaw (packaged, no dressing)
• Cucumber
• Daikon
• Eggplant
• Greens (collard, kale, mustard, turnip)
• Hearts of palm
• Jicama
• Kohlrabi
• Leeks
• Mushrooms
• Okra
• Onions
• Pea pods
• Peppers
• Radishes
• Rutabaga
• Salad greens (chicory, endive, escarole, lettuce, romaine, spinach, arugula, radicchio, watercress)
• Sprouts
• Squash (cushaw, summer, crookneck, spaghetti, zucchini)
• Sugar snap peas
• Swiss chard
• Tomato
• Turnips
• Water chestnuts
• Yard-long beans

Generally, non-starchy vegetables have about 5 grams of carbohydrate in ½ cup cooked or 1 cup raw. Most of the carbohydrate is fiber so unless you eat more than 1 cup of cooked or 2 cups of raw at a time, you may not need to count the carbohydrates from the non-starchy vegetables.

The best choices are fresh, frozen and canned vegetables and vegetable juices without added sodium, fat or sugar.

If using canned or frozen vegetables, look for ones that say low sodium or no salt added on the label.
As a general rule, frozen or canned vegetables in sauces are higher in both fat and sodium.
If using canned vegetables with sodium, drain the vegetables and rinse with water. Then cook the rinsed vegetables in fresh water. This will cut back on how much sodium is left on the vegetables.

For good health, try to eat at least 3-5 servings of vegetables a day. This is a minimum and more is better! A serving of vegetables is:

• ½ cup of cooked vegetables or vegetable juice
• 1 cup of raw vegetables

• Starchy Starchy Vegetables and Grains ³⁴
  

Grains

• At least half of your grains for the day should be whole grains. A whole grain is the entire grain—which includes the bran, germ and endosperm (starchy part).

The most popular grain in the US is wheat so that will be our example. To make 100% whole wheat flour, the entire wheat grain is ground up. “Refined” flours like white and enriched wheat flour include only part of the grain – the starchy part, and are not whole grain. They are missing many of the nutrients found in whole wheat flour.

Examples of whole grain wheat products include 100% whole wheat bread, pasta, tortillas, and crackers. But don’t stop there! There are many whole grains to choose from.

Finding whole grain foods can be a challenge. Some foods only contain a small amount of whole grain but will say it contains whole grain on the front of the package. For all cereals and grains, read the ingredient list and look for the following sources of whole grains as the first ingredient:

Best Choices

• Bulgur (cracked wheat)
• Whole wheat flour/
• Whole oats/oatmeal
• Whole grain corn/corn meal
• Popcorn
• Brown rice
• Whole rye
• Whole grain barley
• Whole farro
• Wild rice
• Buckwheat
• Buckwheat flour
• Triticale
• Millet
• Quinoa
• Sorghum

If you suffer from Celiac disease or gluten intolerance :

• Celiac disease is a digestive disorder. When someone with celiac disease eats food containing gluten, their body reacts by damaging the small intestine. Uncomfortable symptoms such as abdominal pain often occur. The damage to the small intestine also interferes with the body’s ability to make use of the nutrients in food. About 1% of the total population has celiac disease. It is more common in people with type 1 diabetes. An estimated 10% of people with type 1 also have celiac. The only way to manage celiac disease is to completely avoid all foods that have gluten. Following a gluten-free diet will prevent permanent damage to your body and will help you feel better.

• Gluten Intolerance : There are also many people who are said to have a gluten intolerance. When these people eat foods that contain gluten, they also experience uncomfortable symptoms. However, they test negative for celiac disease and actual damage to their small intestine does not occur. More research about gluten intolerance is needed, but avoiding foods with gluten should help to relieve these symptoms.

Gluten is a protein found in wheat, rye, barley and all foods that are made with these grains.

Starchy Vegetables

Starchy vegetables are great sources of vitamins, minerals and fiber . The best choices do not have added fats, sugar or sodium.

Try a variety such as:

• Parsnip
• Plantain
• Potato
• Pumpkin
• Acorn squash
• Butternut squash
• Green Peas
• Corn

Best Choices of Dried Beans, Legumes, Peas and Lentils

Try to include dried beans into several meals per week. They are a great source of protein and are loaded with fiber, vitamins and minerals.

• Dried beans such as black, lima, and pinto
• Lentils
• Dried peas such as black-eyed and split
• Fat-free refried beans
• Vegetarian baked beans

Fruits ³⁵

Wondering if you can eat fruit ? Yes !

Fruits are loaded with vitamins, minerals and fiber just like vegetables.

Fruit contains carbohydrate so you need to count it as part of your meal plan. Having a piece of fresh fruit or fruit salad for dessert is a great way to satisfy your sweet tooth and get the extra nutrition you’re looking for.

The best choices of fruit are any that are fresh, frozen or canned without added sugars.

• Choose canned fruits in juice or light syrup
• Dried fruit and 100% fruit juice are also nutritious choices, but the portion sizes are small so they may not be as filling as other choices. Only 2 tablespoons of dried fruit like raisins or dried cherries contains 15 grams of carbohydrate so be cautious with your portion sizes!
• Includes oranges, melon, berries, apples, bananas, and grapes

For Carbohydrate Counters

• A small piece of whole fruit or about ½ cup of frozen or canned fruit has about 15 grams of carbohydrate. Servings for most fresh berries and melons are from ¾ – 1 cup.
• Fruit juice can range from 1/3 -1/2 cup for 15 grams of carbohydrate.

Fruit can be eaten in exchange for other sources of carbohydrate in your meal plan such as starches, grains, or dairy.

Protein ³⁶

The biggest difference among foods in this group is how much fat they contain, and for the vegetarian proteins, whether they have carbohydrate.

Meats do not contain carbohydrate so they do not raise blood glucose levels. A balanced meal plan usually has about 2-5 ounces of meat.

Most plant-based protein foods, like beans and soy products, and any breaded meats contain carbohydrate. It’s best to read food labels carefully for these foods.

In general there is about 15 grams of carbohydrate in ½ cup beans, and between 5 to 15 grams in soy-based products like veggie burgers and “chicken” nuggets.

The best choices are:

• Plant-based proteins
• Fish and seafood
• Chicken and other poultry
• Cheese and eggs

Fish and Seafood

Try to include fish at least 2 times per week.

• Fish high in omega-3 fatty acids like Albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon
• Other fish including catfish, cod, flounder, haddock, halibut, orange roughy, and tilapia
• Shellfish including clams, crab, imitation shellfish, lobster, scallops, shrimp, oysters.

Poultry

Choose poultry without the skin for less saturated fat and cholesterol.

• Chicken, turkey, cornish hen

Game

• Buffalo, ostrich, rabbit, venison
• Dove, duck, goose, or pheasant (no skin)

Beef, Pork, Veal, Lamb

If you decide to have these, choose the leanest options, which are:

• Select or Choice grades of beef trimmed of fat including: chuck, rib, rump roast, round, sirloin, cubed, flank, porterhouse, T-bone steak, tenderloin
• Beef jerky
• Lamb: chop, leg, or roast
• Organ meats: heart, kidney, liver
• Veal: loin chop or roast
• Pork: Canadian bacon, center loin chop, ham, tenderloin

Cheese and Eggs

• Reduced-fat cheese
• Cottage cheese
• Egg whites and egg substitutes

Dairy ³⁷

Including sources of dairy in your diet is an easy way to get calcium and high-quality protein.

The best choices of dairy products are:

• Fat-free or low-fat (1% milk)
• Plain non-fat yogurt (regular or Greek yogurt)
• non-fat light yogurt (regular or Greek yogurt)
• unflavored fortified soy milk

If you are lactose intolerant or don’t like milk, you may want to try fortified soy milk, rice milk, or almond milk as a source of calcium and vitamin D.

Tips for Carb Counters

• 1 cup of milk or yogurt is equal to 1 small piece of fruit or 1 slice of bread
• Each 1 cup serving of milk or 6 ounce serving of yogurt has about 12 grams of carbohydrate and 8 grams of protein. Greek yogurt is higher in protein than regular yogurt, with about 12 grams per 6 ounce serving.
• If you are trying to switch to lower fat dairy products, take the time to get used to the taste and texture difference. For example, first change from whole milk to 2%. Then to 1% or non-fat milk.
• Switching from whole to 1% milk will save you 70 calories and 4 grams of saturated fat in every serving!

Eat more fiber by eating more whole-grain foods ³⁸. Whole grains can be found in:

• Breakfast cereals made with 100% whole grains.
• Oatmeal.
• Whole grain rice.
• Whole-wheat bread, bagels, pita bread, and tortillas.

What Can you Drink ?

Food often takes center stage when it comes to diabetes. But don’t forget that the beverages you drink can also have an effect on your weight and blood glucose!

The American Diabetes Association recommends choosing zero-calorie or very low-calorie drinks ³⁹. This includes:

• Water
• Unsweetened teas
• Coffee no added sugar
• Diet soda
• Other low-calorie drinks and drink mixes

You can also try flavoring your water with a squeeze of lemon or lime juice for a light, refreshing drink with some flavor. All of these drinks provide minimal calories and carbohydrate. If you choose to drink juice, be sure the label says it is 100% juice with no sugar added. Juice provides a lot of carbohydrates in a small portion, so be sure to count it in your meal plan. Usually about 4 ounces or less of juice contains 15 grams of carbohydrate and 50 or more calories.

What to Avoid

Avoid sugary drinks like regular soda, fruit punch, fruit drinks, energy drinks, sweet tea, and other sugary drinks. These will raise blood glucose and can provide several hundred calories in just one serving! See for yourself:

• One 12-ounce can of regular soda has about 150 calories and 40 grams of carbohydrate. This is the same amount of carbohydrate in 10 teaspoons of sugar!
• One cup of fruit punch and other sugary fruit drinks have about 100 calories (or more) and 30 grams of carbohydrate.

Make your calories count with these nutritious foods:

• Healthy carbohydrates. During digestion, sugars (simple carbohydrates) and starches (complex carbohydrates) break down into blood glucose. Focus on the healthiest carbohydrates, such as fruits, vegetables, whole grains, legumes (beans, peas and lentils) and low-fat dairy products.
• Fiber-rich foods. Dietary fiber includes all parts of plant foods that your body can’t digest or absorb. Fiber moderates how your body digests and helps control blood sugar levels. Foods high in fiber include vegetables, fruits, nuts, legumes (beans, peas and lentils), whole-wheat flour and wheat bran.
• Heart-healthy fish. Eat heart-healthy fish at least twice a week. Fish can be a good alternative to high-fat meats. For example, cod, tuna and halibut have less total fat, saturated fat and cholesterol than do meat and poultry. Fish such as salmon, mackerel, tuna, sardines and bluefish are rich in omega-3 fatty acids, which promote heart health by lowering blood fats called triglycerides. Avoid fried fish and fish with high levels of mercury, such as tilefish, swordfish and king mackerel.
• “Good” fats. Foods containing monounsaturated and polyunsaturated fats can help lower your cholesterol levels. These include avocados, almonds, pecans, walnuts, olives, and canola, olive and peanut oils. But don’t overdo it, as all fats are high in calories.

The glycemic index, or GI, measures how a carbohydrate-containing food raises blood glucose. Foods are ranked based on how they compare to a reference food — either glucose or white bread.

A food with a high GI raises blood glucose more than a food with a medium or low GI.

Meal planning with the GI involves choosing foods that have a low or medium GI. If eating a food with a high GI, you can combine it with low GI foods to help balance the meal.

Examples of carbohydrate-containing foods with a low GI include dried beans and legumes (like kidney beans and lentils), all non-starchy vegetables, some starchy vegetables like sweet potatoes, most fruit, and many whole grain breads and cereals (like barley, whole wheat bread, rye bread, and all-bran cereal).

Meats and fats don’t have a GI because they do not contain carbohydrate.

Low GI Foods (55 or less)

• 100% stone-ground whole wheat or pumpernickel bread
• Oatmeal (rolled or steel-cut), oat bran, muesli
• Pasta, converted rice, barley, bulgar
• Sweet potato, corn, yam, lima/butter beans, peas, legumes and lentils
• Most fruits, non-starchy vegetables and carrots

Medium GI (56-69)

• Whole wheat, rye and pita bread
• Quick oats
• Brown, wild or basmati rice, couscous

High GI (70 or more)

• White bread or bagel
• Corn flakes, puffed rice, bran flakes, instant oatmeal
• Shortgrain white rice, rice pasta, macaroni and cheese from mix
• Russet potato, pumpkin
• Pretzels, rice cakes, popcorn, saltine crackers
• melons and pineapple

What Affects the GI of a Food ?

Fat and fiber tend to lower the GI of a food. As a general rule, the more cooked or processed a food, the higher the GI; however, this is not always true.

Below are a few specific examples of other factors that can affect the GI of a food:

• Ripeness and storage time — the more ripe a fruit or vegetable is, the higher the GI.
• Processing — juice has a higher GI than whole fruit; mashed potato has a higher GI than a whole baked potato, stone ground whole wheat bread has a lower GI than whole wheat bread.
• Cooking methods — how long a food is cooked (al dente pasta has a lower GI than soft-cooked pasta), frying, boiling and baking.
• Fibre: wholegrains and high-fibre foods act as a physical barrier that slows down the absorption of carbohydrate. This is not the same as ‘wholemeal’, where, even though the whole of the grain is included, it has been ground up instead of left whole. For example, some mixed grain breads that include wholegrains have a lower GI than wholemeal or white bread.
• Fat lowers the GI of a food. For example, chocolate has a medium GI because of it’s fat content, and crisps will actually have a lower GI than potatoes cooked without fat.
• Protein lowers the GI of food. Milk and other diary products have a low GI because they are high in protein and contain fat.
• Variety — converted long-grain white rice has a lower GI than brown rice but short-grain white rice has a higher GI than brown rice.

Your food choices matter a lot when you’ve got diabetes. Some are better than others.

Nothing is completely off limits. Even items that you might think of as “the worst” could be occasional treats — in tiny amounts. But they won’t help you nutrition-wise, and it’s easiest to manage your diabetes if you mainly stick to the “best” options.

What is the difference between Glycemic Index (GI) and Glycemic Load (GL) ?

Your blood glucose rises and falls when you eat a meal containing carbs. How high it rises and how long it remains high depends on the quality of the carbohydrates (the GI) and the quantity (the serve size). Glycemic load or GL combines both the quality and quantity of carbohydrate in one ‘number’. It’s the best way to predict blood glucose values of different types and amounts of food.

The formula is:
GL = (GI x available carbohydrate in a 100g serving) divided by 100.

Let’s take a single apple as an example.
It has a GI of 40 and it contains 15 grams of carbohydrate.
GL = 40 x 15/100 = 6 g

What about a small baked potato?
Its GI is 80 and it contains 15 g of carbohydrate.
GL = 80 x 15/100 = 12 g

You can think of GL as the amount of carbohydrate in a food “adjusted” for its glycemic potency.

• Low GL = <10
• Medium GL = 11-19
• High GL = >20

Therefore the Glycemic Load takes into account the amount of carbohydrate consumed and is a more accurate measure of the impact of a food on blood sugars. As a general rule foods that have a low GL usually have a low GI and those with a medium to high GL value almost always have a very high GI value.

Here is an abbreviated chart of the glycemic index and glycemic load, per serving, for more than 100 common foods.

The complete list of the glycemic index and glycemic load for more than 1,000 foods can be found in the article “International tables of glycemic index and glycemic load values: 2008” by Fiona S. Atkinson, Kaye Foster-Powell, and Jennie C. Brand-Miller in the December 2008 issue of Diabetes Care, Vol. 31, number 12, pages 2281-2283. (Source ⁴⁰).

Benefits of Low Glycaemic Index or Low Glycaemic Load Diets for Diabetes Mellitus

To assess the effects of low glycaemic index or low glycaemic load, diets on glycaemic control in people with diabetes, eleven relevant randomised controlled trials, lasting 1 to 12 months, involving 402 participants were analysed ⁴¹.

There was a significant decrease in the glycated haemoglobin A1c (HbA1c) -0.5%. Episodes of hypoglycaemia were significantly fewer with low glycaemic index or low glycaemic load compared to high GI diet in one trial (difference of -0.8 episodes per patient per month), and proportion of participants reporting more than 15 hyperglycaemic episodes per month was lower for low-GI diet compared to measured carbohydrate exchange diet in another study (35% versus 66%). No study reported on mortality, morbidity or costs. The review authors concluded a low-GI diet can improve glycaemic control in diabetes without compromising hypoglycaemic events ⁴¹. This result is consistent with another smaller trial involving eight type 2 diabetes mellitus patients who were given carbohydrate foods with either a high or low glycemic index over a 2 weeks period ⁴².

I) Starches

Your body needs carbs. But you want to choose wisely. Use this list as a guide.

Best Choices

• Whole grains, such as brown rice, oatmeal, quinoa, millet, or amaranth
• Baked sweet potato
• Items made with whole grains and no (or very little) added sugar

Worst Choices

• Processed grains, such as white rice or white flour
• Cereals with little whole grains and lots of sugar
• White bread
• French fries
• Fried white-flour tortillas

II) Vegetables

Load up! You’ll get fiber and very little fat or salt (unless you add them).  Remember, potatoes and corn count as carbs.

Best Choices

• Fresh veggies, eaten raw or lightly steamed, roasted, or grilled
• Plain frozen vegetables, lightly steamed
• Greens such as kale, spinach, and arugula. Iceberg lettuce is not as great, because it’s low in nutrients.
• Low sodium or unsalted canned vegetables
• Go for a variety of colors: dark greens, red or orange (think of carrots or red peppers), whites (onions) and even purple (eggplants). The 2015 U.S. guidelines recommend 2.5 cups of veggies per day.

Worst Choices

• Canned vegetables with lots of added sodium
• Veggies cooked with lots of added butter, cheese, or sauce
• Pickles, if you need to limit sodium — otherwise, pickles are okay.
• Sauerkraut, for the same reason as pickles — so, limit them if you have high blood pressure

Vegetarian Diets Linked to Lower Mortality

Adults who eat a more plant-based diet may be boosting their chance of living longer, according to a large analysis.

Researchers studied more than 73,000 Seventh-day Adventist men and women ages 25 and older ⁴³. The participants were categorized into dietary groups at the time of recruitment based on their reported food intake during the previous year. Nearly half of the participants were nonvegetarian, eating red meat, poultry, fish, milk and eggs more than once a week. Of the remaining, 8% were vegan (eating red meat, fish, poultry, dairy or eggs less than once a month); 29% were lacto-ovo vegetarians (eating eggs and/or dairy products, but red meat, fish or poultry less than once per month); 10% were pesco-vegetarians (eating fish, milk and eggs but rarely red meat or poultry); and 5% were semi-vegetarian (eating red meat, poultry and fish less than once per week).

Over about 6 years, there were 2,570 deaths among the participants. The researchers found that vegetarians (those with vegan, and lacto-ovo-, pesco-, and semi-vegetarian diets) were 12% less likely to die from all causes combined compared to nonvegetarians. The death rates for subgroups of vegans, lacto-ovo–vegetarians, and pesco-vegetarians were all significantly lower than those of nonvegetarians.

Those on a vegetarian diet tended to have a lower rate of death due to cardiovascular disease, diabetes, and renal disorders such as kidney failure. No association was detected in this study between diet and deaths due to cancer. The researchers also found that the beneficial associations between a vegetarian diet and mortality tended to be stronger in men than in women.

The researchers note several limitations to the study. Participants only reported their diet at the beginning of the study, and their eating patterns might have changed over time. In addition, they were only followed for an average of 6 years; it may take longer for dietary patterns to influence mortality ⁴³.

III) Fruits

They give you carbohydrates, vitamins, minerals, and fiber. Most are naturally low in fat and sodium. But they tend to have more carbs than vegetables do.

Best Choices

• Fresh fruit
• Plain frozen fruit or fruit canned without added sugar
• Sugar-free or low-sugar jam or preserves
• No-sugar-added apple sauce

Worst Choices

• Canned fruit with heavy sugar syrup
• Chewy fruit rolls
• Regular jam, jelly, and preserves (unless you have a very small portion)
• Sweetened apple sauce
• Fruit punch, fruit drinks, fruit juice drinks

IV) Protein

You have lots of choices, including beef, chicken, fish, pork, turkey, seafood, beans, cheese, eggs, nuts, and tofu.

Best Choices

The American Diabetes Association lists these as the top options:

• Plant-based proteins, such as beans, nuts, seeds, or tofu
• Fish and seafood
• Chicken and other poultry (Choose the breast meat if possible.)
• Eggs and low-fat dairy

If you eat meat, keep it low in fat. Trim the skin off poultry.

Try to include some plant-based protein from beans, nuts, or tofu, even if you’re not a vegetarian or vegan. You’ll get nutrients and fiber that aren’t in animal products.

Worst Choices

• Fried meats
• Higher-fat cuts of meat, such as ribs
• Pork bacon
• Regular cheeses
• Poultry with skin
• Deep-fried fish
• Deep-fried tofu
• Beans prepared with lard

V) Dairy

Keep it low in fat. If you want to splurge, keep your portion small.

Best Choices

• 1% or skim milk
• Low-fat yogurt
• Low-fat cottage cheese
• Low-fat or nonfat sour cream

Worst Choices

• Regular yogurt
• Regular cottage cheese
• Regular sour cream
• Regular ice cream
• Regular half-and-half

VI) Fats, Oils, and Sweets

They’re tough to resist. But it’s easy to get too much and gain weight, which makes it harder to manage your diabetes.

Best Choices

• Natural sources of vegetable fats, such as nuts, seeds, or avocados (high in calories, so keep portions small)
• Foods that give you omega-3 fatty acids, such as salmon, tuna, or mackerel
• Plant-based oils, such as canola, grapeseed, or olive oils

Worst Choices

• Anything with artificial trans fat in it. It’s bad for your heart. Check the ingredient list for anything that’s “partially hydrogenated,” even if the label says it has 0 grams of trans fat.

VII) Drinks

When you down a favorite drink, you may get more calories, sugar, salt, or fat than you bargained for. Read the labels so you know what’s in a serving.

Best Choices

• Water, unflavored or flavored sparkling water
• Unsweetened tea (add a slice of lemon)
• Coffee, black or with added low-fat milk and sugar substitute

Worst Choices

• Light beer, small amounts of wine, or non-fruity mixed drinks
• Regular sodas
• Regular beer, fruity mixed drinks, dessert wines
• Sweetened tea
• Coffee with sugar and cream
• Flavored coffees and chocolate drinks
• Energy drinks

The 1200 Calories Diabetic Diet (Low Calorie Diet)

The 1200 calorie diet is a low-calorie diet (LCD) ⁴⁴. The 1200 calorie diet is not used for diabetics or as a substitute to healthy diabetic diet outline above, instead the 1200 calories diet (low-calorie diet) is used mainly to treat obesity and for weight loss.

A typical LCD may provide:

• 1,000–1,200 calories/day for a woman
• 1,200–1,600 calories/day for a man

The number of calories may be adjusted based on your age, weight, and how active you are. A 1200 calorie diet is a low-calorie diet usually consists of regular foods, but could also include meal replacements. As a result, you may find this type of diet much easier to follow than a very low calorie diet. In the long term, 1200 calorie diet is a low-calorie diets have been found to lead to the same amount of weight loss as very low calorie diets (VLCDs) ⁴⁴.

• Traditional American Cuisine (non-diabetic) : 1,200 Calories

(Source ⁴⁵).

In a multi-center, randomized controlled trial, designed to determine whether intentional weight loss reduces cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes ⁴⁶. The study involving a total of 5,145 participants, with a mean age of 60 years and body mass index of 36.0 kg/m2 (obese), who have been randomly assigned to a lifestyle intervention or to enhanced usual care condition (i.e., Diabetes Support and Education).

In that Look AHEAD study ⁴⁶, the participants were instructed to do unsupervised at home moderately-intense physical activity to ≥ 175 minutes a week (engage in brisk walking or similar aerobic activity). And are encouraged to replace two meals and one snack a day with liquid shakes and meal bars.

As part of the dietary intervention ⁴⁶, participants are instructed to eat a self-selected diet of conventional foods but restrict their intake of fat as a mean to reduce total calories. They are prescribed < 30% of calories from fat, with < 10% from saturated fat. This is similar to the diet prescribed in the the Diabetes Prevention Program ⁴⁷.

• The energy goal for persons < 114 kg (250 lb) is 1200−1500 kcal/d and
• 1500−1800 kcal/d for individuals ≥ 114 kg.
• Participants count calories and fat grams with the aid of a booklet provided.

Portion control: During weeks 3−19, a portion-controlled meal plan is prescribed to facilitate participants’ adherence to their calorie goals. All individuals are encouraged to replace two meals (typically breakfast and lunch) with a liquid shake and one snack with a bar ⁴⁸. They are to consume an evening meal of conventional foods (which includes the option of frozen food entrees) and to add fruits and vegetables to their diet until they reach their daily calorie goal. Participants potentially can choose from four meal replacements, including SlimFast (SlimFast Foods), Glucerna (Ross Laboratories), OPTIFAST (Novartis Nutrition) and HMR (HMR, Inc.). All products are provided free of charge. Persons who decline meal replacements are provided detailed menu plans that specify conventional foods to be consumed. A variety of meals are offered but all are intended to control portion sizes and calories. From weeks 20−22, participants decrease their use of meal replacements while increasing the consumption of conventional foods.

Rationale for portion control: Meal replacements were included, within a diet of 1200−1500 kcal/d, because they significantly increase weight loss compared with prescribing isocaloric diets comprised of conventional foods ⁴⁸. A meta-analysis of six randomised control trials showed that liquid meal replacements induced a loss approximately 3 kg greater than that produced by a conventional diet ⁴⁹. Obese individuals typically underestimate their calorie intake by 40%−50% when consuming a diet of conventional foods ⁵⁰ because of difficulty in estimating portion sizes, macronutrient composition, and calorie content, as well as in remembering all foods consumed. Meal replacements appear to decrease these difficulties and simplify food choices. Portion-controlled servings of conventional foods similarly facilitate weight loss, as shown by Jeffery and Wing ⁵¹, and other investigators ⁵², ⁵³. Ultimately, simply providing patients detailed menu plans, with accompanying shopping lists, provides sufficient structure to significantly increase weight loss ⁵⁴.

Look AHEAD investigators initially were concerned that the high sugar content of some meal replacement products might adversely affect glycemic control. This concern, however, was alleviated by findings in patients with type 2 diabetes that a meal-replacement plan (that included SlimFast) was associated with significantly greater weight losses and reductions in fasting blood sugar than was a conventional reducing diet with the same calorie goal ⁵⁵. Additional studies found that when participants achieved significant negative energy balance, as expected in Look AHEAD, short-term gylcemic control improved, independent of weight loss ⁵⁶, ⁵⁷.

Conclusion of the Look AHEAD Study: The Look AHEAD’s Intensive Lifestyle Intervention produced clinically meaningful weight loss (≥5%) at year 8 in 50% of patients with type 2 diabetes and can be used to manage other obesity-related co-morbid conditions.

The Diabetes Prevention Program trial ⁴⁷ was a major multicenter clinical research study aimed at discovering whether modest weight loss through dietary changes and increased physical activity or treatment with the oral diabetes drug metformin (Glucophage) could prevent or delay the onset of type 2 diabetes in study participants. At the beginning of the Diabetes Prevention Program trial, participants were all overweight and had blood glucose, also called blood sugar, levels higher than normal but not high enough for a diagnosis of diabetes—a condition called prediabetes.

In the DPP, participants from 27 clinical centers around the United States were randomly divided into different treatment groups. The first group, called the lifestyle intervention group, received intensive training in diet, physical activity, and behavior modification. By eating less fat and fewer calories and exercising for a total of 150 minutes a week, they aimed to lose 7 percent of their body weight and maintain that loss.

The second group took 850 mg of metformin twice a day. The third group received placebo pills instead of metformin. The metformin and placebo groups also received information about diet and exercise but no intensive motivational counseling. A fourth group was treated with the drug troglitazone (Rezulin), but this part of the study was discontinued after researchers discovered that troglitazone can cause serious liver damage. The participants in this group were followed but not included as one of the intervention groups.

All 3,234 study participants (1,079 randomized to lifestyle intervention) were overweight and had prediabetes, averaged 51 years of age at baseline, with 20% aged ≥60 years; 68% were women, 55% were Caucasian. Which are well-known risk factors for the development of type 2 diabetes. In addition, 45 percent of the participants were from minority groups-African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander-at increased risk of developing diabetes.

The calorie goals were calculated by estimating the daily calories needed to maintain the participant’s starting weight and subtracting 500–1,000 calories/day (depending on initial body weight) to achieve a 1–2 pound per week weight loss. The fat goals, given in grams of fat per day, were based on 25% of calories from fat. The fat and calorie goals were used as a means to achieve the weight loss goal rather than as a goal in and of itself. Therefore, if a participant reported consuming more than the calorie or fat goal but was losing weight as planned, the coach did not emphasize greater calorie or fat reduction. Participants were encouraged to gradually achieve the fat and calorie levels through better choices of meals and snack items, healthier food preparation techniques, and careful selection of restaurants, including fast food, and the items offered. Four standard calorie levels were used:

• 1,200 kcal/day (33 g fat) for participants with an initial body weight of 120–170 lbs,
• 1,500 kcal/day (42 g fat) for participants with a body weight of 175–215 lbs,
• 1,800 kcal/day (50 g fat) for participants with a body weight of 220–245 lbs and
• 2,000 kcal/ day (55 g fat) for participants weighing >250 lbs.

In the Diabetes Prevention Program trial ⁴⁷ the goal for physical activity was selected to approximate at least 700 kcal/week expenditure from physical activities. For ease of translation to participants, this goal was described as at least 150 min of moderate physical activities similar in intensity to brisk walking. This goal was adopted for the Diabetes Prevention Program trial because it was determined to be achievable and likely to be beneficial in preventing diabetes based on previous studies.

Conclusion of the DPP trial: The DPP’s results indicate that millions of high-risk people can delay or avoid developing type 2 diabetes by losing weight through regular physical activity and a diet low in fat and calories. Weight loss and physical activity lower the risk of diabetes by improving the body’s ability to use insulin and process glucose. The DPP also suggests that taking metformin can help delay the onset of diabetes, although less dramatically ⁵⁸.

Vegetarian Diets and Diabetes

More and more people are choosing to follow a vegetarian diet for many different reasons. It’s estimated that two per cent of the population now don’t eat meat or fish ⁵⁹.

Reasons for switching to a vegetarian diet include:

• the health benefits
• ethical and moral reasons
• religious or cultural reasons
• concern for animal welfare
• concern about the environment and sustainability
• taste – some people just don’t like the taste of meat or fish.

A vegetarian diet, based on unprocessed foods, can provide many health benefits for us all, whether or not you have diabetes.

If you have diabetes, it’s important to be more aware of how what you eat affects your body and, in turn, you’ll hopefully become more health conscious.

So what is a vegetarian diet ? Are there any ways it could help manage diabetes ? Does it provide any health benefits for people with diabetes ?

For advice and help with what to eat and including vegetarian recipes go to the Vegetarian Society ⁶⁰.

What is a vegetarian ?

According to the Vegetarian Society ⁶¹, a vegetarian is:

• “Someone who lives on a diet of grains, pulses, legumes, nuts, seeds, vegetables, fruits, fungi, algae, yeast and/or some other non-animal-based foods (e.g. salt) with, or without, dairy products, honey and/or eggs. A vegetarian does not eat foods that consist of, or have been produced with the aid of products consisting of or created from, any part of the body of a living or dead animal. This includes meat, poultry, fish, shellfish*, insects, by-products of slaughter** or any food made with processing aids created from these.”
• * Shellfish are typically ‘a sea animal covered with a shell’. We take shellfish to mean; Crustaceans (hard external shell) e.g. lobsters, crayfish, crabs, prawns, shrimps; Molluscs (most are protected by a shell) e.g. mussels, oysters, winkles, limpets, clams, etc. Also includes cephalopods such as cuttlefish, squid, octopus.
• ** By-products of slaughter includes gelatine, isinglass and animal rennet.
• Eggs: Many lacto-ovo vegetarians will only eat free-range eggs. This is because of welfare objections to the intensive farming of hens. Through its Vegetarian Society Approved trademark scheme, the Vegetarian Society will only license its trademark to products containing free-range eggs where eggs are used.

There are different types of vegetarians:

• Lacto-ovo-vegetarians eat both dairy products and eggs (usually free range). This is the most common type of vegetarian diet ⁶².
• Lacto-vegetarians eat dairy products, but avoid eggs.
• Ovo-vegetarian. Eats eggs but not dairy products.
• Vegans do not any products derived from animals – no meat, fish, dairy or eggs.

For advice and help with what to eat and including vegetarian recipes go to the Vegetarian Society ⁶⁰.

