1. October 4, 2012

2. What are we
recommended to eat?
Time Magazine, September 2011

3. Nutrition Guidelines
 Began in 1980: Food Guide Pyramid

4. Nutrition Guidelines
 MyPyramid 2005

5. Nutrition Guidelines
 MyPlate 2011

6. Do we see huge changes in
nutrition recommendations over
the last 30 years?
What do you think?

7. Are we a healthy nation?

9. ―F‖ as in Fat Report 2012
 Adult obesity rose in 16 states over the
past year (2008-2010 data). No
decreases.
 12 states have obesity rates over 30%.
 Mississippi highest (34.4%); Colorado
lowest (19.8%).
 Obesity related diseases: diabetes, heart
disease, hypertension, cancer still high.
 2030? Obesity rates will reach 44%, and in
13 states it will be over 60%!

11. Trends in Obesity
Nutrition Science Initiative

12. Trends in Diabetes
Nutrition Science Initiative

13. Trends in Childhood Obesity
Nutrition Science Initiative

14. Side Effects
 Angina (Chest pain)
 Inflammation
 Cancer
 Hypertension
 Joint pain
 Heart Attack/Stroke
 Amputations
 Blindness
 Pre-mature Death
 Mental Health

15. Side Effects

16. But…
 Obesity and obesity-related diseases
can be prevented and reversed!
 Best method?
CHANGE IN LIFESTYLE!!!

17. Are the current
recommendations correct?

18. Evidence Report NIH 1998
 In 1995, the NIH convened the first
Expert Panel on the Identification,
Evaluation, and Treatment of
Overweight and Obesity in Adults to
develop clinical practice guidelines for
primary care practitioners.
 What do they recommend?

19. Treatment of
Overweight/Obesity
 ≥ 55% energy from carbohydrates
 ≤ 30% energy from fat
 Roughly 15% energy from protein
CHO
FAT
PRO

20. What are we currently told?
 CDC: ―you must use up more calories
than you take in… since one pound [of
fat] equals 3,500 calories reduce 500-
1000 calories per day to lose 1 to 2
pounds per week.‖
 Mayo Clinic: ―when it comes to weight
loss, it’s calories that count.‖

21. What are we currently told?
 NIH Weight-control Information Network:
―to lose weight you need to take in fewer
calories than you use.‖
 ADA: ―you must eat or drink fewer
calories than you body burns off.‖
 ―Eat less, exercise more.‖

22. The issue?
 Recommendations are for general
population.
 Calories, calories, calories.
 Eat less, and exercise more!
 Too general!
 If it’s that simple why are we continuing
to gain weight? Why do people struggle
with weight loss? Why are we sick?

24. What do clinical studies show?
 Low-Carb, High Fat (LCHF) vs. Low-Fat,
high Carb (LFHC) diets.
 Randomized, controlled—not
observational.
 Challenging conventional wisdom
 Just because it’s popular belief does not
mean it’s true.

25. Low-carb Diets
 Yancy et al., 2004: 7-8 months LC
(<20% CHO/day) lost 20.7 lb. LF group
lost 10.58 lb.
 LC group:  serum Triglycerides,  HDL
 Krauss et al., 2006: in absence of weight
loss LC improve antherogenic lipid
status.
 Brehm et al., 2009: 4-6 months eating
LC (<20% CHO/day) lost 13.16 lb. LF
group lost 7.12 lb.

26. A to Z study: Weight loss
 4 ―fad‖ diets
 Atkins: low carb + high fat/protein
 Zone: 40/30/30
 Ornish: low fat; at high carbs- as much
as you want
 LEARN: health-professional diet- low-fat

27. A to Z study: findings

28. Low-Carb, Low-Fat and
Mediterrean Diet

29. Why do low-
carbohydrate, high fat diets
work?

30. Terms…just so you know
 Insulin: storage hormone; fat synthesis;
insulin resistance; anabolic
 Glucagon: release stored energy; inhibit
fat synthesis; high in fasted state
 Leptin: decreases appetite; obese are
leptin resistant
 Other shifts in metabolic hormones &
substrates based on diet.

