The Following Items Can Be Eaten Liberally

Many of our patients have tried to stay healthy by following a low fat diet or by using the idea of eating less, moving more and trying to eat a balanced diet.

Despite this, our diabetic population has risen from 1% to 4.4 %( and we think it may be as high as 7%) over 20 years and the weight of our practice population has risen significantly in line with the rest of the country.

For this reason, we have looked into more effective approaches and suggest that the following works a lot better in terms of leading to better health and weight. It is a lifestyle, rather than a diet, and so it can be continued long term.

The following items can be eaten liberally

 Healthy fat: extra virgin olive oil, sesame oil, coconut oil, butter, ghee, almond milk, avocados, coconuts, olives, nuts and nut butters, cheese (except for blue cheeses), and seeds (flaxseed, sunflower seeds, pumpkin seeds, sesame seeds).  Protein: whole eggs; wild fish (salmon, trout, sardines); shellfish and molluscs (shrimp, crab, lobster, mussels, clams, oysters); grass-fed meat, fowl, poultry, and pork (beef, lamb, liver, chicken, turkey, duck, veal); wild game.  Vegetables: leafy greens and lettuces, collards, spinach, broccoli, kale, chard, cabbage, onions, mushrooms, cauliflower, Brussels sprouts, sauerkraut, artichoke, alfalfa sprouts, green beans, celery, radishes, watercress, turnip, asparagus, garlic, leek, fennel, shallots, spring onions, ginger, parsley, water chestnuts.  Low-sugar Fruit: avocado, peppers, cucumber, tomato, courgettes, squash, pumpkin, aubergine, lemons, limes.  Herbs, Seasonings, and Condiments: You can go wild here as long as you watch labels. Try mustard, horseradish, tapenade, and salsa if they are free of gluten, wheat, soy, and sugar. There are virtually no restrictions on herbs and seasonings; be mindful of packaged products, however, that were made at plants that process wheat and soy.

The following can be used in moderation (“moderation” means eating small amounts of these ingredients once a day or, ideally, just a couple times weekly):

 Non-gluten grains: rice (brown, white, wild), quinoa, gluten free oats. When non-gluten grains are processed for human consumption (e.g., milling whole oats and preparing rice for packaging), their physical structure changes, and this increases the risk of an inflammatory reaction. For this reason, we limit these foods.  Legumes (beans, lentils, peas). Exception: you can have hummus (made from chickpeas).  Carrots and parsnips.  Whole sweet fruit: berries are best; be extra cautious of sugary fruits such as apricots, mangos, melons, papaya, prunes, and pineapple.  Cow’s milk and cream: use sparingly in recipes, coffee, and tea.  Cottage cheese, yogurt, and kefir: use sparingly in recipes or as a topping.  Sweeteners: natural stevia and chocolate (choose dark chocolate that’s at least 70 percent or more cocoa).  Drinks. Water 8-9 glasses a day. Wine: one glass a day if you wish, preferably red.  Exercise. 30 minutes a day if you can do it, divided up if need be. Frequently Asked Questions

Q. Why and how did we get it so wrong?

A. It’s a long story. People have been on this planet for thousands of years and it is only the last 50 years that have tried the low fat/ high carb diets. You can see the results when you look around. In the USA there are obese 6 month old children and teenagers who have needed liver transplants through obesity. These children have gotten that way through low fat diets.

Q. Where does this come from? Where can I get further details?

A. It has been adapted from Dr Perlmutter’s book Grain Brain. See the free website drperlmutter.com for further details. It is part of a more general plan for better brain and body health.

Q. Are there any alternative plans I can follow?

A. Yes. They all have the similar reasoning and reach similar conclusions, although they vary in the detail.

The Harcombe Diet by Zoe Harcombe

Fat Chance by Dr Robert Lustig. Dr Lustig is a Paediatric Endocrinologist and children’s obesity expert.

Wheat Belly by Dr William Davies who is a Cardiologist

Sweet Nothing by Nicole Mowbray who is a journalist

Low Carb Living for families by Monique Le Roux Forslund and Professor Tim Noakes Professor Tim Noakes is a Professor of Exercise and Sports science.

The Decarb diet by Howard Rybko

The 5-2 Diet by Dr Michelle Harvie and Professor Tony Howell. These doctors work at the breast cancer prevention centre in Manchester. Their plan involves following a very low carbohydrate diet for 2 days a week and a Mediterranean diet for 5 days.