It is important to keep an eye on portions sizes of high-fat foods such as cheese and nuts or you might find yourself putting on weight. With the increased risk of cardiovascular disease in people with diabetes, keeping your weight under control and reducing blood pressure and blood cholesterol are all essential and plant-based foods can help with these.

Why you may try a vegetarian diet ?

Plant-based foods, particularly fruit and vegetables, nuts, pulses and seeds have been shown to help in the treatment of many chronic diseases and are often associated with lower rates of Type 2 diabetes, less hypertension, lower cholesterol levels and reduced cancer rates ⁶³.

These foods are also higher in fibre, antioxidants, folate and phytochemicals, which are all good for our general health.

Vegetarian diets have been shown to be beneficial for people with Type 2 diabetes where weight loss is often the most effective way to manage the condition. A wholefood vegetarian diet often contains fewer calories and can help you to maintain a healthy body weight.

In a review of scientific publications from 1946- December 2013, it was found that the consumption of vegetarian diets was associated with a significant reduction in HbA1c and a non-significant reduction in fasting blood glucose concentration ⁶⁴.

In another randomised study with 74 patients with type 2 diabetes, who were given either calorie restricted (-500 kcal/day) vegetarian diet (37 subjects) or calorie restricted (-500 kcal/day) conventional diabetic diet (37 subjects) over 24 weeks ⁶⁵. In the second 12 weeks of the study, the calorie restricted diets were combined with aerobic exercise. Participants were examined at baseline, 12 weeks and 24 weeks. Forty-three per cent of participants in the calorie restricted (-500 kcal/day) vegetarian diet group and 5% of participants in the calorie restricted (-500 kcal/day) conventional diabetic diet group reduce their diabetes medication. Body weight decreased more in the calorie restricted vegetarian diet group (-6.2 kg) than in the calorie restricted conventional diabetic diet group (-3.2 kg). An increase in insulin sensitivity was significantly greater in the calorie restricted vegetarian diet group than in the calorie restricted conventional diabetic diet group. A reduction in both visceral and subcutaneous fat was greater in the calorie restricted vegetarian diet group than in the calorie restricted conventional diabetic diet group. Plasma adiponectin increased (a protein hormone produced and secreted exclusively by adipocytes (fat cells) that regulates the metabolism of lipids and glucose. High blood levels of adiponectin are associated with a reduced risk of heart attack. Low levels of adiponectin are found in people who are obese (and who are at increased risk of a heart attack) and leptin decreased (a hormone produced mainly by adipocytes (fat cells) that is involved in the regulation of body fat. Leptin interacts with areas of the brain that control hunger and behavior and signals that the body has had enough to eat. Leptin tells your brain that you have enough energy stored in your fat cells to engage in normal) in the calorie restricted vegetarian diet group, with no change in the calorie restricted conventional diabetic diet group. Differences between groups were greater after the addition of exercise training. Changes in insulin sensitivity and enzymatic oxidative stress markers correlated with changes in visceral fat ⁶⁵.

Low Calorie Diet on Weight Loss and the Metabolic Profile of Obese Patients with Type 2 Diabetes Mellitus

A small study ⁶⁶ with 60 patients (23 males and 37 postmenopausal females) who have type 2 diabetes and are obese, to compare the effects of low calorie diet (1800 kcal/day) plus intensive insulin therapy (4 insulin injections/day) versus low calorie diet (1800 kcal/day) plus conventional insulin therapy (2/3 insulin injections/day). At 6 months post-interventions, there were significant reductions were observed in the body weight, body mass index (BMI), HbA1c for all participants and cholesterol. At 1 year, median body weight reduction was 4.5 kg for patients on low calorie diet (1800 kcal/day) plus intensive insulin therapy and 4.8 kg for those on low calorie diet (1800 kcal/day) plus conventional insulin therapy. The conclusion was a 12-month 1800-kcal low calorie dietary intervention achieved significant body weight loss and HbA1c reductions irrespectively of insulin regimen. The  low calorie diet (1800 kcal/day) plus conventional insulin therapy was associated with body weight loss greater than 8.0%, whereas low calorie diet (1800 kcal/day) plus intensive insulin therapy was associated with higher rates of normoglycemia ⁶⁶.

Very Low Calorie Diet in Obese Type 2 Diabetes

A small study was conducted with fifty-one obese subjects (24 with diabetes and 27 obese without diabetes) to compare weight loss and change in body composition in obese subjects with and without type 2 diabetes mellitus during a very-low-calorie diet (VLCD) program ⁶⁷. After 24 weeks of intervention, there was no difference in weight loss between the 2 groups. Both groups completing the study per protocol had near-identical weight change during the program, with similar weight loss at 24 weeks (diabetes: 8.5 ± 1.3 kg vs control: 9.4 ± 1.2 kg). Change in fat mass index correlated with change in body mass index (BMI) in both groups, but change in fat mass index per unit change in BMI was less in the diabetic group compared with controls, which persisted after adjusting for age, sex, and baseline BMI. Insulin concentrations remained higher and peak β-hydroxybutyrate concentrations were lower in the diabetic compared with the control group. The conclusion was while following a 24-week very-low-calorie diet program, obese subjects with and without diabetes achieved comparable weight loss; but the decrease in body fat per unit weight loss was less in diabetic subjects. Hyperinsulinemia may have inhibited lipolysis in the diabetic group; however, further investigation into other factors is needed ⁶⁷.

Low Carbohydrate Low Calorie Diet in type 2 Diabetes

In a very small study ⁶⁸ comparing the effects of low carbohydrate low calorie diet (1800 kcal for men and 1600 kcal for women, distributed as 20 % carbohydrates, 30 % protein and 50 % fat) and high carbohydrate low calorie diet (1600-1800 kcal for men and 1400-1600 kcal for women, consisted of approximately 60 % carbohydrates, 15 % protein and 25 % fat) in two groups of obese patients with type 2 diabetes. The diets were tested with regard to glycaemic control and bodyweight. A group of 16 obese patients with type 2 diabetes was advised on a low-carbohydrate diet,  Fifteen obese diabetes patients on a high-carbohydrate diet were control group. Positive effects on the glucose levels were seen very soon. After 6 months a marked reduction in bodyweight of patients in the low-carbohydrate diet group was observed, and this remained one year later. After 6 months the mean changes in the low-carbohydrate group and the control (high carbohydrate low calorie diet) group respectively were fasting blood glucose: -3.4 and -0.6 mmol/l; HBA1c: -1.4 % and -0.6 %; Body Weight: -11.4 kg and -1.8 kg; BMI: -4.1 kg/m2 and -0.7 kg/m2. In conclusion, a low-carbohydrate diet is an effective tool in the treatment of obese patients with type 2 diabetes ⁶⁸.

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23. Cereal fiber improves whole-body insulin sensitivity in overweight and obese women. Weickert MO, Möhlig M, Schöfl C, Arafat AM, Otto B, Viehoff H, Koebnick C, Kohl A, Spranger J, Pfeiffer AF. Diabetes Care. 2006 Apr; 29(4):775-80. https://www.ncbi.nlm.nih.gov/pubmed/16567814/
24. Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Qi L, van Dam RM, Liu S, Franz M, Mantzoros C, Hu FB. Diabetes Care. 2006 Feb; 29(2):207-11. https://www.ncbi.nlm.nih.gov/pubmed/16443861/
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33. American Diabetes Association. Non-starchy Vegetables. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/non-starchy-vegetables.html
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35. American Diabetes Association. Fruits. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/fruits.html
36. American Diabetes Association. Protein Foods. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/meat-and-plant-based-protein.html
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38. Centers for Disease Control and Prevention. Managing Diabetes: Eat Right ! https://www.cdc.gov/diabetes/managing/eatright.html
39. American Diabetes Association. What Can I Drink ? http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/what-can-i-drink.html
40. Diabetes Care 2008 Dec; 31(12): 2281-2283. https://doi.org/10.2337/dc08-1239. International Tables of Glycemic Index and Glycemic Load Values: 2008. http://care.diabetesjournals.org/content/31/12/2281.full
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42. Am J Clin Nutr. 1988 Aug;48(2):248-54. Low-glycemic-index starchy foods in the diabetic diet. https://www.ncbi.nlm.nih.gov/pubmed/3407604
43. JAMA Intern Med. 2013;173(13):1230-1238. doi:10.1001/jamainternmed.2013.6473. Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2. http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1710093
44. The National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center. Very Low-calorie Diets. https://www.niddk.nih.gov/health-information/weight-management/very-low-calorie-diets
45. National Institutes of Health. Traditional American Cuisine: 1,200 Calories. https://www.nhlbi.nih.gov/health/educational/lose_wt/eat/menus_tac_1200.htm
46. Obesity (Silver Spring). 2006 May; 14(5): 737–752. doi: 10.1038/oby.2006.84. The Look AHEAD Study: A Description of the Lifestyle Intervention and the Evidence Supporting It. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613279/
47. Diabetes Care. 2002 Dec; 25(12): 2165–2171. The Diabetes Prevention Program (DPP), Description of lifestyle intervention. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282458/
48. Metabolic and weight-loss effects of a long-term dietary intervention in obese patients. Ditschuneit HH, Flechtner-Mors M, Johnson TD, Adler G. Am J Clin Nutr. 1999 Feb; 69(2):198-204.https://www.ncbi.nlm.nih.gov/pubmed/9989680/
49. Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Heymsfield SB, van Mierlo CA, van der Knaap HC, Heo M, Frier HI. Int J Obes Relat Metab Disord. 2003 May; 27(5):537-49. https://www.ncbi.nlm.nih.gov/pubmed/12704397/
50. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. Lichtman SW, Pisarska K, Berman ER, Pestone M, Dowling H, Offenbacher E, Weisel H, Heshka S, Matthews DE, Heymsfield SB. N Engl J Med. 1992 Dec 31; 327(27):1893-8. https://www.ncbi.nlm.nih.gov/pubmed/1454084/
51. Strengthening behavioral interventions for weight loss: a randomized trial of food provision and monetary incentives. Jeffery RW, Wing RR, Thorson C, Burton LR, Raether C, Harvey J, Mullen M. J Consult Clin Psychol. 1993 Dec; 61(6):1038-45. https://www.ncbi.nlm.nih.gov/pubmed/8113481/
52. A randomized trial of improved weight loss with a prepared meal plan in overweight and obese patients: impact on cardiovascular risk reduction. Metz JA, Stern JS, Kris-Etherton P, Reusser ME, Morris CD, Hatton DC, Oparil S, Haynes RB, Resnick LM, Pi-Sunyer FX, Clark S, Chester L, McMahon M, Snyder GW, McCarron DA. Arch Intern Med. 2000 Jul 24; 160(14):2150-8. https://www.ncbi.nlm.nih.gov/pubmed/10904458/
53. Nutritionally complete prepared meal plan to reduce cardiovascular risk factors: a randomized clinical trial. Haynes RB, Kris-Etherton P, McCarron DA, Oparil S, Chait A, Resnick LM, Morris CD, Clark S, Hatton DC, Metz JA, McMahon M, Holcomb S, Snyder GW, Pi-Sunyer FX, Stern JS. J Am Diet Assoc. 1999 Sep; 99(9):1077-83. https://www.ncbi.nlm.nih.gov/pubmed/10491676/
54. Food provision vs structured meal plans in the behavioral treatment of obesity. Wing RR, Jeffery RW, Burton LR, Thorson C, Nissinoff KS, Baxter JE. Int J Obes Relat Metab Disord. 1996 Jan; 20(1):56-62. https://www.ncbi.nlm.nih.gov/pubmed/8788323/
55. Liquid meal replacements and glycemic control in obese type 2 diabetes patients. Yip I, Go VL, DeShields S, Saltsman P, Bellman M, Thames G, Murray S, Wang HJ, Elashoff R, Heber D. Obes Res. 2001 Nov; 9 Suppl 4():341S-347S. https://www.ncbi.nlm.nih.gov/pubmed/11707563/
56. Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients. Wing RR, Blair EH, Bononi P, Marcus MD, Watanabe R, Bergman RN. Diabetes Care. 1994 Jan; 17(1):30-6. https://www.ncbi.nlm.nih.gov/pubmed/8112186/
57. The effect of short periods of caloric restriction on weight loss and glycemic control in type 2 diabetes. Williams KV, Mullen ML, Kelley DE, Wing RR. Diabetes Care. 1998 Jan; 21(1):2-8. https://www.ncbi.nlm.nih.gov/pubmed/9538962/
58. N Engl J Med. 2002 Feb 7;346(6):393-403. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. https://www.ncbi.nlm.nih.gov/pubmed/11832527
59. Dietary intake and nutritional status of young vegans and omnivores in Sweden. Larsson CL, Johansson GK. Am J Clin Nutr. 2002 Jul; 76(1):100-6. https://www.ncbi.nlm.nih.gov/pubmed/12081822/
60. The Vegetarian Society. https://www.vegsoc.org/food
61. The Vegetarian Society. https://www.vegsoc.org/
62. The Vegetarian Society. https://www.vegsoc.org/definition
63. Diabetes UK. Vegetarian diets and diabetes. https://www.diabetes.org.uk/Guide-to-diabetes/Enjoy-food/Eating-with-diabetes/vegetarian-diets/
64. Cardiovasc Diagn Ther. 2014 Oct; 4(5): 373–382. doi: 10.3978/j.issn.2223-3652.2014.10.04. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221319/
65. Diabet Med. 2011 May;28(5):549-59. doi: 10.1111/j.1464-5491.2010.03209.x. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes. https://www.ncbi.nlm.nih.gov/pubmed/21480966
66. Adv Ther. 2016 Mar;33(3):447-59. doi: 10.1007/s12325-016-0300-2. Epub 2016 Feb 17. Obese Patients with Type 2 Diabetes on Conventional Versus Intensive Insulin Therapy: Efficacy of Low-Calorie Dietary Intervention. https://www.ncbi.nlm.nih.gov/pubmed/26886777
67. Metabolism. 2012 Jun;61(6):873-82. doi: 10.1016/j.metabol.2011.10.017. Epub 2011 Dec 5. Less fat reduction per unit weight loss in type 2 diabetic compared with nondiabetic obese individuals completing a very-low-calorie diet program. https://www.ncbi.nlm.nih.gov/pubmed/22146094?dopt=Abstract
68. Ups J Med Sci. 2005;110(1):69-73. Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes–a brief report. https://www.ncbi.nlm.nih.gov/pubmed/15801687?dopt=Abstract

What are Carbs (Carbohydrate) ?

There are three main types of carbohydrate (carbs) in food.

1. Starches (also known as complex carbohydrates)
2. Sugars
3. Fiber

You’ll also hear terms like naturally occurring sugar, added sugar, low-calorie sweeteners, sugar alcohols, reduced-calorie sweeteners, processed grains, enriched grains, complex carbohydrate, sweets, refined grains and whole grains.

No wonder knowing what kind and how much carbohydrate to eat can be confusing !

On the nutrition label, the term “total carbohydrate” includes all three types of carbohydrates. This is the number you should pay attention to if you are carbohydrate counting for your low carb dieting.

What happens when you eat foods containing carbohydrates ?

When you eat foods containing carbohydrates, your digestive system breaks down the sugars and starches into glucose. Glucose is one of the simplest forms of sugar. Glucose then enters your bloodstream from your digestive tract and raises your blood glucose levels. The hormone insulin, which comes from the pancreas or from insulin shots, helps cells throughout your body absorb glucose and use it for energy. Once glucose moves out of the blood into cells, your blood glucose levels go back down.

How much carbohydrate do you need each day ?

How much carbohydrate you eat is very individual. Finding the right amount of carbohydrate depends on many things including how active you are (sedentary lifestyle or elite athlete), your body weight (healthy weight or overweight or obese) and what, if any, medicines you take. Some people are active and can eat more carbohydrate. You may need to have less carbohydrate to keep your blood glucose in control ¹.

The daily amount of carbohydrate ~ 130 grams of carbohydrate / day, (protein, and fat) for Americans can be found in the U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015 ². Experts suggest that carbohydrate intake for most people should be between 45 and 65 percent of total calories. People on low-calorie diets and people who are physically inactive may want to aim for the lower end of that range ².

You and your health care team can figure out the right amount for you. Once you know how much carb to eat at a meal, choose your food and the portion size to match.

Table of Daily Dietary Reference Intake for Carbohydrate, Protein and Fat (source ²).

However, the daily amount of carbohydrate, protein, and fat for people with diabetes has not been defined—what is best for one person may not be best for another. Everyone needs to get enough carbohydrate to meet the body’s needs for energy, vitamins and minerals, and fiber. Finding the balance for yourself is important so you can feel your best, do the things you enjoy, and lower your risk of diabetes complications. A place to start is at about 45-60 grams of carbohydrate at a meal. You may need more or less carbohydrate at meals depending on how you manage your diabetes ¹.

One gram of carbohydrate provides about 4 calories, so you’ll have to divide the number of calories you want to get from carbohydrates by 4 to get the number of grams. For example, if you want to eat 1,800 total calories per day and get 45 percent of your calories from carbohydrates, you would aim for about 200 grams of carbohydrate daily.

You would calculate that amount as follows:

.45 x 1,800 calories = 810 calories
810 ÷ 4 = 202.5 grams of carbohydrate

You’ll need to spread out your carbohydrate intake throughout the day. A dietitian or diabetes educator can help you learn what foods to eat, how much to eat, and when to eat based on your weight, activity level, medicines, and blood glucose targets.

• Nutrition Labels

You can find out how many grams of carbohydrate are in the foods you eat by checking the nutrition labels on food packages.

Nutrition labels tell you

• the food’s serving size––such as one slice or 1/2 cup
• the total grams of carbohydrate per serving
• other nutrition information, including calories and the amount of protein and fat per serving

If you have two servings instead of one, such as one cup of pinto beans instead of 1/2 cup, you multiply the number of grams of carbohydrate in one serving—for example, 15—by two to get the total number of grams of carbohydrate—30.

15 x 2 = 30

Following is an example of a nutrition label:

How can you find out how much carbohydrate is in the foods you eat ?

To find out the amount of carbohydrate in homemade foods, you’ll need to estimate and add up the grams of carbohydrate from the ingredients. You can use books or websites that list the typical carbohydrate content of homemade items to estimate the amount of carbohydrate in a serving.

You can also weigh foods with a scale or measure amounts with measuring cups or spoons to estimate the amount of carbohydrate. For example, if a nutrition label shows that 1 1/2 cups of cereal contain 45 grams of carbohydrate, then 1/2 cup will have 15 grams of carbohydrate and 1 cup will have 30 grams of carbohydrate.

You will need to learn to estimate the amount of carbohydrate in foods you typically eat. For example, the following amounts of carbohydrate-rich foods each contain about 15 grams of carbohydrate:

• one slice of bread
• one 6-inch tortilla
• 1/3 cup of pasta
• 1/3 cup of rice
• 1/2 cup of canned or fresh fruit or fruit juice or one small piece of fresh fruit, such as a small apple or orange
• 1/2 cup of pinto beans
• 1/2 cup of starchy vegetables such as mashed potatoes, cooked corn, peas, or lima beans
• 3/4 cup of dry cereal or 1/2 cup cooked cereal
• 1 tablespoon of jelly
• 1 small piece of fresh fruit (4 oz)
• 1/2 cup of canned or frozen fruit
• 1 slice of bread (1 oz) or 1 (6 inch) tortilla
• 1/2 cup of oatmeal
• 1/3 cup of pasta or rice
• 4-6 crackers
• 1/2 English muffin or hamburger bun
• 1/2 cup of black beans or starchy vegetable
• 1/4 of a large baked potato (3 oz)
• 2/3 cup of plain fat-free yogurt or sweetened with sugar substitutes
• 2 small cookies
• 2 inch square brownie or cake without frosting
• 1/2 cup ice cream or sherbet
• 1 Tbsp syrup, jam, jelly, sugar or honey
• 2 Tbsp light syrup
• 6 chicken nuggets
• 1/2 cup of casserole
• 1 cup of soup
• 1/4 serving of a medium french fry

Some foods are so low in carbohydrates that you may not have to count them unless you eat large amounts. For example, most nonstarchy vegetables are low in carbohydrates. A 1/2-cup serving of cooked nonstarchy vegetables or a cup of raw vegetables has only about 5 grams of carbohydrate.

As you become familiar with which foods contain carbohydrates and how many grams of carbohydrate are in food you eat, carbohydrate counting will be easier.

What is Low Carb Diet

A low-carbohydrate diet was first characterized by William Banting in the 1860s ³) and this type of diet has currently received much attention due to Dr. Atkins’ New Diet Revolution ⁴). The Atkins’ Diet recommends two weeks of extreme carbohydrate restriction, followed by gradually increasing carbohydrates to 35 g/day. The Atkins’ Diet has 68% of total calories from fat, 27% from protein, and 5% from carbohydrates ⁵. Other popular low-carbohydrate diets are summarized in Table 1.

Low-carbohydrate diets recommend limiting complex and simple sugars, causing the body to oxidize fat to meet energy requirements. During the initial carbohydrate restriction, the body resorts to ketosis for energy needs. Ketones are excreted in the urine with fluid. Rapid initial weight loss may be from this diuretic effect ⁵, which can be encouraging.

In a small randomized, controlled trial with 120 overweight comparing low-carbohydrate ketogenic diet (also known as low-carb high fat diet) versus a low-fat diet over 24 weeks to treat obesity and hyperlipidemia involving hyperlipidemic volunteers from the community ⁶. Participants in the low-carb ketogenic diet were restricted to intake of carbohydrates to less than 20 g/d and were permitted unlimited amounts of animal foods (meat, fowl, fish, and shellfish), unlimited eggs, 4 oz of hard cheese, 2 cups of salad vegetables (such as lettuce, spinach, or celery), and 1 cup of low-carbohydrate vegetables (such as broccoli, cauliflower, or squash) daily. On the other hand the low-fat diet group was restricted to  less than 30% of daily energy intake from fat, less than 10% of daily energy intake from saturated fat, and less than 300 mg of cholesterol daily and calorie intake was 500 to 1000 kcal less than the participant’s calculated energy intake for weight maintenance. Restriction of dietary intake of carbohydrates (low-carbohydrate ketogenic diet) to less than 40 g/d typically results in ketonuria that is detectable by urine dipstick analysis, which can be used to monitor adherence to the low-carbohydrate diet. Patients in both groups lost substantially more fat mass (change, -9.4 kg with the low-carbohydrate ketogenic diet vs. -4.8 kg with the low-fat diet) than lean body mass (change, -3.3 kg vs. -2.4 kg, respectively) (see Figure 1 below). Low-carbohydrate ketogenic diet had greater decreases in serum triglyceride levels and greater increases in high-density (HDL) “good” lipoprotein cholesterol levels. Changes in low-density (LDL) “bad” lipoprotein cholesterol level did not differ statistically between the diets. Minor adverse effects were more frequent in the low-carbohydrate diet group, such as constipation, headache, halitosis, muscle cramps, diarrhea, general weakness and rash ⁶.

Figure 1. Body weight loss over 24 weeks, by diet group. LFD: Low Fat Diet and LCKD: Low Carb Ketogenic Diet (Source ⁶)

A drastic reduction in carbohydrates also leads to an overall decrease in caloric intake ⁷. Even when calories are not actively restricted, low-carbohydrate dieters consume fewer calories compared with baseline ⁸. Weight loss can be sustained by this reduction in caloric intake. Although palatable for the short term, low-carbohydrate diets raise several nutritional and cardiovascular concerns, as summarized in Table 2.

Table 2 summarizes the positive and negative aspects of low-carbohydrate diets. Adapted from data in references ⁴), ⁹, ¹⁰, ¹¹.

Low-Carb Diet: Can it help you lose weight ?

A low-carb diet limits carbohydrates — such as those found in grains, starchy vegetables and fruit — and emphasizes foods high in protein and fat. Many types of low-carb diets exist. Each diet has varying restrictions on the types and amounts of carbohydrates you can eat.

A low-carb diet is generally used for losing weight. Some low-carb diets may have health benefits beyond weight loss, such as reducing risk factors associated with diabetes and metabolic syndrome.

Research shows Americans have increased their carb consumption in recent years, but they’re not eating the right kind of carbohydrates. They’re not eating a lot more fruit. They’re eating a lot more liquid calories, such as sweet juice-like drinks and sodas.

Terms such as “low carb” or “net carbs” often appear on product labels, but the Food and Drug Administration (FDA) doesn’t regulate these terms, so there’s no standard meaning. Typically net carbs is used to mean the amount of carbohydrates in a product excluding fiber or excluding both fiber and sugar alcohols. To add to the confusion, there is no legal definition of what “low-carb” means. Any food or beverage product that says “low-carb” on the label is technically breaking the law, but the FDA has generally only issued a warning letter to offenders.

Therefore, any definition of low-, reduced-, or net carb is entirely up to the manufacturer. And manufacturers are using this terminology, and it really doesn’t mean anything. But one thing is clear: low-carb doesn’t mean low calorie !

You probably have also heard talk about the glycemic index. The glycemic index classifies carbohydrate-containing foods according to their potential to raise your blood sugar level.

Weight-loss diets based on the glycemic index typically recommend limiting foods that are higher on the glycemic index. Foods with a relatively high glycemic index ranking include potatoes and corn, and less healthy options such as snack foods and desserts that contain refined flours. Many healthy foods, such as whole grains, legumes, vegetables, fruits and low-fat dairy products, are naturally lower on the glycemic index.

Although low fat and energy-restricted diets are generally recommended for obese and overweight individuals ¹², ¹³ 1S- 40S. http://onlinelibrary.wiley.com/doi/10.1038/oby.2001.113/abstract;jsessionid=BE222215A3449DCE32557CA68A507841.f03t03)), low-carbohydrate, high-protein diets are one of the most popular alternative weight loss approaches ¹⁴. However, because low carbohydrate diets derive large proportions of calories from protein and fat, there has been considerable concern for their potentially detrimental impact on cardiovascular risk ¹⁵. Increased consumption of fat, particularly saturated fat, has been linked to increased plasma concentrations of lipids ¹⁶, ¹⁷, ¹⁸, ¹⁹, insulin resistance, glucose intolerance ²⁰, ²¹, and obesity ²², ²³. Therefore, it is possible that many Americans could actually suffer adverse health effects by using very low carbohydrate diets in an attempt to lose weight.

To evaluate the effects of a very low carbohydrate diet on weight loss and cardiovascular risk factors, the researchers ²⁴ randomized 53 healthy obese women to 6 months of a very low carbohydrate diet or a calorie-restricted, low fat diet conforming to the guidelines currently recommended by the American Heart Association and other expert panels ²⁵.

In that randomized clinical trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women ²⁴. One group of dieters was instructed to follow a low carb diet of their own choosing with a maximum intake of 20 g carbohydrate/day. It was anticipated that this diet would induce ketosis. After 2 wk of dieting, subjects were permitted to increase their intake of carbohydrate to 40–60 g/d only if self-testing of urinary ketones continued to indicate ketosis. The other group of dieters was instructed on a calorie-restricted, moderately low fat diet with a recommended macronutrient distribution of 55% carbohydrate, 15% protein, and 30% fat. Calorie prescriptions were based on body size and calculated using the Harris-Benedict equation ²⁶.

Two registered dietitians delivered a 3-month intervention aimed at promoting dietary compliance. Group meetings with subjects on the same diet were held biweekly on the University of Cincinnati campus and addressed cooking tips, stress management, behavior modification, and relapse prevention. On alternating weeks, subjects met for individual counseling sessions during which their assigned dietitian reviewed their 3-day food records from the previous week, analyzed by Nutritionist V (First Data Bank, San Bruno, CA), and provided dietary recommendations and positive reinforcement. Subjects were advised to continue their baseline level of activity. To control for possible bias, each dietitian was assigned subjects from each diet group for counseling and alternated as the meeting facilitator for both groups of dieters. Before each weekly session, subjects submitted 3-day food records and were weighed on a single electronic scale. Blood pressure was measured, and assessment of urinary ketones was performed using Ketostix. At the end of the 3-month intervention, subjects were instructed to continue with their weight loss efforts, but without scheduled contact with the dietitians until the 6-month assessment.

Results: Body weight and body fat in the low fat and very low carbohydrate groups were similar at baseline. Although caloric intakes in the two groups were similar, the proportions of carbohydrate, protein, and fat consumed differed dramatically.

• After the initiation of the diets, both groups had a decrease in body weight that was more rapid in the earlier weeks of observation and became less pronounced as the study progressed (see Low Carb Diet vs Low Fat Diet – Weight Loss Graph below). Most diets that have a significant restriction of calories cause a sodium diuresis or was due to decreased body water, presumably accompanying depletion of stored glycogen, that occurs over the first wk or 2 of their use ²⁷, ²⁸. In fact, it was noted the most rapid weight loss in both groups occur over this period. The low fat diet group lost 1.6 kg in the first 2 wk, representing 38% of their mean weight loss during the first 3 months of the study. The very low carbohydrate group lost 3.0 kg during the first 2 wk, or 39% of their mean 3-month weight loss. In analyzing the body composition at 3 and 6 months of dieting, well after the expected period of diuresis – the analysis of body composition showed that the weight lost in the very low carbohydrate diet group consisted of a similar percentage of fat mass as in the low fat diet group. Thus, the authors think it is very unlikely that differences in weight between the two groups at 3 and 6 months are a result of disproportionate changes in body water in the very low carbohydrate dieters.

(Source ²⁴).

• Both fat mass and fat-free mass decreased significantly in the two groups over the course of the trial. However, similar to body weight, fat mass and lean body mass decreased significantly more in the very low carbohydrate group compared with the low fat group at both 3 and 6 months. The reduced fat mass comprised 50–60% of the weight lost in both groups. There were no changes in bone mineral content over the course of the study. Body composition data for the two groups of women are shown in Table 3. The women in the very low carbohydrate group lost an average of 7.6 ± 0.7 kg after 3 months and 8.5 ± 1.0 kg after 6 months of diet. Women following the low fat diet lost 4.2 ± 0.8 and 3.9 ± 1.0 kg at 3 and 6 months, respectively.
• Cardiovascular risk factors: There were no electrocardiographic (EKG) abnormalities in any of the subjects during the study. The blood pressures in the two groups were within the normal range at the outset of the study and remained so throughout the study. Significant differences in blood pressure were not found between the groups during the study.
• Plasma Lipids: Mean plasma concentrations of total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol were normal in each of the two groups before starting the diets. A significant reduction was found for plasma triglycerides (148.73 (mg/dl) at baseline to 113.86 (mg/dl) a 23.44 percent reduction in 6 months; Low Fat Diet Group 109.25 (mg/dl) at baseline to 111.00 (mg/dl) unchanged in 6 months) , but the researchers put the significant difference in triglycerides was probably due to a difference between the groups at baseline. Differences in total cholesterol and HDL cholesterol between the groups were not detected at the 3- or 6-month assessments. Significantly were the diet effects for all of the plasma lipids indicated that the subjects improved their lipid profiles during the course of the study, with significant decreases in total cholesterol, LDL cholesterol, and triglycerides at 3 months and significant increases in HDL cholesterol at 6 months.

• Fasting hormones and substrates: Fasting glucose and insulin did not differ between the two groups at the 3- or 6-month assessments. However, significant time effects for glucose and insulin indicate that the glucose and insulin levels decreased significantly in the women on both diets over the 6-month study. There were no differences in leptin levels between the two groups. Yet a significant time effect shows that plasma leptin levels decreased significantly in both groups of subjects at 3 months. A significant difference between the groups was detected for plasma β-hydroxybutyrate, with this ketone increasing significantly more in the very low carbohydrate group at 3 months. Weekly testing of urinary ketones was positive in the majority of subjects on the very low carbohydrate diet and negative in those on the low fat diet.

• At 3 months, caloric intake in the very low carbohydrate diet group was distributed as 15% carbohydrate, 28% protein, and 57% fat.
• In contrast, the low fat diet group had daily calories distributed as 54% carbohydrate, 18% protein, and 28% fat.
• At 3 months, the very low carbohydrate diet group consumed significantly less carbohydrate, vitamin C, and fiber and significantly more protein, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, and cholesterol than the low fat diet group.
• At 6 months, the two groups still differed significantly for most of these measures.
• 42 of the 53 subjects (79%) completed the 6-month study, with 4 dropouts from the very low carbohydrate diet group and 7 dropouts from the low fat diet group. The majority of subjects discontinuing the study cited difficulty maintaining the scheduled visits as the primary reason, and follow-up measurements were obtained for only 1 of the these women. For subjects missing a follow-up visit, their last recorded weight is included in the calculation of the group mean. One subject from each diet group dropped out due to dislike for their assigned diet.