31. Reasons for Low Carb
 Low insulin response
 High glucagon
 Increase satiety (leptin)
 Lower GI/GL
 Increase MUFA/PUFA
 Increase weight loss + fat loss
 Structuring our body’s energy production
around ―fat burning‖ rather than ―sugar
burning.‖

32. Why fat is better?
 Stores more energy
 Efficient fuel
 Preferred fuel in every day situations
 Quick to mobilize
 Need machinery to use it

33. Becoming Keto Adaptive on Low
Carb
 Ketone bodies: byproducts of fat
metabolism
 Keto adaptive vs ketosis vs ketoacidosis
 What are the benefits?
 Brain fuel,  ROS,  insulin sensitivity,
protein sparing, better recovery, improve
body composition
 Any side effects?
 Initial: fatigue, headache, alcohol breathe

34. Conclusion
 Short-term (4-8 months): LCHF diets are
effective and safe for weight loss.
 Long-term(>12 months): Effective but
weight regain occurs over the long-term.
 Keto adaptive is beneficial.

35. Now…time for the good
stuff!

36. Steps for change
 Step 1: Evaluate Lifestyle
 Step 2: Strengths + Weaknesses
 Step 3: Implement change
 Step 4: Success + Evaluate what works
(and doesn’t work)
 Step 5: Continue Awesomeness

37. Lifestyle Checklist for weight
loss
 Look at 5 things:
 Nutrition
 Sleep
 Exercise
 Family/work/social
 Psychology/Emotional
Weight loss is a team effort–
trainers, family, friends, doctors and
therapists, etc. Just find the right ones!

38. Nutrition: Tips and Tricks
 Paleo/LCHF
 50-100g of carbs/day
 Learn to cook/make your
own meals!
 Family cooking
 Eat Whole Foods
 Bag, box? More than 5
ingredients?

39. Paleo

40. What does a 100g Carb day
look like?
Food CHO (g)
1 kiwi 5.4
½ cup blueberries 10.0
2 tbsp salsa 2.0
1 cup broccoli 11.2
1 cup kale, steamed 7.3
1 cup apple suace 28
½ cup sweet potatoes 18.7
1 cup green beans 9.8
Total: 92.4 g

41. Nutrition: Tips and Tricks
 Shop the perimeter of grocery store

42. Nutrition: Tips and Tricks
 Eat every 3-4 hours
 Intermittent fast (IF)
 Don’t drink your meals
 No fruit juices, sports drinks, diet pop, skim
milk
 Fish Oil: at least 2g DHA/EPA per day
 7g of standard fish oil or 2-3 g concentrated
 High-dose: increase weight loss
○ I recommend at least 10 g per day; cycle for
4-6 weeks

43. Read a Fish Oil Label
Fish Oil 1: Good or Bad Fish Oil?

44. Read a Fish Oil Label
Fish Oil 2: Good or Bad Fish Oil?

45. Read a Fish Oil Label
 Fish Oil 1: One soft gel= 1,000 mg fish
oil (or 1g). EPA= 180mg; DHA = 120mg
 2g EPA/DHA recommended
 Let’s look at DHA specifically so use (.120g
=120mg)
 So… 2g/0.120g DHA = 17 soft gels!
 Fish Oil 2:
 4 capsules = 4,000 mg (or 4g). EPA
=1600mg; DHA =800mg.
 So…2g/.800g = 2.5 x 4 = 10 capsules

46. Fish Oil 1: Fish Oil 2:

47. Nutrition: Tips & Tricks
 Eat slowly and stop at 80% full
 Include protein dense foods with each meal
 Consume 1- 2 vegetables with each meal
 Eat diary if you tolerate it—if so, go full-fat.
 Fat: eat it!
 Avocados, olive oil, nuts (once/day), animal fats,
bacon (mmmm), cheese, grass-fed butter, ghee.

48. Put into Practice
 Time course:
 Today: evaluate lifestyle
 Next 2-3 weeks:
○ Educate yourself: books, blogs, websites
○ See doctor- blood work: fasting insulin,
Hba1c, Lipid panel (esp. apoB and small-
dense LDL), CRP, kidney & liver, Vitamin D,
calcium
○ % body fat + Lean Body Mass- get checked
 See me!
○ Paleo + LCHF: 4-6 Months

49. Nutrition: Things to Avoid
 Do not consume the following:
 Sugar, brown sugar, sugar
cane, HFCS, honey, maple syrup, etc.
 Anything label ―enriched,‖ ―low-fat‖ or ―reduced.‖
 Eating out
 Artificial Sweeteners: Splenda, Sweet n
Low, Equal (Aspartame)
 Grains: whole grains, cereals
breads, muffins, scones, cookies, baked
goods, even gluten-free
 Legumes: beans, peanuts, soy
 Alcohol: all forms (except wine & 100% agave
tequila)
 Vegetable Oils: canola oil, rapeseed oil.