Pure White and Deadly by a physiologist John Yudkin

Paleo diet . See Paleo diets on the internet for further details

Q. What about fibre. Won’t I get constipated?

A. You can get plenty of fibre from vegetables so should not get constipated. Wheat is not essential.

Q. What, no healthy whole grains?

A. Whole grains cause a big rise in your blood glucose, and so are not recommended on this plan.

Q. So what do you eat for breakfast then? A. Most people eat eggs (omelettes, or scrambled or boiled eggs), with some salad or vegetables. Some make their own cereal with nuts and seeds. Some eat meat, like in a Turkish breakfast. Some people eat porridge oats with nuts. If you are not in the habit of having breakfast you don’t need to start.

Q. What about my cholesterol, I thoughts eggs/cheese were bad for cholesterol?

A. It is now accepted that eating healthy fat such as that in meat, cheese and eggs does not lead to a rise in cholesterol in the blood.

Q. I love bread and pasta. Do I really have to give them up?

A. Both bread and pasta raise your blood glucose significantly so are not recommended. If you are overweight, they will have contributed to that.

Q. Do I have to do it all the time? What if I am going to a restaurant or going on holiday

A. It is advised you aim to follow it for around 90% of the time.

Q. What are the alternatives?

A. There are other plans that are similar which may suit your preferences better (see below) and would lead to the similar results. However, if you continue doing as you are doing, nothing will change.

Q. What is not included on this plan?

A. Take Away foods, Fast Food, diet foods, processed foods, fizzy drinks whether sugar free or not, and foods from the gluten free section, apart from oats. We are advising you to stick to unprocessed foods, so no bread, cakes, pasta, pies or any food made with flour, and no sugar, apart from what is naturally present. Studies have shown that people on diet foods put on more weight than people eating non-diet foods, so they are best avoided. Potatoes and sweet fruit are also not on the plan. Fruit is much reduced to two pieces a week.

Q. I thought fruit was really healthy. Why do I have to stick to 2 pieces a week?

Fruit also raises your blood glucose significantly. For this reason it is best regarded as a treat. Remember that this is a guideline, so aim for twice a week, or a small quantity each day.

Q. That makes me think of the 5 a day rule. What about the famous 5 a day?

A. 5 vegetables are very much better as they do not cause the same rise in your blood glucose.

Q. It sounds expensive. Is it expensive?

A. It doesn’t have to be expensive. This plan gradually retrains your appetite so you eat less food, which costs you less. Also, you do not need a great quantity of meat per meal- 3 ounces should be enough. You will probably buy little and often, as fresh food goes off more quickly and so have less waste too. Q. Is it the same as the Atkins diet?

A. No, although the principle of “good fat” is the same. This plan is high in good fat, medium in protein and low in carbohydrate. If you also consider you will be doing it 90% of the time it is quite flexible.

Q. I am vegetarian/ vegan. Can I follow this diet?

A. Yes. Vegetarians should have no problem. There is a section giving advice to Vegans on the website mentioned above. The main advice is to completely cut out the refined carbohydrates.

Q. I am diabetic. Can I follow this diet?

A. Yes. If you are not insulin dependent it should be straightforward. If you are insulin dependent you should consult your doctor for advice on your insulin requirements once following the new plan. In general, you cut your carbs and cut your insulin gradually and you may end up on a third to half your original insulin requirements once you have got your carbs right down.

Q. Can anyone follow it e.g. children, the elderly

A. Yes. There is a good book for families called Low Carb Living for families as mentioned above.

Q. Is 30 minutes exercise an essential part of the plan?

Exercise is good for you but it is not necessary for weight loss. You certainly do not need to overdo it, and a taxing exercise schedule is not necessary. Exercise as much as you can within your capabilities, even if it is just chair-based exercise.

Q. Why don’t the government/ department of health/ Diabetes UK recommend this plan?

A. That is a good question. It does take time for new ideas to become main stream.

Q. I have certain food intolerances – can I follow this plan and leave out the food I am intolerant of?

A. Of course. The plan is naturally gluten free, wheat free and low in FODMAPs which can be good for people who have symptoms of food intolerance. Look up FODMAPs/IBS on Google for details if you have been diagnosed as having IBS.

Q. How will the diet affect me generally?

A. Many people notice they feel healthier, they have better concentration, their skin is better, and often joint pains are reduced or go away. It has been claimed that many minor mental health problems resolve as well. However, on these points you will have to see how it works for you and let us know.

Q. How can I break my carbohydrate habits? I think I’m addicted to sugar/bread/a nice glass of wine (or three)

A. Here are some suggestions 1. Cold Turkey 2. Gradual withdrawal 3. Mindfulness, an 8 week course. 4. Yoga 5. Any number of books of people who have done it e.g. on Amazon “How I gave up sugar and you can too”.

Q. Any other questions?

A. If you have lots of questions, it is probably best to read one of the books listed above to gain a greater understanding of the reasoning behind our recommendations. However, please do ask Dr McCormack or Dr Iles if you have a specific question.

Dr J McCormack and Dr Iles Padgate Medical Centre October 2014