Summary: The results of this study demonstrate that a very low carbohydrate diet, taken without a specified restriction of caloric intake, is effective for weight loss over a 6-month period in healthy, obese women. However, the mechanism of the enhanced weight loss in the very low carbohydrate diet group relative to the low fat diet group is not clear. One possibility could be that the very low carbohydrate group could be consuming approximately 300 fewer calories/day over the first 3 months relative to the low fat diet group and that it is possible also that the women in the very low carbohydrate diet group exercised more than those in the low fat diet group. Additionally, it is possible that consuming a very low carbohydrate diet increases resting basal metabolic rate (Resting BMR) or postprandial energy expenditure. Although it has been proposed that ketosis developing from severe carbohydrate intake contributes to a decrease in appetite ²⁹. Although the women following the very low carbohydrate diet developed significant ketonemia, the elevation of circulating β-hydroxybutyrate was mild, well below what is seen in other clinical states of ketosis, such as starvation and diabetic ketoacidosis ³⁰, ³¹ and was noted only at 3 months. In addition, there was no correlation between the level of plasma β-hydroxybutyrate and weight loss.

In addition, despite eating a high percentage of calories as fat and having relatively high intakes of saturated fat and cholesterol, the women in the very low carbohydrate group maintained normal levels of blood pressure, plasma lipids, glucose, and insulin. These data suggest that the deleterious effects of diets containing a high percentage of fat on body weight and cardiac risk factors are mitigated by restriction of caloric intake and associated weight loss.

Several points of caution need to be emphasized. Firstly, whether the very low carbohydrate diet will produce sustained weight loss and continued improvement in cardiovascular risk factors over longer periods of time remains to be determined. Secondly, increased dietary saturated fat has been linked to certain types of cancer ³² and may have effects on cardiovascular health beyond the risk factors assessed in this study ¹⁸.

The possibility that differences in the macronutrient composition of the diet alter energy expenditure is an interesting question that bears further investigation ⁴), ⁹, ¹⁰, ¹¹.

A recent meta-analysis ³³ of randomized controlled trials comparing the effects of low-carbohydrate diets without restriction of energy intake vs low-fat diets in individuals with a body mass index (calculated as weight in kilograms divided by the square of height in meters) of at least 25 on weight loss, blood pressure, and their lipid values in randomized controlled trials with diet interventions for at least 6 months. The review comparing the effects of a low-carbohydrate diet (defined as a diet allowing a maximum intake of 60 g of carbohydrates per day) without energy intake restriction vs a low-fat diet (defined as a diet allowing a maximum of 30% of the daily energy intake from fat) with energy intake restriction in individuals with a body mass index (BMI) of at least 25. The review conclusions were that low-carbohydrate, non–energy-restricted diets appear to be at least as effective as low-fat, energy-restricted diets in inducing weight loss for up to 1 year. However, potential favorable changes in triglyceride and high-density lipoprotein (HDL) cholesterol values should be weighed against potential unfavorable changes in low-density lipoprotein (LDL) cholesterol values when low-carbohydrate diets to induce weight loss are considered.

In another small randomised controlled trial involving 132 severely obese subjects (including 77 blacks and 23 women) with a mean body-mass index (BMI) of 43 kg/m2 and a high prevalence of diabetes (39 percent) or the metabolic syndrome (43 percent) to a carbohydrate-restricted (low-carbohydrate) diet or a calorie- and fat-restricted (low-fat) diet ³⁴. Out of the seventy-nine subjects who completed the six-month study showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet (-5.8 kg vs. -1.9 kg) and had greater decreases in triglyceride levels (-20 percent vs. -4 percent), irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications. Insulin sensitivity, measured only in subjects without diabetes, also improved more among subjects on the low-carbohydrate diet. The amount of weight lost and assignment to the low-carbohydrate diet were independent predictors of improvement in triglyceride levels and insulin sensitivity ³⁴.

Four randomized, controlled clinical trials (Table 4) have compared low-carbohydrate diets with low-fat diets ³⁵, ³⁶, ³⁷, ³⁸, ³⁹. Although the trials differed in design, all found an average of 4 to 6 kg greater weight loss in the low-carbohydrate group at six months. However, the two studies followed to one year showed no significant weight difference ⁴⁰, ⁴¹.

Low-carbohydrate diets may increase HDL cholesterol, decrease triglyceride levels, and improve glycemic control, but there appears to be no significant difference in weight loss compared with a low-fat diet at one year. Because the longest trial extends to one year with relatively few subjects, more studies are required to assess the efficacy of a low-carbohydrate diet on long-term weight loss and cardiovascular outcomes ⁴².

Although there is no consensus on what appropriate attrition rates for clinical trials of diets should be, attrition rates of 24% to 39% (Table 4) point to the difficulty of following a low-carbohydrate diet over time. Only in one six-month trial ⁴³ was the attrition rate in the low-carbohydrate group significantly lower than that in the low-fat group.

CHO = carbohydrate.

Low-Carbohydrate Diets versus Low-Fat Diets on Metabolic Risk Factors

Over the past several decades, low-fat diets have been recommended to the public for weight loss primarily because of their beneficial effects on metabolic risk factors ⁴⁷.

In a meta-analysis of 23 randomized controlled trials across multiple countries with a total of 2,788 participants ⁴⁸ comparing the effects of low-carbohydrate diets (≤45% of energy from carbohydrates) versus low-fat diets (≤30% of energy from fat) on metabolic risk factors (cholesterol, body weight, waist circumference, systolic blood pressure, fasting blood glucose) over a period of 6 months or more. ⁴⁸. The outcome of this study was that both diets were equally effective at reducing body weight and waist circumference. Both diets reduced participants’ blood pressures, total to HDL cholesterol ratios, and total cholesterol, LDL cholesterol, triglycerides, blood glucose, and serum insulin levels and raised HDL cholesterol; however, participants on low-carbohydrate diets had greater increases in HDL cholesterol and greater decreases in triglycerides but experienced less reduction in total and LDL cholesterol compared with persons on low-fat diets.

The weighted mean changes in outcomes were, compared with participants on low-fat diets, those on low-carbohydrate diets experienced slightly but statistically significantly less reduction in total cholesterol and LDL cholesterol but a greater increase in HDL cholesterol and a greater decrease in triglycerides. Pooled mean net changes in systolic blood pressure, ratio of total to HDL cholesterol and fasting blood glucose were not significantly different between the 2 diets. The pooled mean net changes in diastolic blood pressures and serum insulin were also not significant (see data in table below).

(Source ⁴⁷).

The results for lowering in blood pressure and lipids are consistent with those of a meta-analysis of randomized trials of Low-Carbohydrate vs Low-Fat dietary interventions conducted by Nordmann et al. in 2006 ⁴⁹. In that study (477 participants with BMI greater than 25) found that low-carbohydrate diets produced significantly greater weight loss (weighted mean difference, -3.3 kg) after 6 months than did low-fat diets, although the differences were not statistically significant at 1 year. There were no differences in blood pressure. Triglyceride and high-density lipoprotein cholesterol values changed more favorably in individuals assigned to low-carbohydrate diets (after 6 months, for triglycerides, weighted mean difference, -22.1 mg/dL; and for high-density (HDL) lipoprotein cholesterol, weighted mean difference, 4.6 mg/dL, but total cholesterol and low-density (LDL) lipoprotein cholesterol values changed more favorably in individuals assigned to low-fat diets (weighted mean difference in low-density lipoprotein cholesterol after 6 months, 5.4 mg/dL ⁴⁹.

Low Carb Diet details

As the name says, a low-carb diet restricts the type and amount of carbohydrates you eat. Carbohydrates are a type of calorie-providing macronutrient found in many foods and beverages.

Many carbohydrates occur naturally in plant-based foods, such as grains. In natural form, carbohydrates can be thought of as complex and fibrous such as the carbohydrates found in whole grains and legumes, or they can be less complex such as those found in milk and fruit. Common sources of naturally occurring carbohydrates include:

• Grains
• Fruits
• Vegetables
• Milk
• Nuts
• Seeds
• Legumes (beans, lentils, peas)

Food manufacturers also add refined carbohydrates to processed foods in the form of flour or sugar. These are generally known as simple carbohydrates. Examples of foods that contain simple carbohydrates are white breads and pasta, cookies, cake, candy, and sugar-sweetened sodas and drinks.

Your body uses carbohydrates as its main fuel source. Sugars and starches are broken down into simple sugars during digestion. They’re then absorbed into your bloodstream, where they’re known as blood sugar (glucose). Fiber-containing carbohydrates resist digestion and although they have less effect on blood sugar, complex carbohydrates provide bulk and serve other body functions beyond fuel.

Rising levels of blood sugar trigger the body to release insulin. Insulin helps glucose enter your body’s cells. Some glucose is used by your body for energy, fueling all of your activities, whether it’s going for a jog or simply breathing. Extra glucose is usually stored in your liver, muscles and other cells for later use or is converted to fat. People who are resistant to insulin have a higher risk of prediabetes and type 2 diabetes.

The idea behind the low-carb diet is that decreasing carbs lower insulin levels, which causes the body to burn stored fat for energy and ultimately leads to weight loss.

Why you might follow a low-carb diet

You might choose to follow a low-carb diet because:

• You want a diet that restricts certain carbs to help you lose weight,
• You want to change your overall eating habits,
• You enjoy the types and amounts of foods featured in low-carb diets.

Understanding carbohydrates

Carbohydrates are a type of macronutrient found in many foods and beverages. Most carbohydrates are naturally occurring in plant-based foods, such as grains. Food manufacturers also add carbohydrates to processed foods in the form of starch or added sugar.

Think of carbs as raw material that powers your body. They come in two types: simple and complex. What’s the difference ? Simple carbs are like quick-burning fuels. They break down fast into sugar in your system. You want to eat less of this type.

Complex carbs are usually a better choice. It takes your body longer to break them down.

Common sources of naturally occurring carbohydrates include:

• Fruits
• Vegetables
• Milk
• Nuts
• Grains
• Seeds
• Legumes

Types of carbohydrates

There are three main types of carbohydrates:

1. Sugar. Sugar is the simplest form of carbohydrates. Sugar occurs naturally in some foods, including fruits, vegetables, milk and milk products. Sugars include fruit sugar (fructose), table sugar (sucrose) and milk sugar (lactose).
2. Starch. Starch is a complex carbohydrate, meaning it is made of many sugar units bonded together. Starch occurs naturally in vegetables, grains, and cooked dry beans and peas.
3. Fiber. Fiber also is a complex carbohydrate. Fiber occurs naturally in fruits, vegetables, whole grains, and cooked dry beans and peas.

Typical foods for a low-carb diet

In general, a low-carb diet focuses on proteins, including meat, poultry, fish and eggs, and some nonstarchy vegetables. A low-carb diet generally excludes or limits most grains, legumes, fruits, breads, sweets, pastas and starchy vegetables, and sometimes nuts and seeds. Some low-carb diet plans allow small amounts of certain fruits, vegetables and whole grains.

A daily limit of 60 to 130 grams of carbohydrates is typical with a low-carb diet. These amounts of carbohydrates provide 240 to 520 calories.

Some low-carb diets greatly restrict carbs during the initial phase of the diet and then gradually increase the number of allowed carbs. Very low-carb diets restrict carbohydrates to 60 grams or less a day.

In contrast, the Dietary Guidelines for Americans recommend that carbohydrates make up 45 to 65 percent of your total daily calorie intake. So if you consume 2,000 calories a day, you would need to eat between 900 and 1,300 calories a day from carbohydrates or between 225 and 325 grams of carbohydrates a day.

Choosing carbohydrates wisely

Carbohydrates are an essential part of a healthy diet, and they also provide many important nutrients. Still, not all carbs are created equal. Here’s how to make healthy carbohydrates work in a balanced diet:

• Limit added sugars. Added sugar probably isn’t harmful in small amounts. But there’s no health advantage to consuming any amount of added sugar. In fact, too much added sugar, and in some cases naturally occurring sugar, can lead to such health problems as tooth decay, poor nutrition and weight gain. The chemical name for table sugar is sucrose. Other names you might see include fructose, dextrose, and maltose. The higher up they appear in the ingredients list, the more added sugar the food has.
• Emphasize fiber-rich fruits and vegetables. Aim for whole fresh, frozen and canned fruits and vegetables without added sugar. They’re better options than are fruit juices and dried fruits, which are concentrated sources of natural sugar and therefore have more calories. Also, whole fruits and vegetables add fiber, water and bulk, which help you feel fuller on fewer calories. Plus, most are a good source of nutrients like vitamin C and potassium. Fruits with skins you can eat, such as pears, apples, and berries, are especially high in fiber.
• Choose whole grains. Whole grains are better sources of fiber and other important nutrients, such as selenium, potassium and magnesium, than are refined grains. Refined grains go through a process that strips out parts of the grain — along with some of the nutrients and fiber.
• Eat more beans and legumes. Legumes, which include beans, peas and lentils, are among the most versatile and nutritious foods available. Legumes are typically low in fat; contain no cholesterol; and are high in folate, potassium, iron and magnesium. They also have beneficial fats and soluble and insoluble fiber. Because they’re a good source of protein, legumes can be a healthy substitute for meat, which has more saturated fat and cholesterol.

Results

1) Low Carb Atkins Diet vs Zone Diet vs LEARN Diet vs Ornish Diet for Weight loss

In a 2007 study ⁵⁰, where researchers randomly assigned 311 individuals to four groups: one group was assigned the high-fat, high-protein and low-carbohydrate (Atkins diet); the second was assigned Ornish’s very low-fat vegetarian diet, which requires consuming fewer than 10 percent of calories from fat; the third was assigned the Zone diet, which aims for a 40/30/30 percent distribution of carbohydrate, protein and fat (macronutrient balance); and the fourth was assigned the high-carbohydrate, low–saturated fat LEARN (for: lifestyle, exercise, attitudes, relationships, nutrition) diet. Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up. Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non–high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The participants all had trouble adhering to their regimens, but all lost about the same statistically significant amounts of weight, and when compared head to head, the Atkins dieters saw greater improvements in blood pressure and HDL cholesterol than the Ornish dieters did.

Results ⁵⁰: Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets. Mean 12-month weight loss was as follows:

• Atkins, −4.7 kg ( −6.3 to −3.1 kg),
• Zone, −1.6 kg (−2.8 to −0.4 kg),
• LEARN, −2.6 kg (−3.8 to −1.3 kg), and
• Ornish, −2.2 kg (−3.6 to −0.8 kg).
• Weight loss was not statistically different among the Zone, LEARN, and Ornish groups.
• At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups.

Conclusions  ⁵⁰: In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss.

Most people can lose weight on diet plans that restrict calories and what you can eat — at least in the short term. And low-carb diets, especially very low-carb diets, may lead to greater short-term weight loss than low-fat diets.

But most studies have found that at 12 or 24 months, the benefits of a low-carb diet are not very large. A 2014 review found that higher protein, low-carbohydrate diets may offer a slight advantage in terms of weight loss and loss of fat mass compared to a normal protein diet. At a year, the difference was only about a pound (about 0.4 kilograms), though, and those who had the greatest benefits stuck to the diet long term.

Cutting calories and carbs may not be the only reason for the weight loss. Some studies show that you may shed some weight because you eat less on low-carb diets because the extra protein and fat keep you feeling full longer.

2) Other health benefits

Low-carb diets may help prevent or improve serious health conditions, such as metabolic syndrome, diabetes, high blood pressure and cardiovascular disease. In fact, almost any diet that helps you shed excess weight can reduce or even reverse risk factors for cardiovascular disease and diabetes. Most weight-loss diets — not just low-carb diets — may improve blood cholesterol or blood sugar levels, at least temporarily.

Low-carb diets may improve HDL cholesterol and triglyceride values slightly more than do moderate-carb diets. That may not only be due to how many carbs you eat but also the quality of your other food choices. Lean protein (fish, poultry, legumes), healthy fats (monounsaturated and polyunsaturated) and unprocessed carbs — such as whole grains, legumes, vegetables, fruits and low-fat dairy products — are generally healthier choices.

A report from the American Heart Association, the American College of Cardiology and he Obesity Society concluded that there isn’t enough evidence to say whether most low-carbohydrate diets provide heart-healthy benefits.

Risks

Some diets restrict carbohydrate intake so much that in the long term they can result in vitamin or mineral deficiencies, bone loss, and gastrointestinal disturbances and may increase risks for various chronic diseases.

Severely restricting carbohydrates to less than 20 grams a day can result in a process called ketosis. Ketosis occurs when you don’t have enough sugar (glucose) for energy, so your body breaks down stored fat, causing ketones to build up in your body. Side effects from ketosis can include nausea, headache, mental and physical fatigue, and bad breath.

It’s not clear what kind of possible long-term health risks a low-carb diet may pose because most research studies have lasted less than a year. Some health experts believe that if you eat large amounts of fat and protein from animal sources your risk of heart disease or certain cancers may actually increase.

Conclusion:

The low-carbohydrate diet is very effective for short-term weight loss and for cardiovascular risk factor reduction than the low-fat diet. However, the long-term effects on cardiovascular disease risk factors, such as weight loss, HDL and LDL cholesterol, triglycerides, glycemic control, and blood pressure, are unknown.

Restricting carbohydrate is a good an option for persons seeking to lose weight and reduce cardiovascular risk factors. Rather than cutting carbs across the board, a more healthful goal is to increase the “good” or complex carbohydrates found in whole grains, fruits, and vegetables and cut back on “bad” or simple carbohydrates, such as sugar and processed grains. So choose your carbohydrates wisely. Just make sure you cut out processed foods and refined added sugary foods and drink from your diet- refined grains, such as sugary drinks, desserts and candy, which are packed with calories but low in nutrition. Instead, go for fruits, vegetables and whole grains. and eat plenty of vegetables and fruits so you get plenty of good vitamins and minerals.

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The Detox Diet

Before it was co-opted in the recent craze, the word “detox” referred chiefly to a medical procedure that rids the body of dangerous, often life-threatening, levels of alcohol, drugs, or poisons. Patients undergoing medical detoxification are usually treated in hospitals or clinics. The treatment generally involves the use of drugs and other therapies in a combination that depends on the type and severity of the toxicity ¹.

Infomercials and websites urge you to eliminate the buildup of toxins that supposedly results from imprudent habits or exposure to hazardous substances. But the human body defends itself very well against most environmental insults and occasional indulgences ². Detoxification (detox) diets are popular, but there is little evidence that they eliminate toxins from your body ³.

The detox programs now being promoted to the health-conscious public are a different matter. These are largely do-it-yourself procedures aimed at eliminating alleged toxins that are held responsible for a variety of symptoms, including headache, bloating, joint pain, fatigue, and depression. Detox products are not available by prescription; they are sold in retail stores, at spas, over the Internet, and by direct mail. Many are advertised as useful for detoxifying specific organs or systems; others are portrayed as “whole body” cleansers. With a wide range of detox products available at your local pharmacy, celebrity eating plans popping up on your social media feeds and new books on the topic appearing regularly, there’s no doubt the ‘detox diet’ business is a lucrative one.

Specific detox diets vary — but typically a period of fasting is followed by a strict diet of raw vegetables, fruit and fruit juices, and water. In addition, some detox diets advocate using herbs and other supplements along with colon cleansing (enemas) to empty the intestines.

Some people report feeling more focused and energetic during and after detox diets. However, there’s little evidence that detox diets actually remove toxins from the body. Indeed, the kidneys and liver are generally quite effective at filtering and eliminating most ingested toxins.

The only type of detox diet that is worthwhile is one that limits processed, high-fat, and sugary foods, and replaces them with more whole foods like fruits and vegetables. That clean-eating approach is your best bet to getting your body in tip-top shape.

So why do so many people claim to feel better after detoxification ? It may be due in part to the fact that a detox diet eliminates highly processed foods that have solid fats and added sugar. Simply avoiding these high-calorie low-nutrition foods for a few days may be part of why people feel better ³.

You Body’s Own Detox System

You tend to forget that your body is equipped with a detoxification system of its own ¹, which includes the following:

• The skin. The main function of the body’s largest organ is to provide a barrier against harmful substances, from bacteria and viruses to heavy metals and chemical toxins. The skin is a one-way defense system; toxins are not eliminated in perspiration.
• The respiratory system. Fine hairs inside the nose trap dirt and other large particles that may be inhaled. Smaller particles that make it to the lungs are expelled from the airways in mucus.
• The immune system. This exquisitely orchestrated network of cells and molecules is designed to recognize foreign substances and eliminate them from the body. Components of the immune system are at work in blood plasma, in lymph, and even in the small spaces between cells.
• The intestines. Peyer’s patches — lymph nodes in the small intestine — screen out parasites and other foreign substances before nutrients are absorbed into the blood from the colon.
• The liver. Acting as the body’s principal filter, the liver produces a family of proteins called metallothioneins, which are also found in the kidneys. Metallothioneins not only metabolize dietary nutrients like copper and zinc but also neutralize harmful metals like lead, cadmium, and mercury to prepare for their elimination from the body. Liver cells also produce groups of enzymes that regulate the metabolism of drugs and are an important part of the body’s defense against harmful chemicals and other toxins.
• The kidneys. The fact that urine tests are used to screen for drugs and toxins is a testament to the kidneys’ remarkable efficiency in filtering out waste substances and moving them out of the body.

Summary of your body’s own detox system

The human body can defend itself very well against most environmental insults and the effects of occasional indulgence. If you’re generally healthy, concentrate on giving your body what it needs to maintain its robust self-cleaning system — a healthful diet, adequate fluid intake, regular exercise, sufficient sleep, and all recommended medical check-ups. If you experience fatigue, pallor, unexplained weight gain or loss, changes in bowel function, or breathing difficulties that persist for days or weeks, visit your doctor instead of a detox spa.

• Master Cleanse Detox Diet

A seemingly infinite array of products and diets is available for detoxifying the entire body. One of the most popular is the Master Cleanse diet, favored by a number of Hollywood celebrities, supposedly to restore energy, lose weight, and relieve symptoms of chronic conditions like arthritis and fibromyalgia. Dieters take a quart of warm salt water in the morning; consume a 60-ounce concoction of water, lemon juice, maple syrup, and cayenne pepper throughout the day; and finish with a cup of laxative tea in the evening. Proponents of the Master Cleanse diet recommend adhering to it for at least 10 days.

Evidence of effectiveness:

There are no data on this particular diet in the medical literature. But many studies have shown that fasts and extremely low-calorie diets invariably lower the body’s basal metabolic rate as it struggles to conserve energy. Once the dieter resumes normal eating, rapid weight gain follows. Much of the weight loss achieved through this diet results from fluid loss related to extremely low carbohydrate intake and frequent bowel movements or diarrhea produced by salt water and laxative tea. When the dieter resumes normal fluid intake, this weight is quickly regained.

Risks:

The diet is lacking in protein, fatty acids, and other essential nutrients. Carbohydrates supply all the calories — an extremely low 600. The daily laxative regimen can cause dehydration, deplete electrolytes, and impair normal bowel function. It can also disrupt the native intestinal flora, microorganisms that perform useful digestive functions. A person who goes on this diet repeatedly may run the risk of developing metabolic acidosis, a disruption of the body’s acid-base balance, which results in excessive acidity in the blood. Severe metabolic acidosis can lead to coma and death.

• Intestinal Cleansing

Numerous kits are marketed for this purpose, most of which include a high-fiber supplement, a “support” supplement containing herbs or enzymes, and a laxative tea, each to be used daily. Manufacturers of the herbal detox kits recommend continuing the regimen for several weeks. Such regimens may be accompanied by frequent enemas. The aim is to eradicate parasites and expel fecal matter that allegedly adheres to the intestinal walls ².

Evidence of effectiveness:

Several studies suggest that milk thistle, which is often included as a supportive supplement, may improve liver function with few side effects. But there’s no medical evidence for the cleansing procedure as a whole. Promotional materials often include photographs of snake-like gelatinous substances expelled during cleansing. When these pictures are not faked, they are probably showing stool generated by large doses of the regimen’s fiber supplement. More important, the rationale for intestinal cleansing — to dislodge material adhering to the colon walls — is fundamentally mistaken. When fecal matter accumulates, it compacts into firm masses in the open interior of the colon; it does not adhere to the intestinal walls as the “sludge” depicted in the advertisements.

Risks:

Like fasting, colonic cleansing carries a risk of dehydration, electrolyte imbalance, impaired bowel function, and disruption of intestinal flora.

• Foot Detox

The food detox method employs a special type of adhesive pad worn on the bottoms of the feet during sleep. Another approach is to immerse the feet for 30 minutes in an “ionic foot bath,” containing salt water and two electrodes that supply a low-voltage electric charge. Both methods claim to stimulate the outflow of toxins through the feet. However, there is no scientific evidence that ionic changes in the environment can stimulate a discharge of toxins through the feet — or any other part of the body ².

Evidence of effectiveness:

Both methods claim to emit ions that stimulate the outflow of toxins through the feet. The pads contain tourmaline crystals, which are purported to emit ion-generating infrared rays. The foot baths allegedly generate ions by running an electric current through salt water. However, there is no scientific evidence that ionic changes in the environment can stimulate a discharge of toxins through pores in the feet — or any other part of the body, for that matter. Promoters assert that the success of the process can be monitored by a color change in the pad or in the water of the foot bath as impurities are leached from the body. But the pads, which are impregnated with wood vinegar, have been shown to turn the same dark color whether they absorb foot perspiration or are sprayed with tap water; and the color of the foot bath changes because the metal electrodes corrode.

Risks:

No ill effects on health have been reported for either method.

• Oxygen detox

Air containing an 85% to 95% concentration of oxygen is delivered through a mask or nasal tube. Concentrated oxygen is said to boost the immune system, relieve headaches, increase energy, and improve cognitive function ¹.

Evidence of effectiveness:

Pressurized oxygen has long been used in treating people with respiratory distress or chronic lung conditions like emphysema, because their lungs cannot extract enough oxygen from normal air. Since the late 1990s, detox spas and oxygen bars have been marketing a short version of the treatment to healthy people. There is no evidence that healthy lungs need more oxygen than is contained in normal air to supply the body with adequate oxygen. (The FDA has warned that it is illegal to administer oxygen from a tank without a prescription, but most states have failed to enforce the ruling, enabling oxygen bars to thrive.)

Risks:

Although there is little danger from inhaling concentrated oxygen, the FDA cautions against “flavored” oxygen, which may contain fragrant oil suspensions that can irritate the lungs.

But do they work, and does the body even need to detox ?

If your goal is to detox your system, don’t waste your time or money. Your body is an expert at getting rid of toxins no matter what you eat. There’s little evidence detox diets actually remove toxins – because your kidneys and liver do it by themselves naturally every day and you’re not going to get rid of them with the latest detox wonder.

If your goal is weight loss, a detox diet might help you drop a few pounds, but you’ll likely just gain it back. In the end, you haven’t accomplished anything, and it’s certainly not a healthy approach.

People who buy the detox diet bandwagon are often “hoping to find a remedy” after a particularly poor period of eating or drinking. People have this idea of a detox diet as a way of dealing with their guilt about having a diet that previously contained sugars, fats and or alcohol, but two wrongs don’t make a right.

The problem is, the punishment of a strict “detox” diet doesn’t really make up for your bad eating behavior.

Doing the detox diet may alleviate your guilt but it is actually doing more harm than good.

Most detox products spruik some kind of cleansing benefit for the liver or kidneys. In some cases, products encourage severe restrictions of key food groups, such as meat and dairy. Worryingly, others recommend eliminating food altogether.

The idea that you need a detox product to achieve a healthy liver is totally nonsense and unscientific. Liver cleansing doesn’t actually have to be a complicated process at all — all you need to do is avoid excessive amounts of alcohol, caffeine, sugar and saturated fats.

What You Can Eat and What You Can’t

You’re going to go without a lot of the foods you usually eat. Detox diets are typically very rigid and involve eating the same few things over and over.

Some detox plans recommend herbs, pills, powders, enemas, and other forms of colon cleansing. Methods vary and often include products that are only available from the author’s web site.

That depends on the particular detox diet you’re following. There are many of them. Some involve fasting, or just drinking liquids. Others allow some foods, like fruits and vegetables. They typically are short diets — they’re not a way of eating you can stick with in the long run.

Ingredients in detox products

You’ll have heard the claims before – “specially designed with this”, “professionally formulated from that”, “rare combinations”, “unique blends” and even “powerful super foods”, all claimed to be the next big thing helping you lose weight fast. But what’s really in the detox box ?

Of the powders, potions and pills – most contain a combination of fruit and vegetable extracts, liver tonics, laxatives and traditional weight-loss aids.

Caffeine

Known for its ability to stimulate your central nervous system, caffeine is present in two of these products, most likely because of its ability to speed up your metabolism. It’s generally accepted that the caffeine in two to four cups of coffee each day is harmless, however too much caffeine can make you anxious and may cause headaches or abnormal heart rhythms. It’s interesting to note that while some products give you added caffeine, others require it to be eliminated for the duration of the detox, which can cause headaches for those who regularly consume coffee.

Green tea

Some detox diet products also contain green tea, considered to have antioxidant properties and the ability to improve mental alertness (most likely because of its caffeine content) and often used as a weight loss aid. But despite this, there is little reliable data to determine whether this age-old beverage will help to cleanse or cut the kilos. Green tea extract has been linked to serious liver problems in rare cases.

Bitter orange

Also said to speed up metabolism is bitter orange. Experts say there’s not enough evidence to support the use of this ingredient for health purposes, particularly given reports of its links to fainting, heart attack and stroke. Bitter orange should be avoided by people with high blood pressure and should not be taken in conjunction with caffeine.

Super berries

Berries such as acai, goji and cranberries also appear in a number of products. Cranberries have known antioxidant properties and can help prevent urinary tract infections, although the evidence is not definitive and caution should be exercised by those who take blood-thinning drugs, such as warfarin and aspirin, in taking a product that contains cranberries. Goji berries should also be avoided by people on warfarin. There is no definitive scientific evidence to support the claims that acai berries, native to Central and South America and promoted widely as a “superfood”, promote weight loss.

Ingredients to encourage bowel movement

The inclusion of psyllium to promote regular bowel movements. Although not harmful in itself, psyllium should not be taken with the common painkiller aspirin and people with diabetes, heart disease or high blood pressure should be especially cautious. Rhubarb and senna are also used in some of the products to promote regular bowel movements. However, if you eat a sufficient amount of high-fibre foods, such as oats, grains and fruits, this should not be an issue for you.

Silybin

Silybin, the biologically active element of milk thistle. Historically thought to protect and improve liver function, laboratory studies suggest this could be correct, although clinical trials have not been able to link the two.

Taurine

Taurine is thought to contain antioxidants and may improve liver function in patients with existing liver disease (hepatitis), however there’s no evidence to support the idea that taurine can improve the function of a healthy liver. The QuickTrim Fast Cleanse (endorsed by Kim and Khloe Kardashian) claims you’ll slim down and lose your bloat in just 48 hours – although the fructose and soybean fibre may have exactly the opposite effect on some people.

Chitosan

Chitosan, a dietary fibre derived from the shell of crustaceans, is popular in weight-loss products for its ability to bind small amounts of fat into waste. Chitosan does not distinguish between different types of fat, which means good fats, such as omega-3s, can also be lost in the process. More importantly, good-quality studies suggest the effect of chitosan on body weight is minimal. The US Food and Drug Administration warns directly against the use of chitosan, which it says may cause problems for those allergic to shellfish.

Side Effects of Detox Diet

A seemingly infinite array of diets is available for detoxifying the whole body. However, studies have shown that fasting and extremely low calorie intake — common elements of detox diets — cause a slowdown of metabolism and an increase in weight after the dieter returns to normal eating.

Detox diets that severely limit protein or that require fasting, for example, can result in fatigue. Long-term fasting can result in vitamin and mineral deficiencies.

Colon cleansing, which is often recommended as part of a detox plan, can cause cramping, bloating, nausea and vomiting. Dehydration also can be a concern.

Finally, keep in mind that fad diets aren’t a good long-term solution. For lasting results, your best bet is to eat a healthy diet based on fruits and vegetables, whole grains, and lean sources of protein.

If you do choose to do a detox diet, you may want to use it as a way to jump-start making healthier food choices going forward every day.

Take home message on detox diets

You’ve heard a great deal about detox diets in recent years. But it’s all hype with no health benefits. They also may not provide all of the nutrients your body needs. There are many ways to get your body clean and healthy. Detox diets isn’t one of them.

If you’re healthy, concentrate on giving your body what it needs to maintain its self-cleaning system — a healthful diet, adequate fluids, exercise, sleep, and all recommended medical check-ups, instead of relying on so-called detox diets and procedures.

And if you are overweight or obese, losing weight can improve your health. It might also help you prevent weight-related diseases, such as heart disease, diabetes, arthritis and some cancers. A healthy diet is an important part of a weight-loss program.