50. What foods should I buy?

51. Proteins
 Grass-Fed red meat
 Wild Game: bison, elk, deer, bear
 Salmon (wild)
 Eggs (cage-free, free-range)
 Chicken, duck, wild turkey
 Plain Greek yogurt, cottage cheese (full
fat), coconut milk yogurt

52. Vegetables
 Spinach, Kale (all kinds), mustard
greens, collards
 Tomatoes, peppers, cucumber
 Cruciferous vegetables
(Broccoli, cabbage, cauliflower)
 Brussel Sprouts, mushrooms
 Tubes/Root Vegetables*:
parsnips, turnips, sweet
potatoes, beets, carrots

53. Fruits
 Raspberries
 Blueberries
 Blackberries
 Kiwi
 Oranges (whole)
 Cantaloupe

54. Fats
 Extra virgin Coconut oil
 Palm kernel oil
 Avocados
 Extra virgin olive oil
 Fish oil (EPA/DHA)
 Flax seeds (ground)
 Raw, mixed nuts & seeds
 Hidden fats in fish/meats

55. Liquids
 Coffee (black
preferred)
 Tea – no
sweetener
 Water
 Alcohol - leave it
to a minimum

56. Design the Right Meal
 Step 1: pick a protein
 Lean/fatty cut? Fish?
 Step 2: pick 1-2 vegetables
 Step 3: pick your fat
 Avocado? Cooking oil?
 Step 4: pick your Liquid
 Step 5: grub!

57. Lifestyle Checklist for weight
loss
 Look at 5 things:
 Nutrition
 Sleep
 Exercise
 Family/work/social
 Psychology

59. Exercise: Fuel to Perform
 Idea ―Burn Fat during Exercise‖ – needs
to be forgotten (one exception)
 Fuel to perform—body prefers CHO at
high intensities (no oxygen around)
 ―Anaerobic state‖
 Eat CHOs around your workout.
 Fruits + Vegetables
 Pre-WOD honey/applesauce

60. Exercise as a Tool
 Wellness and weight loss tool.
 Functional, constantly varied
movements.
 CF + nutrition = (fast) results
 ―Cherry-picking‖ workouts
 If you suck at something, continue to do it.

61. m

62. Websites to Visit…
Mark’s Daily Apple – Mark Sisson
Livin’ La Vida Low Carb – Jimmy Moore
Wellness Fx
Mother Nature Obeyed – Chris Masterjohn
Paleo Solution- Robb Wolf
Chris Kresser – Chris Kresser
Whole 9 Life- Dallas & Mellissa Hartwig
Paleo Physicians Network
Ground Up Health – Collin Popp

63. Overall: Weight Loss Keys
 Evaluate lifestyle
 Paleo + LCHF
 Keto adaptive
 Avoid sugar, grains, legumes, processed
crap
 Exercise as a tool
 Constantly varied, functional diet!
 If you eat crap, your body will turn into
crap. Don’t turn into crap!

64. Questions???

65. Worksal.Cited
Yancy et ―A low-carbohydrate, Ketogenic Diet versus a
low-fat diet to treat obesity and hyperlipidemia.‖ Ann Inter
Med. 2004, 140: 769-777
 Krauss et al. ―Separate effects of reduced carbohydrate
intake and weight loss on atherogenic dyslipidemia.‖ Am
J Clin Nutr 2006, 83(5):1025-1031
 Brehm et al. ―A randomized trial comparing a very low
carbohydrate diet and a calorie-restricted low fat diet on
bdoy weight and cardiovascular risk factors in healthy
women.‖ J Clin Endocrinol Metab. 2003;88:1617-1623
 Gardner et al. ―Comparison of the Atkins, Zone, Ornish
and LEARN diets for change in weight and related risk
factors among overweight premenopausal women.‖
JAMA 2007; 297:969-977.
 Shai et al. ―Weight loss with a low-
carbohydrate, mediterranean or low-fat diet.‖ N Engl J
Med 2008;359: 229-241.