• It may include fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• It may include lean meats, poultry, fish, beans, eggs and nuts
• It means go easy on saturated fats, trans fat, cholesterol, salt (sodium), and added sugars

The key to losing weight is to burn more calories than you eat and drink. A diet can help you to do this through portion control. There are many different types of diets. Some, like the Mediterranean diet, describe a traditional way of eating from a specific region. Others, like the Mediterranean Diet and DASH (Dietary Approaches to Stop Hypertension) diet, were designed for people who have certain health problems. But they may also help you to lose weight. There are also fad or crash diets that severely restrict calories or the types of food you are allowed to eat. They may sound promising, but they rarely lead to permanent weight loss.

In addition to a diet, weight loss is most likely to be successful when you change your habits, replacing old, unhealthy ones with new, healthy behaviors. Here are some ways to make that happen:

• Exercise. Regular physical activity burns calories and builds muscle — both of which help you look and feel good and keep weight off. Walking the family dog, cycling to school, and doing other things that increase your daily level of activity can all make a difference. If you want to burn more calories, increase the intensity of your workout and add some strength exercises to build muscle. The more muscle you have, the more calories you burn, even when you aren’t exercising.

• Reduce screen time. People who spend a lot of time in front of screens are more likely to be overweight. Set reasonable limits on the amount of time you spend watching TV, playing video games, and using computers, phones, and tablets not related to school work. Be sure to set aside enough time to exercise every day and get enough sleep.

• Watch out for portion distortion. Big portions pile on extra calories that cause weight gain. Sugary beverages, such as sodas, juice drinks, and sports drinks, are empty calories that also contribute to obesity. So choose smaller portions (or share restaurant portions) and go for water or low-fat milk instead of soda.

Here are 5 clues that a diet may be more about empty promises than real results:

Lots of today’s popular diets take advantage of our desire to drop weight quickly. Unfortunately, though, “quick-fix” diets don’t work.

5 Ways To Spot Fad Diets ⁴

• 1) The diet is based on drastically cutting back calories. Starvation-type diets that require the body to fast often promise quick results. But our bodies simply aren’t designed to drop pounds quickly. In fact, doctors say it’s nearly impossible for a healthy, normally active person to lose more than 2 to 3 pounds per week of actual fat, even on a starvation diet.

Here’s the trick that very low-calorie diets rely on: The body’s natural reaction to near-starvation is to dump water. So most, if not all, of the weight lost on quick-weight-loss diets is not fat — it’s just water. And the body sucks this lost water back up like a sponge once a person starts eating normally again.

• 2) The diet is based on taking special pills, powders, or herbs. These are usually just gimmicks — and the only thing they slim down is your wallet.

Some diet pills contain laxatives or diuretics that force a person’s body to eliminate more water. Just like restricted-calorie diets, the weight lost with these supplements is mostly water, not fat.

Other supplements claim that their ingredients speed up metabolism; suppress appetite; or block the absorption of fat, sugars, or carbohydrates. For most diet supplements, there’s no reliable scientific research to back up their claims. And doctors consider diet supplements risky for teens because not much is known about how the ingredients affect the growing body.

• 3) The diet tells you to eat only specific foods or foods in certain combinations. There’s no reliable scientific proof that combining certain foods works. And limiting the foods you eat means you might not get all the nutrition you need.

• 4) The diet makes you completely cut out fat, sugar, or carbs. Depriving our bodies of needed food groups is a bad idea (especially when they’re still growing). It’s better to eat smaller portions in well-rounded meals (meals that contain lean protein, whole grains, fruits, veggies, and low-fat dairy). When your body gets the right balance of nutrition, it’s less likely to send you willpower-busting cravings! Eating smaller portions also helps you set good eating habits that will help you keep the weight off.

• 5) The diet requires you to skip meals or replace meals with special drinks or food bars. As with diets that ban certain food groups, skipping or substituting meals can mean you don’t get the nutrition needed to support healthy development. Plus, you miss out on the enjoyment of sharing a satisfying meal with friends or family.

1. Harvard University. Harvard Women’s Health Watch. The dubious practice of detox. http://www.health.harvard.edu/staying-healthy/the-dubious-practice-of-detox
2. Harvard University. Harvard Health Publications. Detox diets, procedures generally don’t promote health. http://www.health.harvard.edu/press_releases/detox-diets-procedures-generally-dont-promote-health
3. Mayo Foundation for Medical Education and Research. MayoClinic. Do detox diets offer any health benefits ? http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/detox-diets/faq-20058040
4. Kidshealth. 5 Ways to Spot a Fad Diet. https://kidshealth.org/en/teens/fad-diet-tips.html

What is the South Beach Diet ?

The South Beach Diet ¹, which is named after a glamorous area of Miami, is sometimes called a Glycemic index diet or Modified low-carbohydrate diet, similar to Sugar Busters and the Zone Diet. The South Beach Diet is a popular weight-loss diet created in 2003 by cardiologist Arthur Agatston and outlined in his best-selling book, “The South Beach Diet: The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss” ²). The South Beach Diet is lower in carbs (carbohydrates): low-carbohydrate diet initially <20 g/day carbohydrate without formal prescribed energy restriction but realized energy deficitand higher in protein and healthy fats than is a typical eating plan. But it’s not a strict low-carb diet, and you don’t have to count carbs.

The South Beach plan recommends certain types of carbohydrates and fats. The South Beach plan is organized into three phases ¹. But the South Beach Diet has evolved over time and now recommends exercise as an important part of your lifestyle. The South Beach Diet says that regular exercise will boost your metabolism and help prevent weight-loss plateaus.

South Beach Diet Phase 1, Weight Loss

The first 2 weeks restricts consumption of particular foods (eg, bread, rice, potatoes, pasta, baked goods, alcohol, fruit, or sugar products). This two-week phase is designed to eliminate cravings for foods high in sugar and refined starches to jump-start weight loss. You cut out almost all carbohydrates from your diet, including pasta, rice, bread and fruit. You can’t drink fruit juice or any alcohol. You focus on eating lean protein, such as seafood, skinless poultry, lean beef and soy products. You can also eat high-fiber vegetables, low-fat dairy and foods with healthy, unsaturated fats, including avocados, nuts and seeds.

The South Beach Diet says that you’ll lose 8 to 13 pounds (3.6 to 5.9 kilograms) in the two-week period that you’re in phase 1. It also says that most of the weight will be shed from your midsection. In phase 2, it says that you’ll likely lose 1 to 2 pounds (0.5 to 1 kilogram) a week.

The plan is liberalized in the second (continued weight loss) and third (maintenance) phases.

South Beach Diet Phase 2, Continued Weight Loss

In phase 2, dieters are instructed to have lean protein and low-fat dairy, and gradually reintroduce whole-grain carbohydrates and fruit. You begin adding back some of the foods that were prohibited in phase 1, such as whole-grain breads, whole-wheat pasta, brown rice, fruits and more vegetables. You stay in this phase until you reach your goal weight.

South Beach Diet Phase 3, Maintenance

Subjects expand the quantity and selection of whole grains and particular fruits and vegetables. This is a maintenance phase meant to be a healthy way to eat for life. You continue to follow the lifestyle principles you learned in the two previous phases. You can eat all types of foods in moderation.

The South Beach Diet allows carbohydrate consumption as long as they have a low Glycemic Index (GI). The Glycemic Index (GI) is a measure of the blood glucose response to intake of a particular carbohydrate ³. The higher the peak in postprandial blood glucose levels, the higher the GI value. The glycemic load (GL) is the product of dietary GI and total dietary carbohydrate, providing a useful measure of the total glycemic effect ⁴. Table 1 shows a list of common foods and their associated Glycemic Index (GI) and Glycemic load (GL). A high-GI diet has been proposed to increase hunger and elevate free fatty acid levels, leading to an increased risk of obesity, diabetes, and cardiovascular disease ⁵. Several in vitro experiments indicate that elevated postprandial blood glucose levels cause oxidative stress, leading to endothelial damage and activation of coagulation ⁶.

Table 1 shows the glycemic index and glycemic load of various foods compared with glucose. Adapted from data in reference ⁵.

The framework of the South Beach Diet includes an initial two-week period of extreme carbohydrate restriction followed by gradual re-introduction of low-GI carbohydrates. The maintenance phase encourages intake of fruits, vegetables, whole grains, mono- and polyunsaturated fats, omega-3 fatty acids, nuts, and moderate dairy products. Unlike the Atkins’ Diet, the South Beach Diet encourages lean protein, such as fish and poultry, and allows olive oil as a source of mono- and polyunsaturated fat.

The longest interventional study conducted in humans related to Glycemic Index (GI) was a crossover study lasting 12 weeks ⁷. Thirty women were randomized to a low-GI or high-GI diet. Those on a high-GI diet lost 7.4 kg, whereas those on a low-GI diet lost 9.4 kg. In 16 women who participated in a 12-week follow-up, crossover study, those on a low-GI diet lost 7.4 kg, compared with 4.5 kg on a high-GI diet. However, the results from other interventional studies, although shorter in duration and with smaller populations, have been inconsistent ⁸.

A possible association between a high-GI diet and diabetes has been observed. Studies that investigated this relationship include the Nurses’ Health Study ⁹, which followed over 65,000 U.S. women for six years, the Health Professionals’ Survey ¹⁰, which followed 42,750 U.S. men for six years, and the Iowa Women’s Health Study, which followed 36,000 women for six years ¹¹. All of these prospective cohort studies showed an association between diabetes and high GL. A recent meta-analysis of 14 randomized, controlled trials comparing low- and high-GI diets in diabetes management showed that glycated proteins were reduced 7.4% on a low-GI diet ¹². Multiple cohort studies have been inconclusive as to whether a high-GI diet may also be linked to CVD risk factors ¹³, ¹⁴, ¹⁵, ¹⁶, ¹⁷. Cohort studies are a type of medical research used to investigate the causes of disease, establishing links between risk factors and health outcomes. Cohort studies are usually forward-looking, that is, they are “prospective” studies, or planned in advance and carried out over a future period of time.

High-GI diets may alter HDL metabolism. A survey of 1,420 British adults ¹⁶ evaluated GI through a seven-day diet survey and showed an inverse relationship between GI and HDL cholesterol. The Third National Health and Nutrition Examination Survey (NHANES III) ¹⁷, which followed 13,907 subjects older than 20 years old, demonstrated that for every 15-U increase in GI, there was a 0.06-mmol/l decrease in HDL cholesterol.

Many of these prospective cohort studies contain confounding variables. Most of these studies based their GI and GL calculations on self-reporting. Portion size and recall bias could result in inaccurate reporting ¹⁸. Also, the GI of a food can change depending on the method of food preparation and different types of the same food (i.e., different grains of rice). Despite suggestive evidence, no trials have shown that low-GI diets prevent cardiovascular disease. Longer studies with more participants are needed before low-GI diets can be definitively recommended ¹⁹.

In a study ²⁰ comparing the dietary quality of popular weight-loss plans (their status on the New York Times Bestseller list) – the New Glucose Revolution, Weight Watchers, Atkins Diet, South Beach Diet, Zone Diet, Ornish Diet, and 2005 US Department of Agriculture Food Guide Pyramid (2005 Food Guide Pyramid) plans. The Dietary quality was estimated using the Alternate Healthy Eating Index (AHEI), a measure that isolates dietary components that are most strongly linked to cardiovascular disease risk reduction ²¹,²². The Alternate Healthy Eating Index (AHEI) was developed to measured adherence to the 1995 US Department of Agriculture Food Guide Pyramid dietary guidelines and the quality within food groups and acknowledged health benefits of unsaturated oils ²³. The score was then used to predict development of cardiovascular disease, cancer or other causes of death in the same population previously tested. Men and women with AHEI scores in the top vs. bottom quintile had a significant 20% and 11% reduction in overall major chronic disease, respectively. Reductions were stronger for cardiovascular disease risk in men than in women. The score did not predict cancer risk. The AHEI was twice as strong at predicting major chronic disease and cardiovascular disease risk compared to the original Healthy Eating Index (HEI) ²⁴, suggesting that AHEI may be a better proxy of dietary quality ²⁵, ²⁶.

The AHEI incorporates several aspects of the original HEI ²⁴, and therefore some components correspond to existing dietary guidelines (eg, to increase fruit and vegetable intakes). The AHEI has nine components for evaluating and determining dietary quality, including fruit, vegetables, nuts and soy, ratio of white to red meat, cereal fiber, trans fat, ratio of polyunsaturated fat to saturated fat, alcohol, and duration of multivitamin use ²⁷. Seven of the nine AHEI components were used to calculate the AHEI score for each plan ²⁷. Duration of multivitamin use and daily alcohol intake were not used because neither were addressed in the diet book meal plans.

The AHEI also provides quantitative scoring for qualitative dietary guidance (eg, choose more fish, poultry, and whole grains, and if you drink alcohol, do so in moderation). AHEI variables were chosen and scoring decisions were made a priori, on the basis of discussions with nutrition researchers. AHEI sought to capture specific dietary patterns and eating behaviors that have been associated consistently with lower risk for chronic disease in clinical and epidemiologic investigations. AHEI score of 10 indicates that the recommendations were fully met, whereas a score of 0 represents the least healthy dietary behavior. Intermediate intakes were scored proportionately between 0 (worst) and 10 (best). For example, zero vegetable servings per day was given the score of 0, and five servings per day or more was given a 10. For meat, when no red meat was consumed, the component score was set to 10. The multivitamin component was dichotomous, contributing either 2.5 points (for nonuse) or 7.5 points (for use). All component scores were summed to obtain a total AHEI score  ²⁷ ranging from 2.5 (worst) to 87.5 (best).

The results of that study ²⁰ that compares the dietary quality of popular weight-loss plans (the New Glucose Revolution, Weight Watchers, Atkins Diet, South Beach Diet, Zone Diet, Ornish Diet, and 2005 US Department of Agriculture Food Guide Pyramid (2005 Food Guide Pyramid) plans), ordered from the highest to the lowest plan were:

1. Ornish (score 64.6),
2. Weight Watchers high-carbohydrate (score 57.4),
3. the New Glucose Revolution (score 57.2),
4. South Beach/Phase 2 (score 50.7),
5. Zone (score 49.8),
6. 2005 Food Guide Pyramid (score 48.7),
7. Weight Watchers high-protein (score 47.3),
8. Atkins/100-g carbohydrate (score 46),
9. the South Beach/Phase 3 (score 45.6), and
10. Atkins/45-g carbohydrate (score 42.3).

The Zone plan was lowest in energy (mean 1,025±122 kcal per day), whereas the 2005 Food Guide Pyramid plan was highest (mean 1,946±200 kcal per day).

The Ornish plan, which is almost a completely vegetarian plan, scored high largely due to the amount of vegetables, fruit, cereal fiber intake, and low trans fat ²⁸, ²⁹, ³⁰, ³¹, ³², ³², ³²(28-34).

The Weight Watchers higher-carbohydrate and the New Glucose Revolution plans also fared well due to the emphasis on fruits and vegetables, higher whole-grain composition, and low trans fats.

In light of the study limitations, further investigations are warranted to observe what patients actually consume when following a popular weight-loss diet plan.

Purpose

According to Arthur Agatston, M.D., author of The South Beach Diet – the key to losing weight quickly and getting healthy isn’t cutting all carbohydrates and fats from your diet, it’s learning to choose the right carbs and the right fats.

The South Beach Diet says that you’ll lose 8 to 13 pounds (3.6 to 5.9 kilograms) in the two-week period that you’re in phase 1. It also says that most of the weight will be shed from your midsection. In phase 2, it says that you’ll likely lose 1 to 2 pounds (0.5 to 1 kilogram) a week.

Most people can lose weight on almost any diet, especially in the short term. Most important to weight loss is how many calories you take in and how many calories you burn off. A weight loss of 1 to 2 pounds a week is the typical recommendation. Although it may seem slow, it’s a pace that’s more likely to help you maintain your weight loss permanently.

The purpose of the South Beach Diet is to change the overall balance of the foods you eat to encourage weight loss and a healthy lifestyle. The South Beach Diet says it’s a healthy way of eating whether you want to lose weight or not.

This approach is part of a three-step program Dr. Agatston developed to help his heart patients lose weight and lower cholesterol.

Emphasizing foods that are loaded with fiber and nutrients, the South Beach Diet promises to help you kick your cravings, jump-start your weight loss, and keep those unwanted pounds off — for life.

In the first 2 weeks, Phase 1 of the diet, you can expect to lose between 8 and 13 pounds, Dr. Agatston says.  With Phase 1 the most restrictive: no bread, rice, potatoes, pasta, or fruit.

In Phase 2, you gradually add back in some of these foods. You move into Phase 3 when you hit your goal weight, and you stay there for life.

Why you might follow the South Beach Diet ?

You might choose to follow the South Beach Diet because:

• You like the related South Beach Diet products, such as cookbooks and diet foods.
• It’s a healthy approach to eating that can help you shed pounds. Nutrition experts warn against the restrictive first phase, though.
• You want a diet that restricts certain carbs and fats to help you lose weight.
• You want to change your overall eating habits.
• You want a diet you can stick with for life.

What You Can Eat and What You Can’t ?

That depends on the phase you’re in. Phase 1 is the strictest and includes:

• A lot of protein, such as beef, poultry, seafood, eggs, and cheese.
• Some fats, including canola oil, extra-virgin olive oil, and avocado.
• Carbs with the lowest glycemic index, including vegetables such as broccoli, tomatoes, spinach, and eggplant.

What’s off-limits in Phase 1: Fruit, fruit juices, starchy foods, dairy products, and alcohol.

In Phase 2, you slowly reintroduce healthy carbs into your diet — fruit, whole-grain bread, whole-grain rice, whole wheat pasta, and sweet potatoes. Expect weight loss to slow to 1 to 2 pounds a week, on average.

Phase 3 is about maintaining your weight. There’s no food list to follow. By this time, you’ll know how to make good food choices and how to get back on track if you overindulge once in a while. If cravings return or your eating gets off track, the plan recommends going back to Phase 1 or 2.

South Beach Diet Details

• Carbohydrates
  The South Beach Diet is lower in carbohydrates than is a typical eating plan, but not as low as a true low-carb diet. On a typical eating plan, about 45 to 65 percent of your daily calories come from carbohydrates. Based on a 2,000-calorie-a-day diet, this amounts to about 225 to 325 grams of carbohydrates a day. In the final maintenance phase of the South Beach Diet, you can get as much as 28 percent of your daily calories from carbohydrates, or about 140 grams of carbohydrates a day. A true low-carb diet might restrict your carb intake to as little as 50 to 100 grams a day.
• Exercise
  The South Beach Diet has evolved over time and now recommends exercise as an important part of your lifestyle. The South Beach Diet says that regular exercise will boost your metabolism and help prevent weight-loss plateaus.

Phases of the South Beach Diet

The South Beach Diet has three phases:

• Phase 1. This two-week phase is designed to eliminate cravings for foods high in sugar and refined starches to jump-start weight loss. You cut out almost all carbohydrates from your diet, including pasta, rice, bread and fruit. You can’t drink fruit juice or any alcohol. You focus on eating lean protein, such as seafood, skinless poultry, lean beef and soy products. You also can eat high-fiber vegetables, low-fat dairy, and foods with healthy, unsaturated fats, including avocados, nuts and seeds.
• Phase 2. This is a long-term weight-loss phase. You begin adding back some of the foods that were prohibited in phase 1, such as whole-grain breads, whole-wheat pasta, brown rice, fruits and more vegetables. You stay in this phase until you reach your goal weight.
• Phase 3. This is a maintenance phase meant to be a healthy way to eat for life. You continue to follow the lifestyle principles you learned in the two previous phases. You can eat all types of foods in moderation.

A typical day’s menu on the South Beach Diet

Here’s a look at what you might eat during a typical day in phase 1 of the South Beach Diet:

• Breakfast. Breakfast might be an omelet with smoked salmon or baked eggs with spinach and ham, along with a cup of coffee or tea.
• Lunch. Lunch might be a vegetable salad with scallops or shrimp, along with iced tea or sparkling water.
• Dinner. Dinner may feature grilled tuna or pork paired with grilled vegetables and a salad.
• Dessert. The diet encourages you to enjoy a dessert, such as a ricotta cheesecake or chilled espresso custard, even in phase 1.
• Snacks. You can enjoy snacks during the day, too, such as a Muenster cheese and turkey roll-up or roasted chickpeas.

Health benefits

The South Beach Diet, while mainly directed at weight loss, may promote certain healthy changes. Research shows that following a long-term eating plan that’s rich in healthy carbohydrates and dietary fats can improve your health. For example, lower carbohydrate diets with healthy fats may improve your blood cholesterol levels.

On the other hand, no long-term, randomized controlled clinical trials have measured the health outcomes of the South Beach Diet. Nor have there been such studies of the overall health or cardiovascular benefits of following a low-glycemic-index diet. But eating such foods as whole grains, unsaturated fats, vegetables and fruits should help to promote good health.

Does It Work for Weight Loss ?

Yes. Besides the restrictive first phase, this is a healthy Mediterranean-style approach to eating that can help you shed pounds.

Most people can lose weight on almost any diet, especially in the short term. Most important to weight loss is how many calories you take in and how many calories you burn off. A weight loss of 1 to 2 pounds a week is the typical recommendation. Although it may seem slow, it’s a pace that’s more likely to help you maintain your weight loss permanently.

Losing a large amount of weight rapidly could indicate that you’re losing water weight or lean tissue, rather than fat. In some situations, however, faster weight loss can be safe if it’s done in a healthy way. For example, some diets include an initiation phase to help you jump-start your weight loss, including the South Beach Diet and the Mayo Clinic Diet.

For long-term success, get regular exercise as recommended in the South Beach Diet Supercharged plan.

Side Effects of South Beach Diet

The South Beach Diet is generally safe if you follow it as outlined in official South Beach Diet books and websites. However, if you severely restrict your carbohydrates, you may experience problems from ketosis. Ketosis occurs when you don’t have enough sugar (glucose) for energy, so your body breaks down stored fat, causing ketones to build up in your body. Side effects from ketosis can include nausea, headache, mental fatigue and bad breath, and sometimes dehydration and dizziness.

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What is High Protein Diet

Increased protein intakes and supplementation have generally been focused on athletic populations. However, over the past few years high protein diets have become a method used by the general population to enhance weight loss. The low-carbohydrate, high protein, high fat diet promoted by Atkins may be the most popular diet used today for weight loss in the United States ¹. The basis behind this diet is that protein is associated with feelings of satiety and voluntary reductions in caloric consumption ², ³. A recent study has shown that the Atkins diet can produce greater weight reduction at 3 and 6 months than a low-fat, high carbohydrate diet based upon U.S. dietary guidelines ⁴. However, potential health concerns have arisen concerning the safety of high protein diets. In 2001, the American Heart Association published a statement on dietary protein and weight reduction and suggested that individuals following such a diet may be at potential risk for metabolic, cardiac, renal, bone and liver diseases ⁵.

The Institute of Medicine recommends that adults get a minimum of 0.8 grams of protein for every kilogram of body weight per day (or 8 grams of protein for every 20 pounds of body weight) ⁶, ⁷. In the United States, the recommended daily allowance of protein is 46 grams per day for women over 19 years of age, and 56 grams per day for men over 19 years of age ⁸. The Institute of Medicine also sets a wide range for acceptable protein intake, anywhere from 10 to 35 percent of calories each day.

A high protein diet is considered high in protein if it exceeds 0.8 g/kg of body weight or the habitual 15-16% of total energy ⁹.

High-protein (and low carbohydrate) diets (based on a 2000 kcal diet and a 75 kg person) have recently received much attention in form of:

• High Protein Normal Carb ¹⁰ ~ 1.3 g/kg/day Protein (20% of total calories), 30% Fat, 50% Carbohydrate,
• USDA Recommended  ~ 0.8 g/kg/day Protein (10-35% of total calories), 20-35% Fat, 45-65% Carbohydrate,
• the Atkins diet which is a non-energy-restricting, low carbohydrate (as low as 30 g/day), high-protein/high-fat diet ¹¹ ~ 2.3 g/kg/day Protein (35% of total calories), 59% Fat, 6% Carbohydrate,
• the South Beach diet (low carbohydrate/high protein diet) ¹² ~ 2.6 g/kg/day Protein (39% of total calories), 33% Fat, 28% Carbohydrate,
• the Stillman diet (very low carbohydrate/very high protein/low fat) ¹² ~ 4.3 g/kg/day Protein (64% of total calories), 33% Fat, 3% Carbohydrate,
• the Zone diet (low carbohydrate/high protein) ¹² ~ 2.3 g/kg/day Protein (34% of total calories), 29% Fat, 36% Carbohydrate.

Animal Protein

Proteins from animal sources (i.e. eggs, milk, meat, fish and poultry) provide the highest quality rating of food sources ¹³. This is primarily due to the ‘completeness’ of proteins from these sources. Animal protein includes all of the building blocks that your body needs.  Protein from animal sources during late pregnancy is believed to have an important role in infants born with normal body weights. A low intake of protein from dairy and meat sources during late pregnancy was associated with low birth weights.

In addition to the benefits from total protein consumption, elderly subjects have also benefited from consuming animal sources of protein. Diets consisting of meat resulted in greater gains in lean body mass compared to subjects on a lacto-ovo-vegetarian diet ¹⁴. High animal protein diets have also been shown to cause a significantly greater net protein synthesis than a high vegetable protein diet ¹⁵. This was suggested to be a function of reduced protein breakdown occurring during the high animal protein diet.

There have been a number of health concerns raised concerning the risks associated with protein emanating primarily from animal sources. Primarily, these health risks have focused on cardiovascular disease (due to the high saturated fat and cholesterol consumption), bone health (from bone resorption due to sulfur-containing amino acids associated with animal protein) and other physiological system disease that will be addressed in the section on the high protein diets.

1. Whey: Whey is a general term that typically denotes the translucent liquid part of milk that remains following the process (coagulation and curd removal) of cheese manufacturing. From this liquid, whey proteins are separated and purified using various techniques yielding different concentrations of whey proteins. There are three main forms of whey protein that result from various processing techniques used to separate whey protein. They are whey powder, whey concentrate, and whey isolate ¹³.

Whey is one of the two major protein groups of bovine milk, accounting for 20% of the milk while casein accounts for the remainder. All of the constituents of whey protein provide high levels of the essential and branched chain amino acids. The bioactivities of these proteins possess many beneficial properties as well. Additionally, whey is also rich in vitamins and minerals. Whey protein is most recognized for its applicability in sports nutrition. Additionally, whey products are also evident in baked goods, salad dressings, emulsifiers, infant formulas, and medical nutritional formulas.

Whey is a complete protein whose biologically active components provide additional benefits to enhance human function. Whey protein contains an ample supply of the amino acid cysteine. Cysteine appears to enhance glutathione levels, which has been shown to have strong antioxidant properties that can assist the body in combating various diseases ¹⁶. In addition, whey protein contains a number of other proteins that positively effect immune function such as antimicrobial activity ¹⁷. Whey protein also contains a high concentration of branched chain amino acids (BCAA) that are important for their role in the maintenance of tissue and prevention of catabolic actions during exercise ¹⁸.

• Whey Protein Powder

Whey protein powder has many applications throughout the food industry. As an additive it is seen in food products for beef, dairy, bakery, confectionery, and snack products. Whey powder itself has several different varieties including sweet whey, acid whey (seen in salad dressings), demineralized (seen primarily as a food additive including infant formulas), and reduced forms. The demineralized and reduced forms are used in products other than sports supplements.

• Whey Protein Concentrate

The processing of whey concentrate removes the water, lactose, ash, and some minerals. In addition, compared to whey isolates whey concentrate typically contains more biologically active components and proteins that make them a very attractive supplement for the athlete.

• Whey Protein Isolate (WPI)

Isolates are the purest protein source available. Whey protein isolates contain protein concentrations of 90% or higher. During the processing of whey protein isolate there is a significant removal of fat and lactose. As a result, individuals who are lactose-intolerant can often safely take these products ¹⁹. Although the concentration of protein in this form of whey protein is the highest, it often contain proteins that have become denatured due to the manufacturing process. The denaturation of proteins involves breaking down their structure and losing peptide bonds and reducing the effectiveness of the protein.

2. Casein: Casein is the major component of protein found in cow (bovine) milk accounting for nearly 70-80% of its total protein and is responsible for the white color of milk ¹³. It is the most commonly used milk protein in the industry today. Milk proteins are of significant physiological importance to the body for functions relating to the uptake of nutrients and vitamins and they are a source of biologically active peptides. Similar to whey, casein is a complete protein and also contains the minerals calcium and phosphorous. Casein has a PDCAAS (protein digestibility corrected amino acid score) rating of 1.23 (generally reported as a truncated value of 1.0)  ²⁰.

Casein exists in milk in the form of a micelle, which is a large colloidal particle. An attractive property of the casein micelle is its ability to form a gel or clot in the stomach. The ability to form this clot makes it very efficient in nutrient supply. The clot is able to provide a sustained slow release of amino acids into the blood stream, sometimes lasting for several hours ²¹. This provides better nitrogen retention and utilization by the body.

3. Bovine Colostrum: Bovine colostrum is the “pre” milk liquid secreted by female mammals the first few days following birth. This nutrient-dense fluid is important for the newborn for its ability to provide immunities and assist in the growth of developing tissues in the initial stages of life. Evidence exists that bovine colostrum contains growth factors that stimulate cellular growth and DNA synthesis ²² and as might be expected with such properties, it makes for interesting choice as a potential sports supplement.

Although bovine colostrum is not typically thought of as a food supplement, the use by strength/power athletes of this protein supplement as an ergogenic aid has become common. Oral supplementation of bovine colostrum has been demonstrated to significantly elevate insulin-like-growth factor 1 (IGF-1) ²³ and enhance lean tissue accruement ²⁴, ²⁵. However, the results on athletic performance improvement are less conclusive. Mero and colleagues (1997) reported no changes in vertical jump performance following 2-weeks of supplementation, and Brinkworth and colleagues ²⁵ saw no significant differences in strength following 8-weeks of training and supplementation in both trained and untrained subjects. In contrast, following 8-weeks of supplementation significant improvements in sprint performance were seen in elite hockey players ²⁶. Further research concerning bovine colostrum supplementation is still warranted.

Vegetable Protein

Vegetable proteins, when combined to provide for all of the essential amino acids, provide an excellent source for protein considering that they will likely result in a reduction in the intake of saturated fat and cholesterol. Popular sources include legumes, nuts and soy. Aside from these products, vegetable protein can also be found in a fibrous form called textured vegetable protein. Textured vegetable protein is produced from soy flour in which proteins are isolated. Textured vegetable protein is mainly a meat alternative and functions as a meat analog in vegetarian hot dogs, hamburgers, chicken patties, etc. It is also a low-calorie and low-fat source of vegetable protein. Vegetable sources of protein also provide numerous other nutrients such as phytochemicals and fiber that are also highly regarded in the diet diet.

1. Soy:

Soy is the most widely used vegetable protein source. The soybean, from the legume family, was first chronicled in China in the year 2838 B.C. and was considered to be as valuable as wheat, barley, and rice as a nutritional staple. It is found in modern American diets as a food or food additive ²⁷. Soybeans, the high-protein seeds of the soy plant, contain isoflavones—compounds similar to the female hormone estrogen (phytoestrogens). Isoflavones are often referred to as phytoestrogens or plant-based estrogens because they have been shown, in cell line and animal studies, to have the ability to bind with the estrogen receptor ²⁸. Research alos suggests that daily intake of soy protein may slightly lower levels of LDL (“bad”) cholesterol. Soy products are used for menopausal symptoms, bone health, improving memory, high blood pressure, and high cholesterol levels ²⁷. In addition to its food uses, soy is available in dietary supplements, in forms such as tablets, capsules, and powders. Soy supplements may contain soy protein, isoflavones (compounds that have effects in the body similar to those of the female hormone estrogen), or other soy components ²⁷.

Soy protein is a high quality protein that has been extensively studied. Soy provides a complete source of dietary protein, meaning that, unlike most plant proteins, it contains all the essential amino acids ²⁹. The quality of soy protein has been assessed through several metabolic studies of nitrogen balance ³⁰, ³¹, ³², which have demonstrated that soy protein supports nitrogen balance on par with beef and milk proteins. One recent study reported that amino acids from soy protein appear in the serum sooner, but that this may lead to a more rapid breakdown of the amino acids in the liver ³³. Americans as a whole still consume very little soy protein. Based on 2003 data from the UN Food and Agriculture Organization, per-capita soy protein consumption is less than 1 gram (g) per day in most European and North American countries, although certain subpopulations such as vegetarians, Asian immigrants, and infants fed soy-based formula consume more. The Japanese, on the other hand, consume an average 8.7 g of soy protein per day; Koreans, 6.2–9.6 g; Indonesians, 7.4 g; and the Chinese, 3.4 g ²⁹.

Traditional soy foods include tofu, which is produced by puréeing cooked soybeans and precipitating the solids, and miso and tempeh, which are made by fermenting soybeans with grains. “Second generation” soy products involve chemical extractions and other processing, and include soy protein isolate and soy flour. These products become primary ingredients in items such as meatless burgers, dietary protein supplements, and infant formula, and are also used as nonnutritive additives to improve the characteristics of processed foods ²⁹.

Soy Protein Types

The soybean can be separated into three distinct categories; flour, concentrates, and isolates. Soy flour can be further divided into natural or full-fat (contains natural oils), defatted (oils removed), and lecithinated (lecithin added) forms. Of the three different categories of soy protein products, soy flour is the least refined form. It is commonly found in baked goods. Another product of soy flour is called textured soy flour. This is primarily used for processing as a meat extender. See Table 1 for protein composition of soy flour, concentrates, and isolates.

Soy concentrate was developed in the late 1960s and early 1970s and is made from defatted soybeans. While retaining most of the bean’s protein content, concentrates do not contain as much soluble carbohydrates as flour, making it more palatable. Soy concentrate has a high digestibility and is found in nutrition bars, cereals, and yogurts.

Isolates are the most refined soy protein product containing the greatest concentration of protein, but unlike flour and concentrates, contain no dietary fiber. Isolates originated around the 1950s in The United States. They are very digestible and easily introduced into foods such as sports drinks and health beverages as well as infant formulas.

What we know about Soy ³⁴, ²⁷

• Consuming soy protein in place of other proteins may lower levels of LDL (“bad”) cholesterol to a small extent ³⁵, ³⁶.
• Soy isoflavone supplements may help to reduce the frequency and severity of menopausal hot flashes, but the effect may be small ³⁷, ³⁸.
• It’s uncertain whether soy supplements can relieve cognitive problems associated with menopause ³⁹.
• Current evidence suggests that soy isoflavone mixtures do not slow bone loss in Western women during or after menopause ⁴⁰.
• Diets containing soy protein may slightly reduce blood pressure ⁴¹.
• There’s not enough scientific evidence to determine whether soy supplements are effective for any other health uses.
• Current National Center for Complementary and Integrative Health-funded studies on soy and its components are investigating a variety of topics, including stroke outcomes, anti-inflammatory effects, and effects on diabetes.

What are Amino Acids ?

Amino acids are organic compounds that combine to form proteins ⁴². Amino acids and proteins are the building blocks of life that help maintain and repair muscles, organs, and other parts of the body.

Animal protein includes all of the building blocks that your body needs. Plant proteins need to be combined to get all of the building blocks that your body needs.

In the human body, certain amino acids can be converted to other amino acids, proteins, glucose, fatty acids or ketones. For example, in the human body, glucogenic amino acids can be converted to glucose in the process called gluconeogenesis; they include all amino acids except lysine and leucine ⁴³, ⁴⁴.

Ketogenic amino acids, are amino acids that can be converted into ketone bodies through ketogenesis. In humans, the ketogenic amino acids are leucine and lysine, while threonine, isoleucine, phenylalanine, tyrosine and tryptophan can be either ketogenic or glucogenic ⁴⁵. Ketones can be used by the brain as a source of energy during fasting or in a low-carbohydrate diet.

When proteins are digested or broken down, amino acids are left.

The human body uses amino acids to make proteins to help the body:

• • Break down food
  • Grow
  • Repair body tissue
  • Perform many other body functions
  • Amino acids can also be used as a source of energy by the body, like proteins, they can provide about 4 Calories per gram.

Other functions of amino acids:

• Chemical messengers (neurotransmitters) in the nervous system: aspartate, GABA, glutamate, glycine, serine
• Precursors of other neurotransmitters or amino acid-based hormones:
• Tyrosine is a precursor of dopamine, epinephrine, norepinephrine and thyroxine.
• Tryptophan is a precursor of melatonin and serotonin and nicotinic acid (vitamin B3).
• Histidine is a precursor of histamine.
• Glycine is a precursor of heme, a part of hemoglobin.
• Aspartate, glutamate and glycine are precursors of nucleic acids, which are parts of DNA.

Amino acids are classified into three groups:

1. Essential amino acids.
2. Nonessential amino acids.
3. Conditional amino acids.

You do not need to eat essential and nonessential amino acids at every meal, but getting a balance of them over the whole day is important. A diet based on a single plant item will not be adequate, but we no longer worry about pairing proteins (such as beans with rice) at a single meal. Instead we look at the adequacy of the diet overall throughout the day.

Essential Amino Acids

The 9 amino acids are essential (vital), which means they are necessary for the human life and health but cannot be produced in your body so you need to get them from foods ⁴⁶.

1. Histidine (His)
2. Isoleucine (Ile)
3. Leucine (Leu)
4. Lysine (Lys)
5. Methionine (Met)
6. Phenylalanine (Phe)
7. Threonine (Thr)
8. Tryptophan (Trp)
9. Valine (Val).

Conditionally Essential Amino Acids

These amino acids can be synthesized in your body, but in certain circumstances, like young age, illness or hard exercise, you need to get them in additional amounts from foods to meet the body requirements for them. Ornithine is also considered conditionally essential amino acid, but it does not form proteins ⁴².

1. Arginine (Arg)
2. Cysteine (Cys)
3. Glutamine (Gln)
4. Glycine (Gly)
5. Proline (Pro)
6. Serine (Ser)
7. Tyrosine (Tyr)

Nonessential Amino Acids

These amino acids can be synthesized in your body from other amino acids, glucose and fatty acids, so you do not need to get them from foods.

1. Alanine (Ala)
2. Asparagine (Asn)
3. Aspartic acid (Asp)
4. Glutamic acid (Glu)
5. Selenocysteine (Sec).

Finding balance, choosing the right kind and amount of protein.

Foods that Contain All 9 Essential Amino Acids

Food protein containing all 9 amino acids in adequate amounts is called complete or high-quality protein.

• ANIMAL FOODS with complete protein include liver (chicken, pork, beef), goose, duck, turkey, chicken, lamb, pork, most fish, rabbit, eggs, milk, cheese (cottage, gjetost, cream, swiss, ricotta, limburger, gruyere, gouda, fontina, edam) and certain beef cuts. Animal foods with incomplete protein include certain yogurts and beef cuts.

• PLANT FOODS with complete protein include spinach, beans (black, cranberry, french, pink, white, winged, yellow), soy, split peas, chickpeas, chestnuts, pistachios, pumpkin seeds, avocado, potatoes, quinoa, a seaweed spirulina, tofu and hummus. Common plant foods with incomplete protein: rice (white and brown), white bread (including whole-wheat), pasta, beans (adzuki, baked, kidney, lima, pinto, snap), peas, lentils, nuts (walnuts, peanuts, hazelnuts, almonds, coconut), sunflower seeds, kamut.

• Foods made of mycoprotein also contain complete protein.

When choosing protein, opt for low-fat options, such as lean meats, skim milk or other foods with high levels of protein. Legumes, for example, can pack about 16 grams of protein per cup and are a low-fat and inexpensive alternative to meat.

Choose main dishes that combine meat and vegetables together, such as low-fat soups, or a stir-fry that emphasizes veggies.

• Some high-protein foods are healthier than others because of what comes along with the protein: healthy fats or harmful ones, beneficial fiber or hidden salt. It’s this protein package that’s likely to make a difference for health. For example, a 6-ounce broiled porterhouse steak is a great source of protein—about 40 grams worth. But it also delivers about 12 grams of saturated fat ⁴⁷. For someone who eats a 2,000 calorie per day diet, that’s more than 60 percent of the recommended daily intake for saturated fat.
• Watch portion size. Aim for 2- to 3-ounce servings.
• If you’re having an appetizer, try a plate of raw veggies instead of a cheese plate. Cheese adds protein, but also fat.
• A 6-ounce ham steak has only about 2.5 grams of saturated fat, but it’s loaded with sodium—2,000 milligrams worth, or about 500 milligrams more than the daily sodium max.

6-ounces of wild salmon has about 34 grams of protein and is naturally low in sodium, and contains only 1.7 grams of saturated fat ⁴⁷. Salmon and other fatty fish are also excellent sources of omega-3 fats, a type of fat that’s especially good for the heart. Alternatively, a cup of cooked lentils provides about 18 grams of protein and 15 grams of fiber, and it has virtually no saturated fat or sodium ⁴⁷.

Sustained satiety is a key component to induce a negative energy balance and to promote weight loss. An ideal weight loss strategy would promote satiety and maintain basal metabolic rates despite a negative energy balance and reduction in fat-free mass. Satiety is multifactorial and influenced by many components including but not limited to the endocrine system, the cognitive and neural system as well as the gastrointestinal system. The hierarchy for macronutrient-induced satiating efficiency is similar to that observed for diet-induced thermogenesis : protein is the most satiating macronutrient followed by carbohydrates and fat, which is least satiating ⁴⁸. This satiating effect is most significant after high-protein diets ⁴⁹. Satiety was significantly greater after a 60% protein meal than after a 19% protein meal ⁵⁰. These findings were confirmed by Crovetti et al. who reported significantly greater satiety after consumption of an isocaloric meal containing 68% protein compared with a 10% protein meal ⁵¹. Increased satiety helps to decrease energy intake, which is a requisite for successful weight loss. In general, increased satiety has been observed after meals with a protein content in the range of 25% to 81% ⁵².

The thermic effect of food (energy expenditure), also called diet-induced thermogenesis, is a metabolic response to food. Food intake results in a transient increase in energy expenditure attributable to the various steps of nutrient processing (i.e. digestion, absorption, transport, metabolism and storage of nutrients). The diet-induced thermogenesis is mostly indicated as percentage increase in energy expenditure over the basic metabolic rate (BMR). The diet-induced thermogenesis values are highest for protein (~15-30%), followed by carbohydrates (~5-10%) and fat (~0-3%) ⁵³, ⁵⁴. Based on a recent meta-analysis, the thermic effect of food increases ≈ 29 kJ/4184 kJ of ingested food for each increase of 10 percentage points in the percentage of energy from protein ⁵⁵. In other words, if a subject therefore consumes an 8368 kJ/d diet with 30% energy from protein, then the thermic effect of food will be 58 kJ/d higher than if protein contributes only 20% of the dietary energy. Mikkelsen et al. ⁵⁶ found that subjects consuming a diet containing 29% of protein had a 891 kJ/d higher resting metabolic rate than subjects consuming the same eucaloric diet with 11% energy from protein. For weight loss, however, diet-induced thermogenesis-related satiety is even more important. A high protein diet is associated with increased 24-h diet-induced energy expenditure ⁵⁷. The increase in diet-induced thermogenesis may increase satiety.

Long-term effects of high-protein diets depend on the population studied as well as the exact composition of the diet but have generally been shown to include weight reduction and weight loss maintenance as well as beneficial effects on metabolic risk factors such total cholesterol and triacylglycerol. Claessens et al. ⁵⁸ compared a low-fat, high-carbohydrate diet against a low-fat, high-protein diet. The authors conclude that after 12 weeks of diet intervention, the low-fat, high-protein diet was more effective for weight control.

Clifton et al. analyzed data from 215 obese subjects which were either assigned to a 12 week high-protein or standard-protein diet. The authors conclude that subjects in the high-protein group had beneficial effects on total cholesterol and triacylglycerol and achieved greater weight loss and better lipid results. In another study, Clifton et al. determined the efficacy of a high-protein and high-carbohydrate intake on the maintenance of weight loss after 64 weeks of follow-up. The authors found no significant difference between groups regarding weight loss. Protein intake in grams derived from the dietary records, however, was directly related to weight loss. Westerterp-Plantenga et al. studied that effect of a 20% higher protein intake (18% of energy vs 15% of energy) for subsequent 3 months of weight maintenance after weight loss. They found that higher protein intake resulted in a 50% lower body weight regain over this time, possibly related to increased satiety and decreased energy efficiency. It has to be mentioned, however, that a hypochaloric diet with a high protein content of 20-30% is only relatively high in protein compared to a eucaloric diet with a normal protein level of 10-15% while the absolute amount of protein often does not differ between the two diets.

Other possible mechanisms to explain the improvement in satiety with high-protein diets are:

• The secretion of gut neuropeptides that induce satiation, glucagon-like peptide-1 (GLP-1), cholecystokinin (CCK), and peptide YY (PYY) seem to be increased in response to a high-protein diet.
• High-protein diets may directly promote a satiety response due to a complex homeostatic mechanisms between the peripheral organs and the central nervous system.
• High-protein and low-carbohydrate diets promote hepatic gluconeogenesis to maintain plasma glucose levels. Alteration of gluconeogenesis has been found to contribute to satiety.
• High-protein diets can help preserve lean body mass during weight loss. Mettler et al. examined the effect of increased dietary protein intake (~2.3 g/kg BW/d) on lean body mass maintenance during hypoenergetic weight loss in athletes ⁵⁹.
• For obese subjects, lowering carbohydrate in favor of protein might be advantageous as dietary carbohydrates might impair fat oxidation ⁶⁰ whereas low-carbohydrate, high-protein diets reduce adipose tissue development in rats ⁶¹. Higher daily protein intake at the expense of fat intake could substantially reduce total energy intake, which could possibly translate to a healthier weight status ⁶².

Possible risk factors associated with a high-protein diet

• Metabolomics studies revealed that high intake of branched-chain amino acids (BCAAs, Valine, Leucine, Isoleucine) and aromatic amino acids (Phenylalanine, Tyrosine) may be associated with the development of metabolic diseases, that is branched-chain amino acids (BCAA) and related metabolites are more strongly associated with insulin resistance and the incident of diabetes. Importantly, this only occurs in combination with a high-fat diet ⁶³.

• Metabolic ketosis: One of the major concerns for individuals on high protein, low carbohydrate diets is the potential for the development of metabolic ketosis. As carbohydrate stores are reduced the body relies more upon fat as its primary energy source. The greater amount of free fatty acids that are utilized by the liver for energy will result in a greater production and release of ketone bodies in the circulation. This will increase the risk for metabolic acidosis and can potentially lead to a coma and death. A recent multi-site clinical study ⁴ examined the effects of low-carbohydrate, high protein diets and reported significant elevation in ketone bodies during the first three months of the study. However, as the study duration continued the percentage of subjects with positive urinary ketone concentrations became reduced, and by six months urinary ketones were not present in any of the subjects ⁴.

• Diets high in protein pose a potential acid load to the kidneys, mainly as sulfates and phosphates ⁶⁴. The authors conclude that renal hemodynamics and renal excretion is altered in response to a short-term, high-protein diet. Although depended on the source of protein, interventional studies in humans have shown that high-protein diets have the potential to increase the risk of calcium stone-formation in the urinary tract ⁶⁴, ⁶⁵. In a study on bodybuilders consuming a high protein (2.8 g/kg) diet no negative changes were seen in any kidney function tests ⁶⁶. However, in individuals with existing kidney disease it is recommended that they limit their protein intake to approximately half of the normal RDA level for daily protein intake (0.8 g/kg per day). Lowering protein intake is thought to reduce the progression of renal disease by decreasing hyperfiltration ⁶⁷. In order to maintain an acid–base balance in the body, people on a high-protein diet should consider ingestion of alkali buffers such as fruits and vegetables high in potassium (alkaline-forming foods). Glutamine or sodium bicarbonate supplements can also help to restore acid–base balance in the body. In general, people experimenting with high-protein diets are advised to monitor their renal function.

Protein and Chronic Diseases

Proteins in food and the environment are responsible for food allergies, which are overreactions of the immune system. Beyond that, relatively little evidence has been gathered regarding the effect of the amount of dietary protein on the development of chronic diseases in healthy people.

However, there’s growing evidence that high-protein food choices do play a role in health—and that eating healthy protein sources like fish, chicken, beans, or nuts in place of red meat (including processed red meat) can lower the risk of several diseases and premature death ⁸, ⁶⁸, ⁶⁹, ⁷⁰, ⁷¹, ⁷², ⁷³.

• Cardiovascular disease

Research conducted at Harvard School of Public Health has found that eating even small amounts of red meat, especially processed red meat, on a regular basis is linked to an increased risk of heart disease and stroke, and the risk of dying from cardiovascular disease or any other cause ⁶⁸, ⁷⁰, ⁷⁴. Conversely, replacing red and processed red meat with healthy protein sources such as poultry, fish, or beans seems to reduce these risks.

One investigation followed 120,000 men and women in the Nurses’ Health Study and Health Professionals Follow-Up Study for more than two decades ⁷⁰. For every additional 3-ounce serving of unprocessed red meat the study participants consumed each day, their risk of dying from cardiovascular disease increased by 13 percent.

Processed red meat was even more strongly linked to dying from cardiovascular disease—and in smaller amounts: Every additional 1.5 ounce serving of processed red meat consumed each day—equivalent to one hot dog or two strips of bacon—was linked to a 20 percent increase in the risk of cardiovascular disease death.

Cutting back on red meat could save lives: the researchers estimated that if all the men and women in the study had reduced their total red and processed red meat intake to less than half a serving a day, one in ten cardiovascular disease deaths would have been prevented.

In terms of the amount of protein consumed, there’s evidence that eating a high-protein diet may be beneficial for the heart, as long as the protein comes from a healthy source.

A 20-year prospective study of over 80,000 women found that those who ate low-carbohydrate diets that were high in vegetable sources of fat and protein had a 30 percent lower risk of heart disease compared with women who ate high-carbohydrate, low-fat diets. Diets were given low-carbohydrate scores based on their intake of fat, protein, and carbohydrates ⁷⁵. However, eating a low-carbohydrate diet high in animal fat or protein did not offer such protection.

Further evidence of the heart benefits of eating healthy protein in place of carbohydrate comes from a randomized trial known as the Optimal Macronutrient Intake Trial for Heart Health (OmniHeart). A healthy diet that replaced some carbohydrate with healthy protein (or healthy fat) did a better job of lowering blood pressure and harmful low-density lipoprotein (LDL) cholesterol than a similarly healthy, higher carbohydrate diet ⁷⁶.

Similarly, the “EcoAtkins” weight loss trial compared a low-fat, high -carbohydrate, vegetarian diet to a low-carbohydrate vegan diet that was high in vegetable protein and fat. Though weight loss was similar on the two diets, study participants on the high protein diet saw improvements in blood lipids and blood pressure ⁷⁷.

A more recent study generated headlines because it had the opposite result. In that study, Swedish women who ate low-carbohydrate, high-protein diets had higher rates of cardiovascular disease and death than those who ate lower-protein, higher-carbohydrate diets ⁷⁸. But the study, which assessed the women’s diets only once and then followed them for 15 years, did not look at what types of carbohydrates or what sources of protein these women ate. That was important because most of the women’s protein came from animal sources.

• Diabetes

Again, protein quality matters more than protein quantity when it comes to diabetes risk ⁷⁹.

A recent study found that people who ate diets high in red meat, especially processed red meat, had a higher risk of type 2 diabetes than those who rarely ate red or processed meat ⁷¹. For each additional serving a day of red meat or processed red meat that study participants ate, their risk of diabetes rose 12 and 32 percent, respectively.

Substituting one serving of nuts, low-fat dairy products, or whole grains for a serving of red meat each day lowered the risk of developing type 2 diabetes by an estimated 16 to 35 percent.

Another study also shows that red meat consumption may increase risk of type 2 diabetes. Researchers found that people who started eating more red meat than usual were found to have a 50% increased risk of developing type 2 diabetes during the next four years, and researchers also found that those who reduced red meat consumption lowered their type 2 diabetes risk by 14% over a 10-year follow-up period.

More evidence that protein quality matters comes from a 20-year study that looked at the relationship between low-carbohydrate diets and type 2 diabetes in women. Low-carbohydrate diets that were high in vegetable sources of fat and protein modestly reduced the risk of type 2 diabetes ⁸⁰. But low-carbohydrate diets that were high in animal sources of protein or fat did not show this benefit.

For type 1 diabetes (formerly called juvenile or insulin-dependent diabetes), proteins found in cow’s milk have been implicated in the development of the disease in babies with a predisposition to the disease, but research remains inconclusive ⁸¹, ⁸².

• Protein Intake and Liver Disease Risk

The American Heart Association has suggested that high protein diets may have detrimental effects on liver function ⁵. This is primarily the result of a concern that the liver will be stressed through metabolizing the greater protein intakes. However, there is no scientific evidence to support this contention. Jorda and colleagues ⁸³ did show that high protein intakes in rats produce morphological changes in liver mitochondria. However, they also suggested that these changes were not pathological, but represented a positive hepatocyte adaptation to a metabolic stress.

Protein is important for the liver not only in promoting tissue repair, but to provide lipotropic agents such as methionine and choline for the conversion of fats to lipoprotein for removal form the liver ⁸⁴. The importance of high protein diets has also been acknowledged for individuals with liver disease and who are alcoholics. High protein diets may offset the elevated protein catabolism seen with liver disease ⁸⁴, while a high protein diet has been shown to improve hepatic function in individuals suffering from alcoholic liver disease ⁸⁵.

• Cancer

When it comes to cancer, protein quality again seems to matter more than quantity. Research on the association between protein and cancer is ongoing, but some data shows that eating a lot of red meat and processed meat is linked to an increased risk of colon cancer ⁸.

In the Nurse’s Health Study and the Health Professionals Follow-Up Study, every additional serving per day of red meat or processed red meat was associated with a 10 and 16 percent higher risk of cancer death, respectively ⁷⁰.

A 2014 study showed that higher consumption of red meat during adolescence was associated with premenopausal breast cancer, suggesting that choosing other protein sources in adolescence may decrease premenopausal breast cancer risk ⁸⁶.

People should aim to reduce overall consumption of red meat and processed meat, but when you do opt to have it, go easy on the grill. High-temperature grilling creates potentially cancer-causing compounds in meat, including polycyclic aromatic hydrocarbons and heterocyclic amines. You don’t have to stop grilling, but try these tips for healthy grilling from the American Institute of Cancer Research: Marinate meat before grilling it, partially pre-cook meat in the oven or microwave to reduce time on the grill, and grill over a low flame.

In October 2015, the World Health Organization (WHO)’s International Agency for Research on Cancer announced that consumption of processed meat is “carcinogenic to humans,” and that consumption of red meat is “probably carcinogenic to humans.” ⁸⁷

The IARC Working Group, comprised of 22 scientists from ten countries, evaluated over 800 studies. Conclusions were primarily based on the evidence for colorectal cancer. Data also showed positive associations between processed meat consumption and stomach cancer, and between red meat consumption and pancreatic and prostate cancer ⁸⁷.

• Osteoporosis

Digesting protein releases acids into the bloodstream, which the body usually neutralizes with calcium and other buffering agents. Eating lots of protein, then, requires a lot of calcium – and some of this may be pulled from bone.

Following a high-protein diet for a long period of time could weaken bone. In the Nurses’ Health Study, for example, women who ate more than 95 grams of protein a day were 20 percent more likely to have broken a wrist over a 12-year period when compared with those who ate an average amount of protein (less than 68 grams a day) ⁸⁸. This area of research is still controversial, however, and the findings have not been consistent. Some studies suggest that increasing protein increases risk of fractures; others have linked high-protein diets with increased bone-mineral density, and thus stronger bones ⁸⁹, ⁹⁰, ⁹¹. Given the effect of protein on bone health is still unclear, but it does appear to be prudent to monitor the amount of animal protein in the diet for susceptible individuals. This may be more pronounced in individuals that may have a genetic predisposition for this. However, if animal protein consumption is modified by other nutrients (e.g. calcium) the effects on bone health may be lessened ¹³.

• Protein and Weight Control

The same high-protein foods that are good choices for disease prevention may also help with weight control. Researchers at Harvard School of Public Health followed the diet and lifestyle habits of 120,000 men and women for up to 20 years, looking at how small changes contributed to weight gain over time ⁹².

Those who ate more red and processed meat over the course of the study gained more weight, about one extra pound every four years, while those who ate more nuts over the course of the study gained less weight, about a half pound less every four years.

One study showed that eating approximately one daily serving of beans, chickpeas, lentils or peas can increase fullness, which may lead to better weight management and weight loss ⁹³.

There’s no need to go overboard on protein. Though some studies show benefits of high-protein, low-carbohydrate diets in the short term, avoiding fruits and whole grains means missing out on healthful fiber, vitamins, minerals, and other phytonutrients.

Summary

The mechanisms by which increased long-term dietary protein intake regulate body weight are not well understood but are most likely multifactorial ⁹⁴. Depending on the diet, lower triacylglycerol levels and hence fat mass loss with a higher-protein diet as well as increased satiety possibly mediated by increased leptin sensitivity have been discussed ⁹⁵, ⁹⁶, ⁹⁷. Fluid loss related to reduced carbohydrate intake and overall caloric restriction have also been discussed to mediate weight loss ⁵.

There are some risk factors to high protein diets such as increased acid load to the kidneys or high fat content of animal proteins. Awareness of these risk factors enables individuals choosing to consume a high-protein diet to get the most benefit from it.

The Role of Protein in the Body

Protein is in every cell in the body and it’s the building blocks of life. At least 10,000 different proteins make you what you are and keep you that way. They make up about 15% of the average person’s body weight. Your body need protein from the foods you eat to build and maintain bones, muscles and skin. You get proteins in your diet from meat, dairy products, nuts, and certain grains and beans. Proteins from meat and other animal products are complete proteins. This means they supply all of the amino acids the body can’t make on its own. Most plant proteins are incomplete. The basic structure of protein is a chain of amino acids. You should eat different types of plant proteins every day to get all of the amino acids your body needs ⁹⁸.

It is important to get enough dietary protein to help your body repair cells and make new ones. Protein is also important for growth and development in children, teens, and pregnant women ⁹⁹. You need to eat protein every day, because your body doesn’t store it the way it stores fats or carbohydrates. How much you need depends on your age, sex, health, and level of physical activity. Most Americans eat enough protein in their diet, most Americans already eat about 12-18% of their calories as protein ¹⁰⁰.

Some people, such as vegetarians, do have to pay attention to the protein in their diets. While animal proteins have all the essential amino acids, plant-based proteins can have low amounts of some. That’s why vegetarians have to eat protein from several different sources to get all the different amino acids they need. Vegetarian food combinations that give you complete protein, for example, include rice and beans or peanut butter and bread. Eggs are also a good source of complete protein. People who don’t eat eggs or dairy products need to be particularly careful to get all the essential amino acids they need ¹⁰⁰.

Another group that may not get enough protein is older adults. A recent NIH study of men and women in their 70s found that those who ate the least protein lost significantly more muscle than those who ate the most protein. Maintaining muscle is particularly important as you age. Older adults who lose muscle in their legs and hips are more likely to fall and have injuries like broken hips. Those who don’t maintain strong muscles as they age might also have trouble doing basic things like getting up from a chair, walking up stairs or taking a stroll through the park ¹⁰⁰.

Increased protein intakes and supplementation have generally been focused on athletic populations. In special cases, these products can prove useful. For elderly people who can’t eat enough protein or patients with diseases that leave them malnourished, a protein supplement can be one way to help get enough protein. However, over the past few years high protein diets have become a method used by the general population to enhance weight reduction. The low-carbohydrate, high protein, high fat diet promoted by Atkins may be the most popular diet used today for weight loss in the United States. Numerous studies have shown that a high-protein diet has major benefits for weight loss and metabolic health. There’s growing evidence ¹⁰¹, ¹⁰², ¹⁰³, ¹⁰⁴, ¹⁰⁵, ¹⁰⁶, ¹⁰⁷ that high-protein food choices do play a role in health and that eating healthy protein sources like fish, chicken, beans, or nuts in place of red meat (including processed red meat) can lower the risk of several diseases and premature death.

In terms of the amount of protein consumed, there’s evidence that eating a high-protein diet may be beneficial for the heart, as long as the protein comes from a healthy source.

• A 20-year prospective study of over 80,000 women found that those who ate low-carbohydrate diets that were high in vegetable sources of fat and protein had a 30 percent lower risk of heart disease compared with women who ate high-carbohydrate, low-fat diets. Diets were given low-carbohydrate scores based on their intake of fat, protein, and carbohydrates ¹⁰⁸. However, eating a low-carbohydrate diet high in animal fat or protein did not offer such protection.

• Further evidence of the heart benefits of eating healthy protein in place of carbohydrate comes from a randomized trial known as the Optimal Macronutrient Intake Trial for Heart Health (OmniHeart). A healthy diet that replaced some carbohydrate with healthy protein (or healthy fat) did a better job of lowering blood pressure and harmful low-density lipoprotein (LDL) cholesterol than a similarly healthy, higher carbohydrate diet ¹⁰⁹.

• Similarly, the “EcoAtkins” weight loss trial compared a low-fat, high -carbohydrate, vegetarian diet to a low-carbohydrate vegan diet that was high in vegetable protein and fat. Though weight loss was similar on the two diets, study participants on the high protein diet saw improvements in blood lipids and blood pressure ¹¹⁰.

A more recent study generated headlines because it had the opposite result. In that study, Swedish women who ate low-carbohydrate, high-protein diets had higher rates of cardiovascular disease and death than those who ate lower-protein, higher-carbohydrate diets ¹¹¹. But the study, which assessed the women’s diets only once and then followed them for 15 years, did not look at what types of carbohydrates or what sources of protein these women ate. That was important because most of the women’s protein came from animal sources.

For most Americans, however, there’s little benefit to eating more protein than they already do. In long-term studies of high-protein diets, researchers have found that most differences in weight loss can be explained by the amount of calories people eat rather than their protein intake. High-protein diets may make some people feel fuller, but that effect has been hard for researchers to tease out, because many high-protein diets are also high in fat.

Around the world however, millions of people don’t get enough protein. Protein malnutrition leads to the condition known as kwashiorkor. Kwashiorkor is a form of malnutrition that occurs when there is not enough protein in the diet. This disease is more common in very poor countries. It often occurs during a drought or other natural disaster, or during political unrest. These conditions are responsible for a lack of food, which leads to malnutrition. Lack of protein can cause growth failure, loss of muscle mass, decreased immunity, weakening of the heart and respiratory system, and death.

The basis behind this high protein low carbohydrate diet is that protein is associated with feelings of satiety and voluntary reductions in caloric consumption. A recent study has shown that the Atkins diet can produce greater weight reduction at 3 and 6 months than a low-fat, high carbohydrate diet based upon U.S. dietary guidelines. However, potential health concerns have arisen concerning the safety of high protein diets. One of the major concerns for individuals on high protein, low carbohydrate diets is the potential for the development of metabolic ketosis. And there is evidence to suggest that people with certain diseases and conditions should limit their intake. For people with kidney disease, for instance, a reduced-protein diet may help delay the progression towards kidney failure ¹⁰⁰.

High Protein Diet and Weight Loss

For years, proponents of some fad diets have claimed that higher amounts of protein facilitate weight loss. Only in recent years have studies begun to examine the effects of high protein diets on energy expenditure, subsequent energy intake and weight loss as compared to lower protein diets.

In this review ¹¹², the authors conducted a systematic review of randomized investigations on the effects of high protein diets on dietary thermogenesis, satiety, body weight and fat loss across 48 studies with duration ranging from 2 minutes (involving satiety), 2 hours (measuring the thermic effect of food), 7 days (subsequent energy intake) and 12 months (for weight loss). The authors concluded that there is convincing evidence that a higher protein diets might increase weight loss in the short term, but further longer term research is required before definitive conclusions can be drawn. Furthermore, a higher protein intake increases thermogenesis and satiety compared to diets of lower protein content. The weight of evidence also suggests that high protein meals lead to a reduced subsequent energy intake. Some evidence suggests that diets higher in protein result in an increased weight loss and fat loss as compared to diets lower in protein, but findings have not been consistent. In dietary practice, it may be beneficial to partially replace refined carbohydrate with protein sources that are low in saturated fat. Although recent evidence supports potential benefit, rigorous longer-term studies are needed to investigate the effects of high protein diets on weight loss and weight maintenance.

People on high-protein diets are advised to choose their source of protein very carefully (i.e. emphasize the use of high-quality protein sources from plant origin). Many protein-rich foods of animal origin (e.g. red meats, eggs and dairy products) also contain high levels of saturated fats and cholesterol. This may put consumers of high-protein diets at higher risk for heart disease, hyperlipidemia and hypercholesterolemia ¹¹³. Healthier proteins from vegetables (soy protein, beans, tofu, seitan or nuts) or fish could be a valuable alternative. Finally, all excess protein will eventually be converted to glucose (via gluconeogenesis) or ketone bodies ¹¹⁴, ¹¹⁵. This may also explain the increased gluconeogenesis in response to a high-protein diet, due to high-protein and low-carbohydrate diets promoting hepatic gluconeogenesis to maintain plasma glucose levels.. In a state of low energy demand, these metabolites will be stored as glycogen and fat, which is undesirable if weight loss is the goal. Along these lines, weight loss can only be achieved by establishing a negative calorie balance, though this may be more tenable on a high-protein diet.

Red Meat Protein and Weight Control

The same high-protein foods that are good choices for disease prevention may also help with weight control. Researchers at Harvard School of Public Health followed the diet and lifestyle habits of 120,000 men and women for up to 20 years, looking at how small changes contributed to weight gain over time ¹¹⁶.

• Those who ate more red and processed meat over the course of the study gained more weight, about one extra pound every four years, while those who ate more nuts over the course of the study gained less weight, about a half pound less every four years.

• One study showed that eating approximately one daily serving of beans, chickpeas, lentils or peas can increase fullness, which may lead to better weight management and weight loss ¹¹⁷.

Therefore there’s no need to go overboard on protein. Though some studies show benefits of high-protein, low-carbohydrate diets in the short term, avoiding fruits and whole grains means missing out on healthful fiber, vitamins, minerals, and other phytonutrients.

Health Benefits of Dietary Protein

• Meat, poultry, fish, dry beans and peas, eggs, nuts, and seeds supply many nutrients. These include protein, B vitamins (niacin, thiamin, riboflavin, and B6), vitamin E, iron, zinc, and magnesium.
• Proteins function as building blocks for bones, muscles, cartilage, skin, and blood. They are also building blocks for enzymes, hormones, and vitamins.
• Proteins are one of three nutrients that provide calories (the others are fat and carbohydrates).
• B vitamins found in this food group serve a variety of functions in the body. They help the body release energy, play a vital role in the function of the nervous system, aid in the formation of red blood cells, and help build tissues.
• Iron is used to carry oxygen in the blood. Many teenage girls and women in their child-bearing years have iron-deficiency anemia. They should eat foods high in heme-iron (meats) or eat other non-heme iron containing foods along with a food rich in vitamin C, which can improve absorption of non-heme iron.
• Magnesium is used in building bones and in releasing energy from muscles.
• Zinc is necessary for biochemical reactions and helps the immune system function properly.
• EPA and DHA are omega-3 fatty acids found in varying amounts in seafood. Eating 8 ounces per week of seafood may help reduce the risk for heart disease.

Protein in diet (Food Sources)

Protein foods are broken down into parts called amino acids during digestion. The human body needs a number of amino acids in large enough amounts to maintain good health.

Amino acids are found in animal sources such as meats, milk, fish, and eggs.  Animal sources of protein tend to deliver all the amino acids you need. However, animal protein can be high in fat. For example, a 6-ounce broiled porterhouse steak is a great source of protein—about 40 grams worth. But it also delivers about 12 grams of saturated fat ¹¹⁸. For someone who eats a 2,000 calorie per day diet, that’s more than 60 percent of the recommended daily intake for saturated fat. Protein are also found in plant sources such as soy, beans, legumes, nut butters, and some grains (such as wheat germ and quinoa). You do not need to eat animal products to get all the protein you need in your diet. But other non-animal protein sources, such as fruits, vegetables, grains, nuts and seeds, lack one or more essential amino acids ¹¹⁹.

Amino acids are classified into three groups:

1. Essential : Essential amino acids cannot be made by the body, and must be supplied by food. They do not need to be eaten at one meal. The balance over the whole day is more important.
2. Nonessential : Nonessential amino acids are made by the body from essential amino acids or in the normal breakdown of proteins.
3. Conditional : Conditional amino acids are needed in times of illness and stress.

What foods are in the Protein Foods Group ?

All foods made from meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds are considered part of the Protein Foods Group ¹²⁰. Select a variety of protein foods to improve nutrient intake and health benefits, including at least 8 ounces of cooked seafood per week. Young children need less, depending on their age and calorie needs. The advice to consume seafood does not apply to vegetarians. Vegetarian options in the Protein Foods Group include beans and peas, processed soy products, and nuts and seeds. Meat and poultry choices should be lean or low-fat.

The amount of food from the Protein Foods Group you need to eat depends on age, sex, and level of physical activity. Most Americans eat enough food from this group, but need to make leaner and more varied selections of these foods.

How Much Protein Should You Eat ?

The amount of food from the Protein Foods Group you need to eat depends on age, sex, and level of physical activity. Most Americans eat enough food from this group. The Institute of Medicine recommends that adults get a minimum of 0.8 grams of protein for every kilogram of body weight per day (or 8 grams of protein for every 20 pounds of body weight) ⁶, ⁷. In the United States, the recommended daily allowance of protein is 46 grams per day for women over 19 years of age, and 56 grams per day for men over 19 years of age ⁸. The Institute of Medicine also sets a wide range for acceptable protein intake—anywhere from 10 to 35 percent of calories each day. Beyond that, there’s relatively little solid information on the ideal amount of protein in the diet or the healthiest target for calories contributed by protein.

The U.S. Department of Agriculture’s newest food guide, called ChooseMyPlate ¹²¹, can help you make healthy eating choices.

The amount of protein you need in your diet will depend on your overall calorie needs. The daily recommended intake of protein for healthy adults is 10% to 35% of your total calorie needs. For example, a person on a 2000 calorie diet could eat 100 grams of protein, which would supply 20% of their total daily calories ¹²².

Protein Selection Tips

• Choose lean or low-fat meat and poultry. If higher fat choices are made, such as regular ground beef (75-80% lean) or chicken with skin, the fat counts against your limit for calories from saturated fats.
• If solid fat is added in cooking, such as frying chicken in shortening or frying eggs in butter or stick margarine, this also counts against your limit for calories from saturated fats.
• Select some seafood that is rich in omega-3 fatty acids, such as salmon, trout, sardines, anchovies, herring, Pacific oysters, and Atlantic and Pacific mackerel.
• Processed meats such as ham, sausage, frankfurters, and luncheon or deli meats have added sodium. Check the Nutrition Facts label to help limit sodium intake. Fresh chicken, turkey, and pork that have been enhanced with a salt-containing solution also have added sodium. Check the product label for statements such as “self-basting” or “contains up to __% of __”, which mean that a sodium-containing solution has been added to the product. A 6-ounce ham steak has only about 2.5 grams of saturated fat, but it’s loaded with sodium 2,000 milligrams worth, or about 500 milligrams more than the daily sodium max.
• Choose unsalted nuts and seeds to keep sodium intake low.
• Eating peanuts and certain tree nuts (i.e., walnuts, almonds, and pistachios) may reduce the risk of heart disease when consumed as part of a diet that is nutritionally adequate and within calorie needs. Because nuts and seeds are high in calories, eat them in small portions and use them to replace other protein foods, like some meat or poultry, rather than adding them to what you already eat. In addition, choose unsalted nuts and seeds to help reduce sodium intakes.

Why is it important to eat 8 ounces of seafood per week ?

• Seafood contains a range of nutrients, notably the omega-3 fatty acids, EPA and DHA. Eating about 8 ounces per week of a variety of seafood contributes to the prevention of heart disease. Smaller amounts of seafood are recommended for young children.
• 6-ounces of wild salmon has about 34 grams of protein and is naturally low in sodium, and contains only 1.7 grams of saturated fat. Salmon and other fatty fish are also excellent sources of omega-3 fats, a type of fat that’s especially good for the heart. Alternatively, a cup of cooked lentils provides about 18 grams of protein and 15 grams of fiber, and it has virtually no saturated fat or sodium ¹¹⁸.
• Seafood varieties that are commonly consumed in the United States that are higher in EPA and DHA and lower in mercury include salmon, anchovies, herring, sardines, Pacific oysters, trout, and Atlantic and Pacific mackerel (not king mackerel, which is high in mercury). The health benefits from consuming seafood outweigh the health risk associated with mercury, a heavy metal found in seafood in varying levels.

Why is it important to make lean or low-fat choices from the Protein Foods Group ?

Foods in the meat, poultry, fish, eggs, nuts, and seed group provide nutrients that are vital for health and maintenance of your body. However, choosing foods from this group that are high in saturated fat and cholesterol may have health implications ¹²⁴.

• Diets that are high in saturated fats raise “bad” cholesterol levels in the blood. The “bad” cholesterol is called LDL (low-density lipoprotein) cholesterol. High LDL cholesterol, in turn, increases the risk for coronary heart disease. Some food choices in this group are high in saturated fat. These include fatty cuts of beef, pork, and lamb; regular (75% to 85% lean) ground beef; regular sausages, hot dogs, and bacon; some luncheon meats such as regular bologna and salami; and some poultry such as duck. To help keep blood cholesterol levels healthy, limit the amount of these foods you eat.
• Diets that are high in cholesterol can raise LDL cholesterol levels in the blood. Cholesterol is only found in foods from animal sources. Some foods from this group are high in cholesterol. These include egg yolks (egg whites are cholesterol-free) and organ meats such as liver and giblets. To help keep blood cholesterol levels healthy, limit the amount of these foods you eat.
• A high intake of fats makes it difficult to avoid consuming more calories than are needed.

Eating Red Meat and Cardiovascular Disease

Research conducted at Harvard School of Public Health has found that eating even small amounts of red meat, especially processed red meat, on a regular basis is linked to an increased risk of heart disease and stroke, and the risk of dying from cardiovascular disease or any other cause ¹⁰², ¹⁰⁴, ¹⁰⁶. Conversely, replacing red and processed red meat with healthy protein sources such as poultry, fish, or beans seems to reduce these risks.

• One investigation followed 120,000 men and women in the Nurses’ Health Study and Health Professionals Follow-Up Study for more than two decades ¹⁰⁴. For every additional 3-ounce serving of unprocessed red meat the study participants consumed each day, their risk of dying from cardiovascular disease increased by 13 percent.

• Processed red meat was even more strongly linked to dying from cardiovascular disease—and in smaller amounts: Every additional 1.5 ounce serving of processed red meat consumed each day—equivalent to one hot dog or two strips of bacon—was linked to a 20 percent increase in the risk of cardiovascular disease death.

• Cutting back on red meat could save lives: the researchers estimated that if all the men and women in the study had reduced their total red and processed red meat intake to less than half a serving a day, one in ten cardiovascular disease deaths would have been prevented.

Eating Red Meat and Diabetes Risk

Again, protein quality matters more than protein quantity when it comes to diabetes risk ¹²⁵.

• A recent study found that people who ate diets high in red meat, especially processed red meat, had a higher risk of type 2 diabetes than those who rarely ate red or processed meat ¹⁰⁵. For each additional serving a day of red meat or processed red meat that study participants ate, their risk of diabetes rose 12 and 32 percent, respectively.

• Substituting one serving of nuts, low-fat dairy products, or whole grains for a serving of red meat each day lowered the risk of developing type 2 diabetes by an estimated 16 to 35 percent.

• Another study also shows that red meat consumption may increase risk of type 2 diabetes. Researchers found that people who started eating more red meat than usual were found to have a 50% increased risk of developing type 2 diabetes during the next four years, and researchers also found that those who reduced red meat consumption lowered their type 2 diabetes risk by 14% over a 10-year follow-up period.

• More evidence that protein quality matters comes from a 20-year study that looked at the relationship between low-carbohydrate diets and type 2 diabetes in women. Low-carbohydrate diets that were high in vegetable sources of fat and protein modestly reduced the risk of type 2 diabetes ¹²⁶. But low-carbohydrate diets that were high in animal sources of protein or fat did not show this benefit.

For type 1 diabetes (formerly called juvenile or insulin-dependent diabetes), proteins found in cow’s milk have been implicated in the development of the disease in babies with a predisposition to the disease, but research remains inconclusive ¹²⁷, ¹²⁸.

Eating Red Meat and Cancer

When it comes to cancer, protein quality again seems to matter more than quantity. Research on the association between protein and cancer is ongoing, but some data shows that eating a lot of red meat and processed meat is linked to an increased risk of colon cancer ¹⁰¹.

• In the Nurse’s Health Study and the Health Professionals Follow-Up Study, every additional serving per day of red meat or processed red meat was associated with a 10 and 16 percent higher risk of cancer death, respectively ¹⁰⁴.

• A 2014 study showed that higher consumption of red meat during adolescence was associated with premenopausal breast cancer, suggesting that choosing other protein sources in adolescence may decrease premenopausal breast cancer risk ¹²⁹.

• People should aim to reduce overall consumption of red meat and processed meat, but when you do opt to have it, go easy on the grill. High-temperature grilling creates potentially cancer-causing compounds in meat. Heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) are chemicals formed when muscle meat, including beef, pork, fish, or poultry, is cooked using high-temperature methods, such as pan frying or grilling directly over an open flame ¹³⁰. In laboratory experiments, HCAs and PAHs have been found to be mutagenic—that is, they cause changes in DNA that may increase the risk of cancer.

• HCAs are formed when amino acids (the building blocks of proteins), sugars, and creatine (a substance found in muscle) react at high temperatures. PAHs are formed when fat and juices from meat grilled directly over an open fire drip onto the fire, causing flames. These flames contain PAHs that then adhere to the surface of the meat. PAHs can also be formed during other food preparation processes, such as smoking of meats ¹³⁰.
• HCAs are not found in significant amounts in foods other than meat cooked at high temperatures. PAHs can be found in other charred foods, as well as in cigarette smoke and car exhaust fumes.
• Even though no specific guidelines for HCA/PAH consumption exist, concerned individuals can reduce their exposure by using several cooking methods:+ Avoiding direct exposure of meat to an open flame or a hot metal surface and avoiding prolonged cooking times (especially at high temperatures) can help reduce HCA and PAH formation ¹³¹.
  + Using a microwave oven to cook meat prior to exposure to high temperatures can also substantially reduce HCA formation by reducing the time that meat must be in contact with high heat to finish cooking ¹³¹.
  + Continuously turning meat over on a high heat source can substantially reduce HCA formation compared with just leaving the meat on the heat source without flipping it often ¹³¹.
  + Removing charred portions of meat and refraining from using gravy made from meat drippings can also reduce HCA and PAH exposure ¹³¹.

In October 2015, the World Health Organization (WHO)’s International Agency for Research on Cancer (IARC) announced that consumption of processed meat is “carcinogenic to humans,” and that consumption of red meat is “probably carcinogenic to humans.” ¹³²

• The IARC Working Group, comprised of 22 scientists from ten countries, evaluated over 800 studies.
• Conclusions were primarily based on the evidence for colorectal cancer. Data also showed positive associations between processed meat consumption and stomach cancer, and between red meat consumption and pancreatic and prostate cancer ¹³².

High Protein Diet and Increased Mortality

A high-protein diet during middle age was associated with higher mortality in a new study ¹³³. In adults over 65, however, a high-protein diet was linked to lower mortality ¹³³. A team led by Dr. Valter Longo at the University of Southern California set out to explore the link between dietary protein and mortality. The researchers analyzed information on more than 6,800 U.S. adults, ages 50 and over, from the Third National Health and Nutrition Examination Survey (NHANES III), a periodic health and nutritional survey of the U.S. population. Participants were categorized into 3 groups based on the percent of self-reported calorie intake that came from protein: high (20% or more), moderate (10-19%), or low (less than 10%). They were further split into 2 age categories: 50 to 65, and 66 and older.

Adults in the 50 to 65 group who reported a high protein intake had a 75% increase in overall mortality and were 4 times more likely to die from cancer during the following 18 years than those in the low protein group. The moderate-protein diet was associated with a 3-fold increase in cancer mortality compared to the low-protein diet.

These associations—which were adjusted for numerous factors including smoking, waist circumference, and chronic conditions—weren’t altered when the percentage of calories from fat or carbohydrate were considered. However, the associations were only found when the proteins were derived from animal, rather than plant, sources.

Conversely, in participants ages 65 and older, those who consumed high amounts of protein had a 28% lower risk of dying from any cause and a 60% lower risk of dying from cancer. These associations weren’t influenced by whether the protein was derived from animal or plant sources.

A high-protein diet was also associated with a 5-fold increase in diabetes mortality across all ages. One limitation of the study, the researchers note, is that the participants’ protein intake was based on a single 24-hour dietary recall. The study also didn’t examine the effects of specific types of plant- or animal-derived proteins, such as beef or fish.

Mouse studies confirmed the effects of high protein intake. Mice fed a higher protein diet had increased progression of breast and melanoma tumors than those fed a lower protein diet. The low-protein diet, however, had detrimental effects in very old mice. The link between diet and longevity appeared to be moderated by a pathway involving insulin-like growth factor 1 (IGF-1) ¹³³.

Highlights from this study:

• High protein intake is linked to increased cancer, diabetes, and overall mortality.
• High IGF-1 levels increased the relationship between mortality and high protein.
• Higher protein consumption may be protective for older adults.
• Plant-derived proteins are associated with lower mortality than animal-derived proteins.

High Protein Diet and Osteoporosis

Digesting protein releases acids into the bloodstream, which the body usually neutralizes with calcium and other buffering agents. Eating lots of protein, then, requires a lot of calcium – and some of this may be pulled from bone. This area of research is still controversial, however, and the findings have not been consistent. Some studies suggest that increasing protein increases risk of fractures; others have linked high-protein diets with increased bone-mineral density, and thus stronger bones ¹³⁴, ¹³⁵, ¹³⁶.

• Following a high-protein diet for a long period of time could weaken bone. In the Nurses’ Health Study, for example, women who ate more than 95 grams of protein a day were 20 percent more likely to have broken a wrist over a 12-year period when compared with those who ate an average amount of protein (less than 68 grams a day) ¹³⁷.

Protein and Chronic Diseases

Proteins in food and the environment are responsible for food allergies, which are overreactions of the immune system. Beyond that, relatively little evidence has been gathered regarding the effect of the amount of dietary protein on the development of chronic diseases in healthy people.

However, there’s growing evidence that high-protein food choices do play a role in health and that eating healthy protein sources like fish, chicken, beans, or nuts in place of red meat (including processed red meat) can lower the risk of several diseases and premature death ¹⁰¹, ¹⁰², ¹⁰³, ¹⁰⁴, ¹⁰⁵, ¹⁰⁶, ¹⁰⁷.

Protein Health Benefits

Protein provides the building blocks that help maintain and repair muscles, organs, and other parts of the body. Protein foods are important sources of nutrients in addition to protein, including B vitamins (e.g., niacin, vitamin B12, vitamin B6, and riboflavin), selenium, choline, phosphorus, zinc, copper, vitamin D, and vitamin E).

One ounce (30 grams) of most protein-rich foods contains 7 grams of protein. An ounce (30 grams) equals:

• 1 oz (30 g) of meat fish or poultry
• 1 large egg
• ¼ cup (60 milliliters) tofu
• ½ cup (65 grams) cooked beans or lentils
• 1 Tbsp (14 grams) peanut butter

Low fat dairy is also a good source of protein.

Whole grains contain more protein than refined or “white” products

Children and teens may need different amounts, depending on their age. Some healthy sources of meat protein include:

• Turkey or chicken with the skin removed, or bison (also called buffalo meat)
• Lean cuts of beef or pork, such as round, top sirloin, or tenderloin (trim away any visible fat)
• Fish or shellfish

Other good sources of protein include:

• Pinto beans, black beans, kidney beans, lentils, split peas, or garbanzo beans
• Nuts and seeds, including almonds, hazelnuts, mixed nuts, peanuts, peanut butter, sunflower seeds, or walnuts (just watch how much you eat, because nuts are high in fat)
• Tofu, tempeh, and other soy protein products
• Low-fat dairy products

Nutrients provided by various types of protein foods differ. For example, meats provide the most zinc, while poultry provides the most niacin. Meats, poultry, and seafood provide heme iron, which is more bioavailable than the non-heme iron found in plant sources. Heme iron is especially important for young children and women who are capable of becoming pregnant or who are pregnant. Seafood provides the most vitamin B12 and vitamin D, in addition to almost all of the polyunsaturated omega-3 fatty acids, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Eggs provide the most choline, and nuts and seeds provide the most vitamin E. Soy products are a source of copper, manganese, and iron, as are legumes ¹³⁸.

Even though a higher protein intake can have health benefits for many people, it is not necessary for everyone.

Most people already eat protein at around 15% of calories, which is more than enough to prevent deficiency.

However, in certain cases, people can benefit from eating much more than that, or up to 25-30% of calories.

If you need to lose weight, improve your metabolic health or gain muscle mass and strength, then ensuring that you eat enough protein is important.

However, there are vastly different opinions on how much protein we actually need. Most official nutrition organizations recommend a fairly modest protein intake.

The DRI (Dietary Reference Intake) is 0.8 grams of protein per kilogram of body weight, or 0.36 grams per pound. The Recommended Dietary Allowance or Dietary Reference Intake is the amount of a nutrient you need to meet your basic nutritional requirements. In a sense, it’s the minimum amount you need to keep from getting sick — not the specific amount you are supposed to eat every day.

This amounts to:

• 56-91 grams per day for the average sedentary man.
• 46-75 grams per day for the average sedentary woman.

For a relatively active adult, eating enough protein to meet the recommended dietary allowance would supply as little as 10% of his or her total daily calories. In comparison, the average American consumes around 16% of his or her daily calories in the form of protein, from both plant and animal sources.

Although this meager amount may be enough to prevent downright deficiency, studies show that it is far from sufficient to ensure optimal health and body composition. But it turns out that the “right” amount of protein for any one individual depends on many factors – including activity levels, age, muscle mass, physique goals and current state of health.

Proteins are made out of smaller molecules called amino acids, which are linked together like beads on a string. The linked amino acids form long protein chains, which are then folded into complex shapes. Some of these amino acids can be produced by the body, while we must get others from the diet. The ones we can not produce and must get from our foods are called the “essential” amino acids.

Role of Protein

Proteins are nitrogen-containing substances that are formed by amino acids. They serve as the major structural component of muscle and other tissues in the body. In addition, they are used to produce hormones, enzymes and hemoglobin. Proteins can also be used as energy; however, they are not the primary choice as an energy source. For proteins to be used by the body they need to be metabolized into their simplest form, amino acids. There have been 20 amino acids identified that are needed for human growth and metabolism. Twelve of these amino acids (eleven in children) are termed nonessential, meaning that they can be synthesized by our body and do not need to be consumed in the diet. The remaining amino acids cannot be synthesized in the body and are described as essential meaning that they need to be consumed in our diets. The absence of any of these amino acids will compromise the ability of tissue to grow, be repaired or be maintained.

In athletes supplementing their diets with additional protein, casein has been shown to provide the greatest benefit for increases in protein synthesis for a prolonged duration. However, whey protein has a greater initial benefit for protein synthesis. These differences are related to their rates of absorption. It is likely a combination of the two could be beneficial, or smaller but more frequent ingestion of whey protein could prove to be of more value. Considering the paucity of research examining various sources of protein in sport supplementation studies, further research appears warranted on examining the benefits of these various protein sources.

Protein is not just about quantity. It’s also about quality.

Generally speaking, animal protein provides all the essential amino acids in the right ratio for us to make full use of them (only makes sense, since animal tissues are similar to our own tissues).

If you’re eating animal products (like meat, fish, eggs, or dairy) every day, then you’re probably already doing pretty well, protein-wise.

If you don’t eat animal foods, then it is a bit more challenging to get all the protein and essential amino acids that your body needs.

Bottom Line: Protein is a structural molecule assembled out of amino acids, many of which the body can’t produce on its own. Animal foods are usually high in protein, with all the essential amino acids that we need.

Good Sources of Protein

The best sources of protein are meats, fish, eggs and dairy products. They have all the essential amino acids that your body needs.

There are also some plants that are fairly high in protein, like quinoa, legumes and nuts.

1. Protein Can Reduce Appetite and Hunger Levels

Studies show that protein is by far the most filling. It helps you feel more full, with less food. A high-protein diet reduces hunger, helping you eat fewer calories. This is caused by improved function of weight regulating hormones.

Part of the reason is that protein reduces your level of the hunger hormone ghrelin. It also boosts the satiety hormone peptide YY, which makes you feel full.

This effect can be powerful. In one study, increasing protein from 15 to 30% of calories made overweight women eat 441 fewer calories each day, without intentionally restricting anything.

If you need to lose weight or belly fat, then consider replacing some of the carbs and fats you are eating with protein. It can be as simple as making your potato or rice serving smaller, while adding a few extra bites of meat or fish.

2. Protein Can Increase Muscle Mass and Strength

Protein forms the building blocks of muscles. Therefore, it seems logical that eating more protein would help you build more of them.
Perhaps not surprisingly, numerous studies show that eating plenty of protein can help increase muscle mass and strength.

If you’re physically active, lifting weights, or trying to gain muscle and strength, then you need to make sure that you’re getting enough protein.

Keeping protein high can also help prevent muscle loss when your body is in a “catabolic” (breaking down) state, such as during weight loss.

Bottom Line: Muscle is made primarily of protein. A high protein intake can help you gain muscle mass and strength, and can reduce muscle loss when losing weight.

3. Protein is Good For Your Bones (Not The Other Way Around)

There is an ongoing myth that protein (mostly animal protein) is bad for your bones. This is based on the idea that protein increases “acid load” in the body, leading to calcium being leached from the bones in order to neutralize the acid.

However, most long-term studies show that protein, including animal protein, has major benefits for bone health.

People who eat more protein tend to maintain their bone mass better as they get older, and tend to have a much lower risk of osteoporosis and fractures. This is especially important for women, who are at high risk of osteoporosis after menopause. Eating plenty of protein and staying active is a good way to help prevent that from happening.

Bottom Line: People who eat more protein tend to have better bone health as they get older. They have a much lower risk of osteoporosis and fractures.

4. Protein Can Reduce Cravings and Desire for Late-Night Snacking

A food craving is different from normal hunger. It is not just about your body needing energy or nutrients, it is about your brain needing a “reward”.

Just like a drug addict, alcoholic and smoker, the craving for junk food feels exactly the same as a craving for drugs, alcohol and nicotine.

Unfortunately, cravings can be incredibly hard to control. The best way to overcome them may be to prevent them from showing up in the first place. One of the best ways to do that is to increase your protein intake.

One study in overweight men showed that increasing protein to 25% of calories reduced cravings by 60%, and reduced the desire to snack at night by half.

Bottom Line: Eating more protein has been shown to reduce cravings and desire for late-night snacking. Just eating a high-protein breakfast may have a powerful effect.

5. Protein Can Boost Metabolism and Increase Fat Burning

Eating food can boost your metabolism for a short while. That’s because the body uses energy (calories) to digest and make use of the nutrients in foods. This is referred to as the thermic effect of food.

However, not all foods are the same in this regard. In fact, protein has a much higher thermic effect (20-35%) than fat or carbs (5-15%).

A high protein intake has been shown to significantly boost metabolism and increase the amount of calories you burn. This can amount to 80 to 100 more calories burned each day.

One study on protein during overfeeding found that a high protein group burned 260 more calories per day than a low-protein group. This is equivalent to an hour of moderate-intensity exercise per day !

Bottom Line: A higher protein intake has been shown to boost your metabolism significantly, helping you burn more calories throughout the day.

6. Protein Can Lower Your Blood Pressure

High blood pressure (hypertension) is a major cause of heart attacks, strokes and chronic kidney disease.

Interestingly, a higher protein intake has been shown to lower blood pressure in several studies. In a review of 40 controlled trials, increased protein lowered systolic blood pressure by 1.76 mmHg on average, and diastolic blood pressure by 1.15 mmHg.

One study found that, in addition to lowering blood pressure, a high-protein diet also reduced LDL cholesterol and triglycerides.

Bottom Line: Several studies have shown that a higher protein intake can lower blood pressure. Some studies also show improvements in other risk factors for heart disease.

7. Protein Can Help You Lose Weight and Keep it Off in The Long-Term

When it comes to losing weight, protein is the king of nutrients. As mentioned above, a high protein diet boosts metabolism and leads to automatic reduction in calorie intake and cravings. For this reason, it is not surprising to see that people who increase their protein intake tend to lose weight automatically.

In one study in overweight women, eating protein at 30% of calories caused them to lose 11 pounds (5 kg) in 12 weeks, without intentionally restricting anything.

Protein also has benefits for fat loss when intentionally restricting calories. In a 12-month study of 130 overweight people on a calorie-restricted diet, the high-protein group lost 53% more body fat than a normal-protein group eating the same number of calories.

Of course, losing weight is just the beginning. Maintaining the lost weight is actually a much bigger challenge for most people.

Just a modest increase in protein intake has been shown to help with weight maintenance. In one study, increasing protein from 15% to 18% of calories reduced weight regain by 50%.

If you want to lose weight, keep it off and prevent obesity in the future, then consider making a permanent increase your protein intake.

Bottom Line: Eating a lot of protein has numerous benefits for weight loss. It can help you lose more fat, and help you keep it off in the long-term.

8. Protein Does Not Harm Healthy Kidneys

Many people wrongly believe that a high protein intake harms your kidneys.

It is true that in people with pre-existing kidney disease, restricting protein intake can be beneficial. This should not be taken lightly, as kidney problems can be very serious.

However, while high protein intake may be harmful in people with kidney problems, it does NOT mean that it has any relevance to people with healthy kidneys.

In fact, numerous studies have looked at this and found that high-protein diets have no harmful effects in people who are free of kidney disease.

Bottom Line: It is true that protein can cause harm in people with kidney problems, but this has no relevance to people with healthy kidneys.

9. Protein Can Help Your Body Repair Itself After Injury

Protein can help your body repair after it has been injured. This makes perfect sense, given that it forms the main building blocks of the body’s tissues and organs.

Numerous studies have shown that eating more protein after injury can help speed up recovery.

Bottom Line: Eating more protein can help you recover faster after you have been injured.

10. Protein Can Help You Keep Fit as You Get Older

One of the consequences of aging, is that your muscles shrink. This is referred to as age-related sarcopenia, and is one of the main causes of frailty, bone fractures and reduced quality of life in old age.

Eating more protein is one of the best ways to prevent age-related sarcopenia. Staying physically active is also crucial, and lifting weights or doing some sort of resistance exercise can work wonders.

Substituting Healthy Proteins

Cutting back on red meat offers a life-extending dividend. In the Harvard School of Public Health study, adopting a diet with less than half a serving of red meat a day could have prevented about 1 in 10 deaths.

Swapping out red meat for more healthful protein sources is another life-extending option. Six good choices include:

• Fish
• Chicken and turkey
• Nuts
• Beans
• Low-fat dairy products
• Whole grains

Replacing one serving a day of red meat with one of these options reduced mortality in the study by 7% to 19%.

Of course, these numbers apply to a large group of people. How switching will affect you is hard to predict. It’s a good bet that reducing meat consumption—particularly processed meat (e.g. salamis, pepperonis, kabanas, sausages, bacon, ham)—is likely to score you an advantage.

Bottom Line: Eating plenty of protein can help reduce the muscle wasting associated with aging.

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What is Paleo Diet

A paleo diet is a dietary plan based on foods similar to what might have been eaten during the Paleolithic era, which dates from approximately 2.5 million to 10,000 years ago. Other names for a paleo diet include Paleolithic diet, Stone Age diet, hunter-gatherer diet and Caveman Diet ¹. This diet consists of foods that are assumed to have been available to humans prior to the establishment of agriculture. The Paleolithic period began approximately 2.5 million years ago, when humans first started to use stone tools. The period ended with the emergence of agriculture approximately 10,000 years ago. The paleo diet is currently one of the most fashionable diets in the world.

The principal components of this diet are wild-animal source and uncultivated-plant source foods, such as lean meat, fish, vegetables, fruits, roots, eggs, and nuts. The diet excludes grains, legumes, dairy products, salt, refined sugar, and processed oils, all of which were unavailable before humans began cultivating plants and domesticating animals. The main ingredient lacking in a Paleolithic diet is calcium, which must be supplemented to prevent bone mineral loss ¹.

The appeal of this diet is that, since the advent of agriculture and animal domestication approximately 10,000 years ago, there has been little time for significant evolution of core metabolic and physiological processes in response to the major dietary changes introduced by these new food-producing practices. Proponents of the Paleolithic diet believe that modern humans are genetically adapted to a Paleolithic diet and not to the current so-called civilized diet. They believe that the modern so-called civilized diet may lead to chronic diseases such as Type 2 Diabetes Mellitus, obesity, and cardiovascular disease, which are associated with societal affluence ².

Potential disadvantages of a Paleolithic diet might include deficient intake of vitamin D and calcium as well as exposure to environmental toxins from high intake of fish ³.

Furthermore, there is evidence of an association between consumption of red meat (though possibly not of white meat such as chicken) and an increased risk of developing colorectal cancer ⁴, though the evidence is probably confounded by factors like the type of red meat (eg. beef versus pork) ⁵, ⁶ and the way the meat is cooked ⁷, ⁸. The National Cancer Institute’s Division of Cancer Epidemiology & Genetics research has identified that red and processed meats are associated with an increased risk of several cancers, while poultry and fish intake may be protective. Investigators are currently studying carcinogenic compounds formed in meat during processing or cooking, such as: Heterocyclic amines, N-nitroso compounds and Polycyclic aromatic hydrocarbons ⁵, ⁷. Subjects on a paleo diet should however benefit from not consuming processed meat since the evidence that processed meat increases the risk for colorectal cancer is stronger.

The Paleo Diet is based on eating lots of lean meats, fresh fruits, and vegetables.

The Paleo Diet is the one and only diet that ideally fits our genetic makeup. Just 333 generations ago—and for 2.5 million years before that—every human being on Earth ate this way. It is the diet to which all of us are ideally suited and the lifetime nutritional plan that will normalize your weight and improve your health. We didn’t design this diet—Nature did. This diet has been built into our genes.

What do Paleolithic people have to do with us ? Actually, quite a lot: DNA evidence shows that basic human physiology has changed little in 40,000 years. Literally, we are Stone Agers living in the Technology and Space Age; our dietary needs are the same as theirs. Our genes are well adapted to a world in which all the food eaten daily had to be hunted, fished, or gathered from the natural environment—a world that no longer exists. Nature determined what our bodies needed thousands of years before civilization developed, before people started farming and raising domesticated livestock.

The aim of a paleo diet is to return to a way of eating that’s more like what early humans ate. The belief is that the human body is better suited to that type of diet than to the modern diet that emerged with farming. A paleo diet typically includes lean meats, fish, fruits, vegetables, nuts and seeds — foods that in the past could be obtained by hunting and gathering. A paleo diet limits foods that became common when farming emerged about 10,000 years ago. These foods include dairy products, legumes and grains.

Many of our health problems today are the direct result of what we EAT and do not do. This section will show you where we went wrong—how the Standard American Diet (SAD) wreak havoc with our Paleolithic (Old Stone Age) constitutions. It will also show you how you can lose weight and regain health and well-being by eating the way our hunter-gatherer ancestors ate—the diet that nature intended.

This loss of humanity’s original way of life matters a great deal. Why ? Look at us. We’re a mess. We eat too much, we eat the wrong foods, and we’re fat. Incredibly, more Americans are overweight than aren’t: 68 percent of all American men over age twenty-five, and 64 percent of women over age twenty-five are either overweight or obese. And it’s killing us. The leading cause of death in the United States—responsible for 35 percent of all deaths or 1 of every 2.8 deaths—is heart and blood vessel disease. Seventy-three million Americans have high blood pressure; 34 million have high cholesterol levels, and 17 million have type 2 diabetes. It’s not a pretty picture.

Farming changed what people ate and established dairy, grains and legumes as additional staples in the human diet. This relatively late and rapid change in diet, according to the hypothesis, outpaced the body’s ability to adapt. This mismatch is believed to be a contributing factor to the prevalence of obesity, diabetes and heart disease today.

Clinical Research

There is little clinical research on the benefits of paleo diets. A few clinical trials lasting 12 weeks or less have been conducted with small groups of participants.

These trials suggest that a paleo diet may provide some moderate benefits when compared with diets of fruits, vegetables, lean meats, whole grains, legumes and low-fat dairy products. These moderate benefits may include:

• More weight loss,
• Improved glucose tolerance,
• Better blood pressure control,
• Better appetite management

However, longer trials with large groups of people randomly assigned to different diets are needed to understand the long-term, overall health benefits and possible risks of a paleo diet.

The Benefits of Paleo Diet on Type 2 Diabetes and on Cardiovascular risk factors in Type 2 Diabetes

Type 2 diabetes is characterised by fasting hyperglycaemia as a result of insulin resistance and defects in insulin secretion. Obesity is the major risk factor for the development of the condition and a number of studies — including the Diabetes Prevention Program, the Da Qing IGT and Diabetes Study, and the Finnish Diabetes Prevention Study — have shown that lifestyle modification (diet and exercise) can significantly prevent the progression of glucose intolerance (prediabetes) to diabetes by up to 58% ⁹, ¹⁰, ¹¹. In addition, a recent study showed that a very-low-calorie diet for 8 weeks resulted in remission of type 2 diabetes for at least 6 months in 40% of the participants ¹². As such, clinical guidelines prescribe lifestyle modification as first-line treatment for type 2 diabetes and indeed throughout the management of the disease process ¹³. Therefore, it is clear that dietary intervention is a critical component of the glucose-lowering strategy in diabetes ¹⁴.

In a 2009 report by Jönsson and colleagues in Cardiovascular Diabetology ¹⁵ has highlighted the potential benefits of a Paleolithic diet for patients with type 2 diabetes. In that randomized crossover study spanning two consecutive 3-month study periods, involving 13 patients with type 2 diabetes, 3 women and 10 men, were instructed to eat a Paleolithic diet based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts; and a Diabetes diet designed in accordance with dietary guidelines. Outcome variables included changes in weight, waist circumference, serum lipids, C-reactive protein, blood pressure, glycated haemoglobin (HbA1c), and areas under the curve for plasma glucose and plasma insulin in the 75 g oral glucose tolerance test. Dietary intake was evaluated by use of 4-day weighed food records. Study participants had on average a diabetes duration of 9 years, a mean HbA1c of 6,6% units and were usually treated with metformin alone (3 subjects) or metformin in combination with a sulfonylurea (3 subjects) or a thiazolidinedione (3 subjects).

The Paleolithic diet excluded dairy products, cereal grains, beans, refined fats, sugar, candy, soft drinks, beer, and any extra addition of salt. The following items were recommended in limited amounts for the Paleolithic diet: eggs (≤2 per day), nuts (preferentially walnuts), dried fruit, potatoes (≤1 medium-sized per day), grape seed or olive oil (≤1 tablespoon per day), and wine (≤1 glass per day). The intake of other foods was not restricted and no advice was given with regard to proportions of food categories (such as animal versus plant foods). In that study ¹⁵, the Paleolithic diet was lower in cereals, dairy products, potatoes, beans, and bakery foods but higher in fruits, vegetables, meat, and eggs compared to the diabetes diet. The Paleolithic diet worked out to be lower in total energy, energy density, carbohydrate, dietary glycemic load, fiber, saturated fatty acids, and calcium but higher in unsaturated fatty acids, dietary cholesterol, and several vitamins and minerals ¹⁵.

Compared to the diabetes diet, the Paleolithic diet (after two consecutive 3-month study periods) resulted in lower mean values of HbA1c (-0.4% units), triacylglyceride (-0.4 mmol/L), diastolic blood pressure (-4 mmHg), weight (-3 kg), BMI (-1 kg/m2) and waist circumference (-4 cm), and higher mean values of high density lipoprotein (HDL) cholesterol (+0.08 mmol/L). The Paleolithic diet was mainly lower in cereals and dairy products, and higher in fruits, vegetables, meat and eggs, as compared with the Diabetes diet. Further, the Paleolithic diet was lower in total energy, energy density, carbohydrate, dietary glycemic load, saturated fatty acids and calcium, and higher in unsaturated fatty acids, dietary cholesterol and several vitamins. Dietary Glycemic Index was slightly lower in the Paleolithic diet (GI = 50) than in the Diabetic diet (GI = 55). CONCLUSION: Over a 3-month study period, a Paleolithic diet improved glycemic control and several cardiovascular risk factors compared to a Diabetes diet in patients with type 2 diabetes mellitus ¹⁵.

The mechanism of achieving greater improvements in levels of cardiovascular risk factors with a Paleolithic diet compared to diabetes diet is not known. In the Jönsson and colleagues study, the diets of subjects during their period of consuming a Paleolithic diet (compared to a diabetic diet) contained fewer calories and a lower glycemic index in spite of a lower fiber content. The investigators postulated that a Paleolithic diet (compared to a diabetes diet) is more satiating and facilitates a reduced caloric intake. In fact, the Paleolithic diet resulted in greater reductions in both weight and waist circumference. The higher amount of fruit and vegetables during the Paleolithic period was postulated to have promoted weight loss because of the high content of water in fruit, which may be satiating. The Paleolithic diet compared to the diabetes diet resulted in a higher percentage of protein intake as a percentage of total daily calories. A weight loss diet with moderate carbohydrate, moderate protein has been shown to result in more favorable changes in body composition, dyslipidemia, and the post-prandial insulin response compared to a high-carbohydrate, low-protein diet ¹⁶. Therefore, the greater protein intake during a Paleolithic diet might confer an additional benefit (beyond weight reduction) in its favorable effects on risk reduction for metabolic disease.

Comment

What is needed now is more clinical data with greater numbers of subjects and longer study durations so that more robust conclusions can be drawn ¹.

Similarly, in nine overweight healthy individuals, a Paleolithic diet for 10 days resulted in no change in fasting plasma glucose or insulin levels, but it showed reduced plasma lipid levels and blood pressure compared with the baseline usual diet ¹⁷. It is interesting that, while insulin levels during an oral glucose tolerance test were lower with the Paleolithic diet compared with baseline, the authors did not report the glycaemic excursions during this test. Moreover, a 2-week study in obese patients with the metabolic syndrome ¹⁸ did not show an effect on glucose tolerance, but it resulted in reduced blood pressure and plasma lipid levels associated with a small but significant decrease in weight.

In patients with ischaemic heart disease plus either glucose intolerance or type 2 diabetes, a Paleolithic diet for 12 weeks resulted in reduced glucose and insulin
excursions during the glucose tolerance test and was associated with a 26% reduction in energy intake, compared with a Mediterranean-style diet ¹⁹

In addition to the above studies of patients with type 2 diabetes (and cardiovascular risk factors), in a more recent study published in the Medical Journal of Australia, August 2016, by an associate professor Sofianos Andrikopoulos, head of the Islet Biology and Metabolism Research Group at the University of Melbourne ¹⁴ showed that studies are inconclusive about the benefits of the Paleo diet in patients with type 2 diabetes. He said that in the absence of changes in weight or energy intake, the Paleolithic diet is as effective in improving the above metabolic parameters as a standard diet. However, given that even very short deficits in energy balance can improve metabolic parameters ²⁰, it is difficult to make strong conclusions about the long term benefits of the Paleolithic diet in type 2 diabetes (or any other condition), because of the short duration of the interventions (less than 12 weeks), the lack of a proper control group in some instances, and the small sample size (less than 20 individuals) of the above studies. While it makes sense that the Paleolithic diet promotes avoidance of refined and extra sugars and processed energy dense food, clearly more
randomised controlled studies with more patients and for a longer period of time are required to determine whether it has any beneficial effect over other dietary advice.

What Effect Does a Paleolithic Diet Have on Cardiovascular Risk Factors ?

The metabolic effects on humans consuming a Paleolithic diet have been studied in only a handful of studies to date. O’Dea and colleagues reported a controlled 3-month trial of a Paleolithic diet in 13 healthy northwestern Australian Aborigines in Diabetes Care in 1980. Thirteen full-blood Aborigines from the Mowanjum Community, Derby, Western Australia, cooperated in the present study. They spent 3 mo living in their traditional hunter-gatherer life-style, after which their insulin response to glucose was measured in a starch tolerance test. The findings were compared in follow-up studies conducted 3 mo after returning to their urban environment. Similar studies were conducted in Caucasians of comparable age and weight. The data suggest that these Aborigines have an abnormally high insulin response to ingested glucose, which is ameliorated, but not normalized, by reverting to their traditional life-style. Glucose levels were unaffected by the dietary intervention in these subjects without diabetes ²¹.

O’Dea reported an uncontrolled study of initiating a Paleolithic diet in a cohort of 10 northwest Australian Aboriginal type 2 diabetes patients, they were middle aged (53.9 +/- 1.8 yr) and overweight (81.9 +/- 3.4 kg) in 1984. Adoption of a hunter–gatherer lifestyle for 7 weeks resulted in a 10% weight loss (average, 8 kg) and reductions in 2 h glucose levels as well as fasting levels of glucose, insulin, and triglycerides ²². A detailed analysis of food intake over 2 wk revealed a low-energy intake (1200 kcal/person/day). Despite the high contribution of animal food to the total energy intake (64%), the diet was low in total fat (13%) due to the very low fat content of wild animals. The marked improvement in glucose was due to both a fall in fasting glucose (11.6 +/- 1.2 mM before, 6.6 +/- 0.8 mM after) and an improvement in postprandial glucose clearance (incremental area under the glucose curve: 15.0 +/- 1.2 mmol/L/h before, 11.7 +/- 1.2 mmol/L/h after). Fasting plasma insulin concentration fell (23 +/- 2 mU/L before, 12 +/- 1 mU/L after) and the insulin response to glucose improved (incremental area under the insulin curve: 61 +/- 18 mU/L/h before, 104 +/- 21 mU/L/h after). The marked fall in fasting plasma triglycerides (4.0 +/- 0.5 mM before, 1.2 +/- 0.1 mM after) was due largely to the fall in VLDL triglyceride concentration (2.31 +/- 0.31 mM before, 0.20 +/- 0.03 mM after ²².

Lindeberg and associates reported a randomized controlled study in Diabetologia in 2007 in which a cohort of 29 patients with ischemic heart disease and either glucose intolerance or type 2 diabetes was placed on either a Paleolithic diet or a Mediterranean diet. The Mediterranean diet was based on whole grains, low-fat dairy products, vegetables, fruits, fish, oils, and margarines. They found improved glucose tolerance independent of weight loss after 12 weeks in both groups, but the improvement was significantly greater in the Paleolithic diet group. There was no relationship between improvement in glucose tolerance and any decline in weight or waist circumference ²³.

Osterdahl and coworkers reported a small uncontrolled 3-week study of a Paleolithic diet in 14 healthy subjects in the European Journal of Clinical Nutrition in 2008. They found significant improvements with mean weight decreased by 2.3 kg, body mass index (BMI) by 0.8, waist circumference by 0.5 cm, systolic blood pressure by 3 mm Hg and plasminogen activator inhibitor-1 by 72%. Regarding nutrient intake, intake of energy decreased by 36%, and other effects were also observed, both favourable (fat composition, antioxidants, potassium-sodium rate) and unfavourable (calcium) ²⁴.

The effect of a Paleolithic diet on a variety of metabolic risk factors for cardiovascular disease in an uncontrolled trial was reported in August 2009 in the European Journal of Clinical Nutrition. Compared with the usual diet, nine sedentary subjects receiving the intervention diet experienced (a) significant reductions in blood pressure, (b) improved arterial distensibility, (c) significant reduction in plasma insulin versus time in the area under the curve during oral glucose tolerance testing, and (d) significant reductions in total cholesterol, low-density lipoproteins, and triglycerides. The authors concluded that even short-term consumption of a Paleolithic type diet improves blood pressure and glucose tolerance, decreases insulin secretion, increases insulin sensitivity, and improves lipid profiles without weight loss in healthy sedentary humans ²⁵.

The effect of a Paleolithic diet in a randomized controlled trial on domestic pigs was reported in 2006. Jönsson and colleagues provided either a Paleolithic diet or cereal-based swine feed to 24 pigs during a 15-month study. The pigs receiving a Paleolithic diet weighed less and had less subcutaneous fat deposits, lower C-reactive protein levels, lower blood pressure, and greater insulin sensitivity than pigs that received a cereal-based diet. The cereal-fed pigs demonstrated a low-grade inflammation of the exocrine pancreas, although no significant difference was seen in fasting glucose levels between groups ²⁶.

Paleolithic Diet and Cholesterol

Recent small study with twenty volunteers (10 male and 10 female) with high blood cholesterol (hypercholesterolemia) aged 40 to 62 years. Volunteers were not taking any cholesterol-lowering medications and adhered to a traditional heart-healthy diet for 4 months, followed by a Paleolithic diet for 4 months. Four months of Paleolithic nutrition significantly lowered mean total cholesterol, LDL cholesterol, and triglycerides (TG) and increased HDL cholesterol, independent of changes in body weight, relative to both baseline and the traditional heart-healthy diet. Paleolithic nutrition offers promising potential for nutritional management of hyperlipidemia in adults whose lipid profiles have not improved after following more traditional heart-healthy dietary recommendations ²⁷.

Paleo Diet Could Cause Rapid Weight Gain

The study by Melbourne University researchers, who set out to prove the benefits of the Paleo diet have instead discovered it could cause significant and rapid weight gain in laboratory mice ²⁸. The objective of the study was to assess whether a low-carbohydrate and therefore high-fat diet (LCHFD) is beneficial for improving the endogenous insulin secretory response to glucose in prediabetic New Zealand Obese (NZO) mice.

Methods:

New Zealand Obese mice were maintained on either standard rodent chow or a low-carbohydrate and high-fat diet from 6 to 15 weeks of age. Body weight, food intake and blood glucose were assessed weekly. Blood glucose and insulin levels were also assessed after fasting and re-feeding and during an oral glucose tolerance test. The capacity of pancreatic β-cells to secrete insulin was assessed in vivo with an intravenous glucose tolerance test. β-Cell mass was assessed in histological sections of pancreata collected at the end of the study.

Results:

In New Zealand Obese mice, a low-carbohydrate and high-fat diet reduced plasma triglycerides but increased weight gain, adipose tissue mass, high-density lipoprotein cholesterol and exacerbated glucose intolerance. Although fasting insulin levels tended to be higher, insulin secretory function in low-carbohydrate and high-fat diet-fed mice was not improved nor was β-cell mass.

Conclusions:

A low-carbohydrate and high-fat diet is unlikely to be of benefit for preventing the decline in β-cell function associated with the progression of hyperglycemia in type 2 diabetes.

Can the paleolithic diet meet the nutritional needs of older people ?

A number of nutrient analyses of people following a paleo diet have been carried out, albeit mainly on younger subjects (<65 years). Protein intake on a paleo diet is generally found to be similar to or slightly higher than on a normal diet. This high protein intake would be particularly beneficial for the elderly because their protein requirements for maintaining muscle mass and preventing sarcopenia may be higher than those recommended for the general population ²⁹. Advice for the elderly on consuming meat as the main source of protein – as is the case in the paleo diet – is, however, controversial ³⁰.

As might be predicted from the high intake of fruit and vegetables in the paleo diet, some micronutrients, including vitamins C and E and β-carotene, are consumed in high quantities, while sodium intake has been found to be substantially lower than in control diets ³¹, ³². However, several short term clinical studies have found that calcium intake in subjects following a paleo diet is low, ranging from 355 to 395 mg/day ³³, ³¹, ³². Although, the optimal level of calcium intake required specifically to reduce the risk of osteoporotic fractures is currently the subject of considerable debate ³⁴, these values are nevertheless well below current recommended daily intake levels for healthy adults (700 mg in the UK and 1200 mg in the US).

The paleo diet’s low calcium content is probably attributable to the absence of dairy and cereals, which the UK National Diet and Nutrition Survey found contributed 42% and 29% respectively to the intake of calcium in the over 65’s ³⁵. It has been estimated that, for the US, adequate intake for calcium is not possible with dairy-free diets while also meeting other nutrient recommendations ³⁶. Modeling studies on the paleo diet have also confirmed its difficulties in meeting current recommended intakes of calcium ³⁷. Although calcium supplements are an option, these are at odds with the basic philosophy of the paleo diet as one reflecting a Stone Age diet.

Dairy is also the main dietary source of iodine – essential for thyroid hormone production. In the one study that has examined this, iodine intake on the paleo diet was only about half the UK recommended requirement of 140 μg/day ³¹. Some types of fish and shellfish are also good sources of iodine but – at least in this study – these did not compensate for the shortfalls. Iodised salt is available, but its iodine content is low, availability of this product is poor in some countries like the UK  ³⁸, and the paleo diet discourages added salt. Increased salt consumption is not advisable, in any case.

Dairy and cereals are also important sources of other micronutrients, including some (thiamine, riboflavin and iron) that have been reported to be reduced in some studies of the paleo diet. Most of these nutritional assessments of the paleo diet are based on young or middle aged subjects, but they do nevertheless raise concerns that the absence of dairy products and cereals will prevent adequate intake of some key micronutrients for the elderly. Although micronutrient deficiencies frequently occur in the elderly who do not follow a paleo diet, it does seem likely that the absence of dairy and cereals in this diet will exacerbate the risk of deficiencies. Dairy also provides protein in the omnivore diet without the need to trade off against cancer risks, as is the case with red meat.

The paleo diet has been reported to induce a feeling of satiety. This may be a useful short term strategy to lose weight ³⁹, but for many elderly people poor appetite is a significant concern, so the benefit of a diet with high satiety is questionable. In addition, the acceptability of any diet is key to compliance, and there are anecdotal comments on the difficulty of adhering to a paleo diet as it lacks many of the sources of carbohydrates (bread, pasta, etc.) that form a major part of many western meals ⁴⁰.

Long term studies on the health consequences of adhering to a paleo diet may currently be lacking ⁴¹. The knowledge we have is that the healthiest diet is one based on minimally processed foods, mostly coming from plant foods ⁴². Currently the diet with the strongest evidence for preventing nutrient deficiencies and protecting long term health, including in the elderly, is the plant-based Mediterranean diet ⁴³.

Why you might follow a paleo diet ?

You might choose to follow a paleo diet because you:

• You Want to Lose Weight or Maintain a Healthy Weight,
• Want help planning meals

Details of a Paleo Diet:

Paleolithic people ate no dairy food. Imagine how difficult it would be to milk a wild animal, even if you could somehow manage to catch one.

• Paleolithic people hardly ever ate cereal grains. This sounds shocking to us today, but for most ancient people, grains were considered starvation food at best.
• Paleolithic people didn’t salt their food.
• The only refined sugar Paleolithic people ate was honey, when they were lucky enough to find it.
• Wild, lean animal foods dominated Paleolithic diets, so their protein intake was quite high by modern standards, while their carbohydrate consumption was much lower.
• Virtually all of the carbohydrates Paleolithic people ate came from nonstarchy wild fruits and vegetables. Consequently, their carbohydrate intake was much lower and their fiber intake much higher than those obtained by eating the typical modern diet.
• The main fats in the Paleolithic diets were healthful, monounsaturated, polyunsaturated, and omega 3 fats—not the trans fats and certain saturated fats that dominate modern diets.
• The Paleo Diet is a low-carbohydrate diet—but that’s where any resemblance to the low-carbohydrate fad diets ends. Remember, the Paleo Diet is the only diet based on millions of years of nutritional facts—the one ideally suited to our biological needs and makeup and the one that most closely resembles hunter-gatherer diets.

How does the Paleo Diet compare with the low-carb fad diets and the average U.S. diet (the Standard American Diet) ?

People in the Paleolithic Age ate a lot of monounsaturated fats; they had saturated and polyunsaturated fats in moderation—but when they did have polyunsaturated fats, they had a proper balance of the omega 3 and omega 6 fats. They consumed far fewer omega 6 polyunsaturated fats than we do today. In addition, the main saturated fat in wild animals was healthful stearic acid, not the cholesterol-raising palmitic acid, which dominates the fat of feedlot cattle. Avoid fatty processed meats such as bacon, hot dogs, lunch meats, salami, bologna, and sausages because they contain excessive saturated fats, which raise your blood cholesterol levels.

• A paleo diet is rich in vegetables, fruits and nuts — all elements of a healthy diet.

The primary difference between the paleo diet and other healthy diets is the absence of whole grains and legumes, which are considered good sources of fiber, vitamins and other nutrients. Also absent for the diet are dairy products, which are good sources of protein and calcium.

These foods not only are considered healthy but also are generally more affordable and accessible than such foods as wild game, grass-fed animals and nuts. For some people, a paleo diet may be too expensive.

Recommendations vary among commercial paleo diets, and some diet plans have stricter guidelines than others. In general, paleo diets follow these guidelines.

What to eat

• Fruits
• Vegetables
• Nuts and seeds
• Lean meats, especially grass-fed animals or wild game
• Fish, especially those rich in omega-3 fatty acids, such as salmon, mackerel and albacore tuna
• Oils from fruits and nuts, such as olive oil or walnut oil

Here are some LEAN high protein foods that are part of the Paleo Diet:

• Skinless turkey breast (94 percent protein)
• Shrimp (90 percent protein)
• Red snapper (87 percent protein)
• Crab (86 percent protein)
• Halibut (80 percent protein)
• Beef sweetbreads (77 percent protein)
• Steamed clams (73 percent protein)
• Lean pork tenderloin (72 percent protein)
• Beef heart (69 percent protein)
• Broiled tuna (68 percent protein)
• Veal steak (68 percent protein)
• Sirloin beef steak (65 percent protein)
• Chicken livers (65 percent protein)
• Skinless chicken breasts (63 percent protein)
• Beef liver (63 percent protein)
• Lean beef flank steak (62 percent protein)
• Lean pork chops (62 percent protein)
• Mussels (58 percent protein)

You can get plenty of health-sustaining omega 3 fats from many foods found in the supermarket, such as:

• Fish and seafood, particularly cold-water fish such as salmon, mackerel, herring, and halibut
• Flaxseed oil, which can be used in several ways—as an ingredient in salad dressings, poured over steamed vegetables, or taken as a supplement
• Liver
• Game meat
• Free-range chickens
• Pasture-fed beef
• Eggs enriched with omega 3
• Salt-free walnuts and macadamia nuts (which are also tasty in salads)
• Leafy green vegetables
• Fish oil capsules, available at health food stores

What to avoid

• Grains, such as wheat, oats and barley
• Legumes, such as beans, lentils, peanuts and peas
• Dairy products
• Refined sugar
• Salt
• Potatoes
• Highly processed foods in general

A typical day’s menu

• Breakfast. Broiled salmon and cantaloupe.
• Lunch. Broiled lean pork loin and salad (romaine, carrot, cucumber, tomatoes, walnuts and lemon juice dressing).
• Dinner. Lean beef sirloin tip roast, steamed broccoli, salad (mixed greens, tomatoes, avocado, onions, almonds and lemon juice dressing) and strawberries for dessert.
• Snacks. An orange, carrot sticks or celery sticks.

The diet also emphasizes drinking water and being physically active every day.

The bottom line

A paleo diet may help you lose weight or maintain your weight. It may also have other beneficial health effects. However, there are no long-term clinical studies about the benefits and potential risks of the diet.

You might be able to achieve the same health benefits by getting enough exercise and eating a balanced, healthy diet with a lot of fruits and vegetables.

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What is the Atkins Diet

The Atkins Diet ¹, ² is a popular low-sugar or low-carbohydrate eating plan that was created in 1972 by cardiologist Dr. Robert C. Atkins who limited his patients’ intake of sugar and carbohydrates. The original Atkins’ Diet has 68% of total calories from fat, 27% from protein, and 5% from carbohydrates ³. The Atkins Diet, formally called the Atkins Nutritional Approach, has been detailed in many books and is credited with launching the low-carb diet trend.

The central rationale of this diet is that severe restriction of dietary carbohydrate (<10% of daily caloric intake), with its resulting ketosis, promotes lipid oxidation, satiety, and increased energy expenditure, factors that should promote negative energy balance and weight loss ¹. Because the Atkins diet derive large proportions of calories from protein and fat, there has been considerable concern for their potentially detrimental impact on cardiovascular risk ⁴. Increased consumption of fat, particularly saturated fat, has been linked to increased plasma concentrations of lipids ⁵, ⁶, ⁷, ⁸, insulin resistance, glucose intolerance ⁹, ¹⁰, and obesity ¹¹, ¹². According to the American Heart Association Advisory ⁶, cardiovascular disease was lowered by about 30 percent, similar to the effect of cholesterol-lowering statin drugs when vegetable oil replaced saturated fat in the diet, according to the advisory. The switch to healthier oils also was associated with lower rates of death from all causes. The American Heart Association recommends aiming for a dietary pattern that achieves 5% to 6% of calories from saturated fat, that’s about 13 grams of saturated fats a day ⁷.

The new Atkins Diet now restricts sugars and carbs (carbohydrates) while emphasizing high protein and high fats – so that a person’s daily calorie consumption is comprised of:

• 40 percent carbohydrates,
• 30 percent protein, and
• 30 percent fat.
• The Atkins diet is very low in carbohydrate consumption: less than 20 grams of carbohydrates per day and increasing to 50 grams per day.

As a result, many of Atkins dieters have successfully lost weight and kept it off – even though they had previously been unsuccessful on regular low-calorie diets.

Another unexplained, but important, observation was the spontaneous restriction of food intake in the low carbohydrate Atkins diet group to a level equal to that of the control subjects who were following a prescribed restriction of calories. This raises the possibility that the low carbohydrate Atkins diet may have been more satiating. Previous studies have suggested that, calorie for calorie, protein is more satiating than either carbohydrate or fat ¹³, ¹⁴ and it may be that the higher consumption of protein in the low carbohydrate Atkins diet group played a role in limiting food intake. Another explanation for restricted food intake in the low carbohydrate group is that food choices were probably greatly limited by the requirements of minimizing carbohydrate intake, and that dietary adherence per se may have forced caloric restriction due to practical factors. Although it has been proposed that ketosis developing from severe carbohydrate intake contributes to a decrease in appetite ¹. Increased dietary saturated fat has been linked to certain types of cancer ¹⁵ and may have effects on cardiovascular ⁷.

In a study ¹⁶ comparing the dietary quality of popular weight-loss plans (their status on the New York Times Bestseller list) – the New Glucose Revolution, Weight Watchers, Atkins Diet, South Beach Diet, Zone Diet, Ornish Diet, and 2005 US Department of Agriculture Food Guide Pyramid (2005 Food Guide Pyramid) plans. The Dietary quality was estimated using the Alternate Healthy Eating Index (AHEI), a measure that isolates dietary components that are most strongly linked to cardiovascular disease risk reduction ¹⁷,¹⁸. The Alternate Healthy Eating Index (AHEI) was developed to measured adherence to the 1995 US Department of Agriculture Food Guide Pyramid dietary guidelines and the quality within food groups and acknowledged health benefits of unsaturated oils ¹⁹. The score was then used to predict development of cardiovascular disease, cancer or other causes of death in the same population previously tested. Men and women with AHEI scores in the top vs. bottom quintile had a significant 20% and 11% reduction in overall major chronic disease, respectively. Reductions were stronger for cardiovascular disease risk in men than in women. The score did not predict cancer risk. The AHEI was twice as strong at predicting major chronic disease and cardiovascular disease risk compared to the original Healthy Eating Index (HEI) ²⁰, suggesting that AHEI may be a better proxy of dietary quality ²¹, ²².

The AHEI incorporates several aspects of the original HEI ²⁰, and therefore some components correspond to existing dietary guidelines (eg, to increase fruit and vegetable intakes). The AHEI has nine components for evaluating and determining dietary quality, including fruit, vegetables, nuts and soy, ratio of white to red meat, cereal fiber, trans fat, ratio of polyunsaturated fat to saturated fat, alcohol, and duration of multivitamin use ²³. Seven of the nine AHEI components were used to calculate the AHEI score for each plan ²³. Duration of multivitamin use and daily alcohol intake were not used because neither were addressed in the diet book meal plans.

The AHEI also provides quantitative scoring for qualitative dietary guidance (eg, choose more fish, poultry, and whole grains, and if you drink alcohol, do so in moderation). AHEI variables were chosen and scoring decisions were made a priori, on the basis of discussions with nutrition researchers. AHEI sought to capture specific dietary patterns and eating behaviors that have been associated consistently with lower risk for chronic disease in clinical and epidemiologic investigations. AHEI score of 10 indicates that the recommendations were fully met, whereas a score of 0 represents the least healthy dietary behavior. Intermediate intakes were scored proportionately between 0 (worst) and 10 (best). For example, zero vegetable servings per day was given the score of 0, and five servings per day or more was given a 10. For meat, when no red meat was consumed, the component score was set to 10. The multivitamin component was dichotomous, contributing either 2.5 points (for nonuse) or 7.5 points (for use). All component scores were summed to obtain a total AHEI score  ²³ ranging from 2.5 (worst) to 87.5 (best).

The results of that study ¹⁶ that compares the dietary quality of popular weight-loss plans (the New Glucose Revolution, Weight Watchers, Atkins Diet, South Beach Diet, Zone Diet, Ornish Diet, and 2005 US Department of Agriculture Food Guide Pyramid (2005 Food Guide Pyramid) plans), ordered from the highest to the lowest plan were:

1. Ornish (score 64.6),
2. Weight Watchers high-carbohydrate (score 57.4),
3. the New Glucose Revolution (score 57.2),
4. South Beach/Phase 2 (score 50.7),
5. Zone (score 49.8),
6. 2005 Food Guide Pyramid (score 48.7),
7. Weight Watchers high-protein (score 47.3),
8. Atkins/100-g carbohydrate (score 46),
9. the South Beach/Phase 3 (score 45.6), and
10. Atkins/45-g carbohydrate (score 42.3).

The Zone plan was lowest in energy (mean 1,025±122 kcal per day), whereas the 2005 Food Guide Pyramid plan was highest (mean 1,946±200 kcal per day).

Compared to other plans, the Atkins/45-g carbohydrate plan had fewest servings of fruit, the lowest white to red meat ratio, and was second only to the Atkins/100-g carbohydrate plan for percent of energy from trans fat. While the Atkins/45-g carbohydrate plan scored lowest in white to red meat ratio with a ratio of one, the Ornish plan scored the highest with a ratio of four because it is the vegetarian diet plan ¹⁶.

In a study ²⁴ comparing 4 popular weight loss diets – 1) Atkins diet; 2) Zone diet; 3) Ornish diet and 4) LEARN (Lifestyle, Exercise, Attitudes, Relationships, and Nutrition) diet –  where 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women in the US were randomly assigned to follow the Atkins diet (n = 77), Zone diet (n = 79), LEARN diet (n = 79), or Ornish diet (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up.

In that study ²⁴, weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein (LDL cholesterol), high-density lipoprotein (HDL cholesterol), and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12.

RESULTS: Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets. Weight loss was not statistically different among the Zone, LEARN, and Ornish groups.

Mean 12-month weight loss was as follows:

• Atkins diet -4.7 kg (-6.3 to -3.1 kg),
• Zone diet, -1.6 kg (-2.8 to -0.4 kg),
• LEARN diet, -2.6 kg (-3.8 to -1.3 kg),
• Ornish diet, -2.2 kg (-3.6 to -0.8 kg).

At 12 months, secondary outcomes for the Atkins diet group were comparable with or more favorable than the other diet groups.

CONCLUSIONS: In this study ²⁴, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight at 12 months than women assigned to follow the Zone diet, and had experienced comparable or more favorable metabolic effects than those assigned to the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss.

In another study published in the Journal of American Medical Association, where a total of 160 participants were randomly assigned to either Atkins (carbohydrate restriction), Zone , Weight Watchers (calorie restriction), or Ornish (fat restriction) diet groups. After 12 months of maximum effort, participants on the Atkins Diet which had the lowest carbohydrate intake, lost more weight at 12 months than participants assigned to follow the Zone diet, and had experienced comparable or more favorable metabolic effects than those assigned to the Zone, Weight Watchers or Ornish  diets. Each diet significantly reduced the low-density lipoprotein/high-density lipoprotein (HDL) cholesterol ratio by approximately 10%, with no significant effects on blood pressure or glucose at 1 year. Each popular diet modestly reduced body weight and several cardiac risk factors at 1 year. The participants all had trouble adhering to their regimens, although increased adherence was associated with greater weight loss and cardiac risk factor reductions for each diet group. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss.

Several recent trials compared low-carbohydrate vs traditional low-fat, high-carbohydrate weight-loss diets ²⁵, ²⁶, ²⁷, ²⁸, ²⁹. A meta-analysis that pooled the results of these early trials concluded that low-carbohydrate, non–energy-restricted diets were at least as effective as low-fat, high-carbohydrate diets in inducing weight loss for up to 1 year ³⁰.

The Atkins’ Diet Plan

• High fiber vegetables, protein (fish/seafood, poultry, beef, pork, eggs, plant-based), healthy fats (olive oil, avocados, nuts, butter), dairy (cheese, Greek yogurt) and low-glycemic fruits (berries, cherries, melon). If carbohydrate tolerance allows: legumes, higher starch vegetables and whole grains. Avoid: sugar, refined flour, trans fat.

In essence the Atkins’ diet is very similar to a healthy diet – a diet that is rich in fiber that are whole and natural foods and low in sugars and carbohydrate. The main reason low-carb diets are so effective for weight loss, is that when people reduce carbohydrate intake and eat more protein, their appetite goes down and they end up automatically eating fewer calories without having to think about it.

The effectiveness and health benefits of a low-carb approach like the Atkins’ Diet has been shown by over 80 clinical studies. The science has demonstrated low carbohydrate diets, like the Atkins result in more effective weight loss and improvement in certain health markers when compared to some other weight loss programs.  In fact, almost any diet that helps you shed excess weight can reduce or even reverse risks factors for cardiovascular disease and diabetes.

The Atkins’ Diet focuses on both quantity and quality of carbohydrate intake.

The key was understanding that everyone’s metabolism can use two different types of fuel for energy – either sugar (and carbs that are quickly turned into sugar by the body), or fat. But the type of fuel you burn can have a big difference in losing or maintaining weight. A typical diet reduces calories, but is still high in carbohydrates (and thus sugar). As a result, many people constantly cycle between sugar “highs” (where excess sugar is actually stored as fat in the body) and sugar “lows” (where you feel fatigued and ravenously hungry – for more carbs and sugar). For many, it’s really hard to lose weight that way.

What To Eat

The main dietary focus of the Atkins Diet is eating the right balance of carbohydrates, protein and fats for optimal weight loss and health. According to the Atkins Diet, obesity and related health problems, such as type 2 diabetes and heart disease, are the fault of the typical low-fat, high-carbohydrate American diet. The Atkins Diet says that you don’t need to avoid fatty cuts of meat or trim off excess fat. Rather, controlling carbs is what’s important.

The Atkins Diet holds that eating too many carbohydrates — especially sugar, white flour and other refined carbs — leads to blood sugar imbalances, weight gain and cardiovascular problems. To that end, the Atkins Diet restricts carbohydrates and encourages eating more protein and fat. However, the Atkins Diet says it is not a high-protein diet.

Foods to Eat

You should base your diet around these healthy foods.

• Meats: Beef, pork, lamb, chicken and others.
• Fatty Fish and Seafood: Salmon, trout, sardines, etc.
• Eggs: The healthiest eggs are Omega-3 enriched or pastured.
• Low-Carb Vegetables: Kale, spinach, broccoli, asparagus and others.
• Full-Fat Dairy: Butter, cheese, cream, full-fat yoghurt.
• Nuts and Seeds: Almonds, macadamia nuts, walnuts, sunflower seeds, etc.
• Healthy Fats: Extra virgin olive oil, coconut oil, avocados and avocado oil.

As long as you base your meals around a fatty protein source with vegetables or nuts and some healthy fats, then you will lose weight. It’s that simple. However, the American Heart Association cautions people against following the Atkins diet because it is too high in saturated fat and protein, which can be hard on the heart, kidneys, and bones. The lack of carb-rich fruits and vegetables is also worrisome, because eating these foods tends to lower the risk of stroke, dementia, and certain cancers. Most experts believe that the South Beach and other less restrictive low-carbohydrate diets offer a more reasonable approach ³¹.

The Atkins Diet doesn’t require calorie counting or portion control. It does require you to track your carbs, though. It uses a system called net carbs, which is the total carbohydrate content of an item minus its fiber content. For example, a half-cup of raw broccoli has 2.3 grams of total carbs and 1.3 grams of fiber, putting its net carb value at 1 gram.

The Atkins Diet says its approach to carbs will burn off your body’s fat stores, regulate your blood sugar and help you achieve optimal health, while not leaving you feeling hungry or deprived. Once you’re at your goal weight, the Atkins Diet also says it will help you identify your personal carbohydrate tolerance — the number of grams of net carbs you can eat each day without gaining or losing weight.

Like many diet plans, the Atkins Diet continues to evolve. It now encourages eating more high-fiber vegetables, accommodates vegetarian and vegan needs, and addresses health problems that may arise when initially starting a low-carb diet.

Regular Exercise

Although the Atkins Diet originally said that exercise wasn’t vital for weight loss, it now acknowledges that exercise is important to weight loss and maintenance, as well as for achieving other health benefits.

The 4 Phases of the Atkins’ Diet Plan ²

The Atkins Diet has 4 phases ³², ³², ³³, ³⁴, ³⁵ for weight loss and maintenance, starting out with a very low carbohydrate eating plan.

Phase 1: Induction ³².

Phase 1 is about transforming your body into a fat burning machine and kickstarting your weight loss. By limiting the amount of carbs you eat, your body will switch its main fuel source from carbs to fat.

In this strict phase, you cut out almost all carbohydrates (total carbohydrate minus dietary fiber and sugar alcohols) from your diet, eating under 20 grams of carbs a day, mainly from vegetables, for 2 weeks. The Atkins plan refers to fiber and sugar alcohols as nonimpact carbohydrates, and thus not part of the total carbohydrate count ². Instead of getting 45 to 65 percent of your daily calories from carbohydrates, as recommended by most nutrition guidelines, you get only about 10 percent. “Foundation” vegetables, such as asparagus, broccoli, celery, cucumber, green beans and peppers, should account for 12-15 grams of your daily net carbs. You should eat protein, such as fish and shellfish, poultry, meat, eggs and cheese, at every meal. You don’t need to restrict oils and fats, but you can’t have most fruits, sugary baked goods, breads, pastas, grains, nuts or alcohol. You should drink eight glasses of water a day. You stay in this phase for at least two weeks, depending on your weight loss.

• As a rough guide, start at Phase 1 if:

+ Your goal is to lose 14lbs (7kg) or more
+ You’re inactive or have a slow metabolism
+ You’ve regained the weight you once lost
+ You want to lose a little bit of weight, but quickly

• Phase 1 guidelines ³⁶
  

The induction phase is about helping you distinguish hunger from habit, and changing the amount what you eat to suit your appetite as it decreases.

When you’re hungry, eat until you’re satisfied but not overly full. If you’re unsure, wait ten minutes and have a glass of water to see if you’re still hungry. If you don’t have a big appetite at mealtimes, instead of skipping your meal, have a small low carb snack.

To start your low carb diet, there are a few rules you need to stick to.

+ Eat 3 regular sized meals a day or 4-5 smaller meals
+ Don’t skip meals or go for longer than 6 hours during the day without eating
+ Eat at least 115-175 grams of protein-rich food for every meal (up to 225g for taller men)
+ Eat 20g of carbs per day
+ 12-15g of your carb total should come from cooked vegetables and salad
+ You can also take a daily iron-free multivitamin/multimineral tablet and an omega-3 fatty acid supplement to make sure you are getting all the nutrients you need
+ Drink 8 glasses of water (or other acceptable drinks) per day

• Which Carbs Are Off-Limits for Now ?

Phase 1

There are some carbs that you should avoid  during the Phase 1:

• Fruit (other than rhubarb, which is really a vegetable). Avocados, olives, and tomatoes – all of which are actually fruit – are fine
• Fruit juice (other than 2 tablespoons lemon and/or lime juice a day)
• Caloric fizzy drinks/juice
• Bread, pasta, muffins, tortillas, crisps and any other food made with flour or other grain products, with the exception of low-carb products with 3g of net carbs or less
• Any foods made with added sugar of any sort, including but not limited to pastries, biscuits, cakes, and sweets
• Alcohol in any form
• Nuts and seeds, nut and seed butters, and nut flours or meals, with the exception of flax meal and coconut flour. (Nuts and seeds are okay after two weeks on Phase 1)
• Grains, even wholegrains
• Kidney beans, chickpeas, lentils, and other pulses
• Starchy vegetables such as carrots, potatoes, sweet potatoes, and winter squash.
• Dairy products other than cream, soured cream, single cream and aged cheeses. No cow’s or goat’s milk, yoghurt, cottage cheese, or ricotta for now
• ‘Low-fat’ foods, which are usually higher in carbs
• ‘Diet’ products, unless they specifically state ‘low carbohydrate’ and have no more than 3g of Net Carbs per serving
• ‘Junk food’ in any form
• Products such as chewing gum, breath mints, cough syrups and drops, or liquid vitamins, unless they’re sweetened with sorbitol or xylitol. You can have up to three a day of those. Count 1g per piece
• Sauces which contain added carbs such as BBQ, cocktail, ketchup, pasta sauces etc.
• Tomato sauce, tinned or stewed tomatoes, tomato purée and tomato paste are all acceptable in Phase 1, as long as they contain no added sugar.

Acceptable low carb vegetables and salads:

• Your 12–15g of carbs works out at about 175 g (6 oz) of salad leaves plus 200–300 g (7–11 oz) cooked vegetables

Salad leaves
About 30 g (1 oz) or a big handful of each of raw salad leaves comes in at less than 1g of carbs:
• Bok Choy
• Chives
• Cabbage
• Endive
• Lettuce, all types
• Rocket
• Spinach
• Sprouts, all kinds
• Watercress

• Asparagus
• Aubergine
• Beans, French, broad, green
• Broccoli
• Cauliflower
• Swiss Chard
• Courgette
• Kale
• Mushrooms
• Okra
• Sauerkraut
• Spinach
• Squash
• Turnips

• Avocados
• Bamboo shoots, tinned
• Celery
• Cucumber
• Mushrooms
• Olives, black or green
• Onions
• Gherkins, dill or sour
• Radishes, Daikon
• Spring onions
• Sweet peppers, any colour
• Tomatoes

Salad Dressings

You can enjoy any prepared salad dressing that has no added sugar and no more than 3g of carbs per serving (1–2 tablespoons). A better lower-carb option is
to make your own vinaigrette with olive oil plus either vinegar, lemon or lime juice. You can have up to 2 tablespoons of lemon or lime juice a day.
• Blue cheese dressing
• Caesar salad dressing
• Italian dressing
• Ranch dressing
• Vinaigrette
• Celery salt
• Chilli peppers
• Garlic
• Ginger root
• Italian seasoning
• Lemon or orange peel, grated

Protein

Aim for 115-175g (in weight) per meal, or 225g if you’re a larger man. Atkins recommend you weigh your food in the first week so you get a feel for the size of your portions. From then on, it’s ok to estimate.

If you don’t have scales at home, here is a rough guide of portion sizes:
115g is 1 palm-sized fillet of fish, meat or tofu.
175g is a 1.5 palm-sized portion
225g is a 2 palm-sized portion

• Acceptable low carb fish, meat & poultry ³⁷.

  Now you’ve got to grips with your new low carb lifestyle, you can start to enjoy a greater variety of foods. In this phase you will find your carb tolerance – that’s the level of carbs you can eat daily while still losing weight at a steady pace. In Phase 2, you will increase your carb intake by 5g increments to find your carb tolerance. You can now add nuts, seeds, berries and certain cheeses to your menu. By increasing your carbs gradually, you’ll find out exactly how many carbs you can eat while still working towards your goal weight. It’ll form the foundation of your low carb lifestyle in the long term.

  This phase involves increasing net carbohydrate intake to 25 g/day, and each week thereafter net carbohydrate intake is increased by 5 g. When weight loss ceases, net carbohydrate intake is decreased by 5 g daily to reinitiate weight loss, you continue to eat a minimum of 12-15 grams of net carbs as foundation vegetables. You also continue to avoid foods with added sugar. You can slowly add back in some nutrient-rich carbs, such as more vegetables and berries, nuts and seeds, as you continue to lose weight. You stay in this phase until you’re about 10 pounds (4.5 kilograms) from your goal weight.

  • Phase 2 might be right for you

  If you don’t have that much weight to lose, want greater food variety or if you are vegetarian, you can skip Phase 1 and start in Phase 2. Our BMI counter or our nutritionists can help you decide what Phase is best for you.

  • As a rough guide, starting in Phase 2 is right for you if:

  + Your goal is to lose less than 14lbs (7kg)
  + You’re happy to lose weight a little more slowly
  + You have more weight to lose but want to enjoy more food variety
  + You’re vegetarian

  • Phase 2 guidelines ³³
    

  In Phase 2, you will increase your carb intake little by little to find your carb tolerance. You can now add nuts, seeds, berries and certain cheeses to your menu, as well as Atkins food products.

  + By increasing your carbs gradually, you’ll find out exactly how many carbs you can eat while still working towards your goal weight. It’ll form the foundation of your low carb lifestyle in the long term.
  + Remember, weight loss in this phase usually happens at a steadier pace than in Phase 1. Be patient, if you stick to a few rules, you will get to your goal.
  + Vegetarians start at 30g of carbs per day
  + You can add an extra 5g of carbs per week (up to 40g) to find your carb tolerance
  + You can now add nuts, seeds, berries and certain cheeses to your diet
  + You can now enjoy Atkins food products
  + Monitor your daily carb intake – which you can do using a carb counter
  + Eat plenty of natural fats
  + Continue to take your multivitamin, multimineral and omega-3 supplements
  + Consume eight glasses of water (or other acceptable fluids) per day

  Nuts and Seeds

  Chestnuts are very high in carbs and should be avoided, as should salted nuts, because they are difficult to eat in moderation. Nut spread products like Nutella contain added sugars, so avoid them too.

  Acceptable low carb nuts and seeds:
  • Almonds
  • Brazil nuts
  • Cashews
  • Coconut (fresh or grated and unsweetened)
  • Macadamias
  • Hazelnuts
  • Peanuts
  • Pecans
  • Pine nuts
  • Pistachios
  • Pumpkin seeds
  • Sesame seeds
  • Soy “nuts”
  • Sunflower seeds
  • Walnuts

  Berries, Cherries, and Most Melons

  The fruits suitable for Phase 2 are lower in carbs than most other fruits. This is because their fibre content is relatively high and fruit sugar content is relatively low.

  Acceptable low carb fruits for Phase 2:

  • Blackberries, blueberries, boysenberries, fresh currants, gooseberries, loganberries, raspberries, and strawberries
  • Cherries, sour or sweet
  • Unsweetened cranberries and cranberry sauce made with acceptable sweeteners only
  • Melon: cantaloupe and honeydew (but not watermelon)

  Pulses

  If you want the extra variety in your diet, you can now add pulses. Alternatively, you may choose to wait till Phase 3 if that suits you better. Pulses are a great filling addition to salads or as a substitute for rice. You can enjoy the dried, tinned or pulses that are sold fresh or frozen like green soybeans (edamame) and baby lima beans.

  Products such as baked beans are made with added sugar so you should avoid them. Hummus is fine, but watch out for bean dips made with sugar or starches.

  Acceptable low carb pulses:
  • Black beans
  • Black-eyed peas
  • Broad beans
  • Butter beans
  • Chickpeas
  • Edamame
  • Haricot or navy beans
  • Hummus
  • Kidney beans
  • Peas, split
  • Pinto beans
  • Soybeans

  Tomato and lemon/lime juice
  In Phase 1 you could have 2 tablespoons lemon or lime juice; now you can have:
  • 50 ml (2 fl oz) lemon or lime juice
  • 125 ml (4 fl oz) tomato juice or tomato juice cocktail

  Phase 3: Pre-maintenance  ³⁴.

  Phase 3 is all about helping you establish a long-term way of eating so you can stay happy and healthy for good. You’ll gradually build up your carb tolerance, so by the time you’re ready to move on to Phase 4, you know exactly what works for you.

  In this phase, when you are very close to your goal weight, you continue to gradually increase the range of foods you can eat, including fruits, starchy vegetables and whole grains. You can add about 10 grams of carbs to your diet each week, but you must cut back if your weight loss stops. You stay in this phase until you reach your weight goal.

  During Phase 3, you will increase your carb intake by 10g per week. This is so you can find your carb balance – the ideal level that will allow you to reach your goal weight and stay there. Everyone’s different, so it is just trial and error. Take it at your own pace and listen to your body.

  By the time you reach your goal weight and have kept it there for a month, you should have a pretty good idea of what amount and type of carbs your body can handle, and what it can’t.

  Fine-tuning your carbs

  If your cravings come back or your weight loss stalls, drop your carb intake by 10g for a week, then introduce an extra 5g until you find your level. In this final ‘fine-tuning’ stage of your plan, you’ll discover the balance between what you can eat and maintaining your ideal weight.

  Remember, weight loss will be slower as you work find your carb balance. Be patient, if you stick to a few rules, you will find the carb limit that will help you stay at the weight your happy weight.

  + You can add an extra 10g of carbs per week (up to 100g) to find your carb balance
  + You can now add pulses, starchy veg, more fruits and grains to your diet
  + Monitor your daily carb intake – which you can do using our carb counter
  + Consume eight glasses of water (or other acceptable fluids) per day

  Here’s an overview of the additional low carb foods you can enjoy in Phase 3:

  Before adding extra fruit into your low carb diet, add pulses if you haven’t already. However, if you’re not a big fan of lentils and other beans, simply skip them.

  • Other Fruits

  As with the berries, cherries, and melon that you added in Phase 2, introduce these higher-carb fruits in small quantities, starting with one at a time and only once a day. Tropical fruits such as banana, mango, and pineapple are considerably higher in carbs than other fruits, so wait till you’ve seen how you tolerate other fruits before trying them. As long as it’s made without added sugar, you can enjoy a small portion of jelly, jam, preserves, and fruit preserves made from Phase 3 fruits.

  Always try to have fresh or frozen fruit wherever possible, but make sure the frozen varieties have no added sugar. Tinned fruit in water or juice is fine, but avoid syrup.

  Acceptable Phase 3 fruits:
  • Apples
  • Apricots
  • Grapes
  • Grapefruit
  • Kiwi fruit
  • Oranges
  • Papayas
  • Peaches or nectarines
  • Pears
  • Plums
  • Pomegranates
  • Watermelon

  • Starchy Vegetables

  You’ve been eating plenty of foundation vegetables in the first two phases of the New Atkins Diet. After reintroducing other fruits, it’s time to try to reintroduce the rest of the vegetable family. Like foundation vegetables, these vegetables are high in fibre and antioxidants; however, they’re higher in carbs.

  Acceptable Phase 3 vegetables:
  • Beetroot
  • Carrots
  • Corn on (or off) the cob
  • Jerusalem artichokes
  • Peas
  • Parsnips
  • Potatoes, sweet and white
  • Turnips
  • Winter squash
  • Yams

  • Whole Grains

  Right at the top rung of the carb ladder are grains, which is why they are the last wholefood group to be reintroduced. Not everyone can tolerate grains and the
  products made with them, so go slowly and find out what works for you. Products made with wholegrains are acceptable, but remember that the carb counts may vary greatly from one product to another.

  Make sure you don’t confuse refined grains such as white flour and white rice with wholegrains. Baked goods, including bread, pitta, tortillas, biscuits, and cereals made with refined grains are still a no-no, with the exception of low carb products. Products made with wholegrains are acceptable, but the carb count may vary greatly from one product to another.

  Acceptable whole grains for Phase 3:
  • Barley
  • Cornmeal
  • Couscous, whole-wheat
  • Kasha (buckwheat groats)
  • Wholemeal flour, wheat berries, bulgur, and cracked wheat
  • Millet
  • Oat bran and porridge oats (not instant)
  • Quinoa
  • Rice, brown, red, or wild

  Milk

  In Phase 3 you can also increase your daily intake of whole milk to 125 ml (4 fl oz), but continue to steer clear of low-fat milk and other low-fat dairy products. You also can experiment with low-carb products that have up to 9g of Net Carbs per serving.

  Phase 4: Lifetime maintenance ³⁸.

  You move into this phase when you reach your goal weight, and then you continue this way of eating for life. You know the ins and outs of low carb living
  off by heart by now, so you won’t be surprised to hear that the work doesn’t stop just because you’ve hit your goal. If you keep the carb balance that you’ve refined over the last weeks and months, there’s nothing to stop you staying at your goal weight indefinitely.

  Phase 4 is all about helping you enjoy your healthier, low carb life in the future – and keeping you at the weight you’re happy with. You can enjoy all the foods that are acceptable in all of the previous phases. Both phase 3 and 4 are based on the number of grams of carbohydrate needed for weight stability (45 to 100 g/day). Foods high in protein and good fats (ie, unsaturated, polyunsaturated, and monounsaturated) are recommended, although no limit is placed on intake of saturated fats ².

  Low carb for life

  Going forward, you can continue to eat the same variety of foods you enjoyed in Phase 3 with one slight adjustment – your fat intake may go down as your carb intake increases.

  Being active is important to for a balance, healthy lifestyle. If you’re not already exercising, now is the perfect time to get moving. As well as reducing your risk of a number of illnesses, it’ll help you keep the weight off.

  Keeping your Atkins edge

  You know the ins and outs of low carb living off by heart by now, so you won’t be surprised to hear that the work doesn’t stop just because you’ve hit your goal. If you keep the carb balance that you’ve refined over the last weeks and months, there’s nothing to stop you staying at your goal weight indefinitely.

  If you do have a period where things slip and you gain weight or your cravings come back, don’t panic. You can get back your ‘Atkins edge’ by simply dropping your carb in take by 10 to 20 grams to regain control.

   

  **The Atkins Diet acknowledges that you may initially lose water weight. It says that you’ll continue to lose weight in phases 2 and 3 as long as you don’t eat more carbs than your body can tolerate.

  What About Vegetarians ?

  It is possible to do the Atkins diet as a vegetarian (and even vegan), but difficult. You can use soy-based foods for protein and eat plenty of nuts and seeds. Olive oil and coconut oil are excellent plant-based fat sources.

  Lacto-ovo-vegetarians can also eat eggs, cheese, butter, heavy cream and other high-fat dairy foods.

  References
  1. Atkins R. 1992 Dr. Atkins new diet revolution. New York: Avon Books
  2. Atkins RC. Atkins For Life: The Complete Controlled Carb Program for Permanent Weight Loss and Good Health. New York, NY: St Martins; 2003.
  3. S.T. St. Jeor, B.V. Howard, T.E. Prewitt, et al.Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart AssociationCirculation, 104 (2001), pp. 1869-1874
  4. Blackburn GL, Phillips JC, Morreale S. 2001 Physician’s guide to popular low carbohydrate weight-loss diets. Cleve Clin J Med 68:761, 765–766, 768–769, 773–774. https://www.ncbi.nlm.nih.gov/pubmed/11563479
  5. American Heart Association. Recipes for Cholesterol Management. http://www.heart.org/HEARTORG/Conditions/Cholesterol/CholesterolToolsResources/Recipes-for-Cholesterol-Management_UCM_305655_Article.jsp
  6. American Heart Association. Advisory: Replacing saturated fat with healthier fat could lower cardiovascular risks. http://news.heart.org/advisory-replacing-saturated-fat-with-healthier-fat-could-lower-cardiovascular-risks/
  7. American Heart Association. Saturated Fats. https://healthyforgood.heart.org/Eat-smart/Articles/Saturated-Fats
  8. Law M. 2000 Dietary fat and adult diseases and the implications for childhood nutrition: an epidemiologic approach. Am J Clin Nutr 72:1291 S–1296S.
  9. Bennett PH RM, Knowler WC. 1997 Epidemiology of diabetes mellitus. In: Sherwin RS, ed. Diabetes mellitus. Stamford: Appleton and Lange; 373–400.
  10. Diabetologia. 1997 Apr;40(4):430-8. High saturated fat and low starch and fibre are associated with hyperinsulinaemia in a non-diabetic population: the San Luis Valley Diabetes Study. https://www.ncbi.nlm.nih.gov/pubmed/9112020
  11. Am J Clin Nutr. 1998 Dec;68(6):1157-73. Dietary fat intake does affect obesity! https://www.ncbi.nlm.nih.gov/pubmed/9846842
  12. Diabetes Care. 1998 Dec;21(12):2069-76. Genes versus environment. The relationship between dietary fat and total and central abdominal fat. https://www.ncbi.nlm.nih.gov/pubmed/9839096
  13. Int J Obes. 1990 Sep;14(9):743-51. Effects of a high-protein meal (meat) and a high-carbohydrate meal (vegetarian) on satiety measured by automated computerized monitoring of subsequent food intake, motivation to eat and food preferences. https://www.ncbi.nlm.nih.gov/pubmed/2228407
  14. Eur J Clin Nutr. 1996 Jul;50(7):409-17. Breakfasts high in protein, fat or carbohydrate: effect on within-day appetite and energy balance. https://www.ncbi.nlm.nih.gov/pubmed/8862476
  15. Nutr Rev. 1998 May;56(5 Pt 2):S3-19; discussion S19-28. Dietary fat consumption and health. https://www.ncbi.nlm.nih.gov/pubmed/9624878
  16. J Am Diet Assoc. 2007 Oct; 107(10): 1786–1791. doi: 10.1016/j.jada.2007.07.013. A Dietary Quality Comparison of Popular Weight-Loss Plans. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040023/#R10
  17. Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index. McCullough ML, Willett WC. Public Health Nutr. 2006 Feb; 9(1A):152-7. https://www.ncbi.nlm.nih.gov/pubmed/16512963/
  18. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr. 2002 Dec; 76(6):1261-71. https://www.ncbi.nlm.nih.gov/pubmed/12450892/
  19. The Healthy Eating Index: design and applications. Kennedy ET, Ohls J, Carlson S, Fleming K. https://www.ncbi.nlm.nih.gov/pubmed/7560680/J Am Diet Assoc. 1995 Oct; 95(10):1103-8.
  20. Kennedy ET, Ohls J, Carlson S, Fleming K. The Healthy Eating Index: design and applications. J Am Diet Assoc 1995;95:1103–8. https://www.ncbi.nlm.nih.gov/pubmed/7560680?dopt=Abstract
  21. Public Health Nutr. 2006 Feb;9(1A):152-7. Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index. https://www.ncbi.nlm.nih.gov/pubmed/16512963/
  22. Am J Clin Nutr. 2002 Dec;76(6):1261-71. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. https://www.ncbi.nlm.nih.gov/pubmed/12450892/
  23. The American Journal of Clinical Nutrition December 2002, vol. 76 no. 6 1261-1271. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. http://ajcn.nutrition.org/content/76/6/1261.long
  24. The Journal of the American Medical Association (JAMA), JAMA. 2007;297(9):969-977. doi:10.1001/jama.297.9.969. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. http://jamanetwork.com/journals/jama/fullarticle/205916
  25. Brehm BJ, Seeley RJ, Daniels SR, D’Alessio DA. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab. 2003;88:1617-1623. https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2002-021480
  26. Foster GD, Wyatt HR, Hill JO. et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082-2090. http://www.nejm.org/doi/full/10.1056/NEJMoa022207
  27. Stern L, Iqbal N, Seshadri P. et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140:778-785. http://annals.org/aim/article/717452/effects-low-carbohydrate-versus-conventional-weight-loss-diets-severely-obese
  28. Yancy WS Jr, Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med. 2004;140:769-777. http://annals.org/aim/article/717451/low-carbohydrate-ketogenic-diet-versus-low-fat-diet-treat-obesity
  29. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293:43-53. http://jamanetwork.com/journals/jama/fullarticle/200094
  30. Nordmann AJ, Nordmann A, Briel M. et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:285-293. http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/409791
  31. Harvard University. Harvard Medical Publications. Low fat, low carb, or Mediterranean: which diet is right for you ? http://www.health.harvard.edu/staying-healthy/low-fat-low-carb-or-mediterranean-which-diet-is-right-for-you
  32. Atkins – Phase 1: Kickstart your weight loss – https://au.atkins.com/why-atkins/the-phases/phase-1-induction/
  33. Atkins – Phase 2: Low carb confidence. – https://au.atkins.com/why-atkins/the-phases/phase-2-ongoing-weight-loss/
  34. Atkins – Phase 3: Find your carb balance – https://au.atkins.com/why-atkins/the-phases/phase-3-pre-maintenance/
  35. Atkins – Phase 4: Going low carb for life – https://au.atkins.com/why-atkins/the-phases/phase-4-maintenance/
  36. Atkins – Phase 1: Kickstart your weight loss – https://au.atkins.com/why-atkins/the-phases/phase-2-ongoing-weight-loss/
  37. Atkins – Your Atkins food guide for all phases – https://au.atkins.com/static/default/files/documents/pdf/Atkins%20Food%20List.pdf) :

• Low carb cheeses

• Blue cheese
• Brie
• Cheddar
• Cream cheese
• Emmental
• Feta
• Goat’s cheese
• Gouda
• Mozzarella, made with whole-milk
• Parmesan
• Romano

• Fish

• Cod
• Halibut
• Herring
• Salmon
• Sardines
• Sole
• Trout
• Tuna

• Meat

• Bacon
• Beef
• Ham
• Lamb
• Pork
• Veal
• Venison

• Poultry

• Chicken
• Cornish Hen
• Duck
• Goose
• Pheasant
• Quail
• Turkey

• Shellfish

• Clams
• Crab
• Lobster
• Mussels
• Oysters
• Shrimp/Prawns
• Squid

• Beverages

Make sure you check the labels and only the pick the brands with acceptable sweeteners and zero grams of carbs.

Acceptable low carb beverages:
• Coffee (caffeinated or decaffeinated, hot or iced) and espresso
• Tea (caffeinated or decaffeinated)
• Herbal teas and infusions without added sugar
• Soda water
• Diet fizzy drinks sweetened with non-caloric sweeteners, such as Diet Coke, Pepsi Max and Diet Lemonade
• Sugar-free tonic water
• Carbonated water – must say ‘no calories’
• Unflavoured soy/almond milk
• Cream – single or double

Acceptable low carb artificial sweeteners:

• Splenda or Sweetex (sucralose)
• Truvia (a natural product made from stevia)
• Canderel (a blend of aspartame, acesulfame-k, sucralose and stevia)
• Sweet’n Low (saccharin)
• Xylitol (available in health food shops and some supermarkets)

Phase 2: Balancing ((Atkins – Phase 2: Low carb confidence. – https://au.atkins.com/why-atkins/the-phases/phase-2-ongoing-weight-loss/

Atkins – Phase 4: Going low carb for life – https://au.atkins.com/why-atkins/the-phases/phase-4-maintenance/