Notes From Your Doctor

Click on the Notes From Your Doctor Topic below to expand and read the section.

General

Setting a SMART Goal

Summary & Suggestions

SMART is an acronym we can use when setting goals so we can increase our chances of achieving them. Rather than setting goals that are vague and hard to define, SMART goals are intended to be:

S = Specific
M = Measurable
A = Achievable
R = Relevant
T = Timed

A SPECIFIC goal is one that states exactly what/when/where/how, for how long and with who you will do what you want to do. A MEASURABLE goal is one that you can objectively measure and track so you can see your progress. An ACHIEVABLE goal is something that you can see yourself doing. A RELEVANT goal is one that will help you move in the direction you want to go… To be more fit? To have a healthier diet? A TIMED goal is one that lasts for a specific amount of time

For example, many of us have set New Years Resolutions at some point in our lives. Most of the time, these resolutions are very broad, vague, and difficult to assess for success. Things like:

“I will eat better”
“I will exercise more”
“I will take more time for myself”.

While these are all noble goals and worth working toward, how do we know if we have accomplished these goals? Perhaps one of the reasons most of us give up on our resolutions within the first few months is because we have no way of knowing how we are doing?

EXAMPLES OF SMART GOALS

Let’s turn those resolutions into SMART goals so we can see what the differences are.

“I will eat better” can become:

“I will add one serving of berries for breakfast and one serving of vegetables for supper. (SPECIFIC & MEASURABLE). I will do this 3 days/ week, on days that I don’t have to work. (ACHIEVABLE). I will do this for 1 month and then re-assess” (TIMED). This goal is relevant because it will moves me in the direction of a healthier diet. (RELEVANT)

“I will exercise more” can look like:

“I will go for a 30 minute walk every Monday, Wednesday & Friday during my lunch break. (SPECIFIC & MEASURABLE) I have a friend who would go with me, and we can go to the indoor track when the weather is bad. (ACHIEVABLE). I will do this for one month and then re-assess. (TIMED). This is relevant because it will help me increase your exercise. (RELEVANT).

“I will take more time for myself” can be clarified as:

“I will join a 1 hour book club on Tuesday & Thursday evenings (SPECIFIC & MEASURABLE) when my mom looks after my kids. (ACHIEVABLE). I will do this for three months while the class is running and then re-assess. (TIMED). This is relevant if it helps me feel better, more relaxed after I do it (RELEVANT).

KEYS TO SUCCESS

It is easy to see how the SMART goals might be easier to act on and accomplish than the New Year’s Resolutions.

Here are some tips for success:

Make your goals as specific as possible! This leaves little doubt about what has to be done and when. Set the days of the week, the times in the day, where, for how long and with whom you will do the activity. Put it on your schedule and have it become part of your plans for the day.

Choose a goal that you think you will be able to accomplish. You can push yourself a little out of your comfort zone, but not so much that you will be too intimidated to get going, or will have trouble keeping up. For example, choosing to go from not exercising at all to working out every day may be setting yourself up for failure. When/if you miss a day, you may feel like you’ve failed, and may be tempted to give up. But if you set your goal of working out 3 days/week, you are more likely to manage that, and will feel better about sticking to your plan.

Prepare whatever you may need in advance so you have fewer reasons not to do it. This might mean:

– having your gym bag/workout clothes/sneakers ready the day before
– meal prepping on the weekend for the healthy lunches you want to bring to work

Other suggestions to help you along your journey include:

– Know your WHY. One of the most important parts about setting a goal is knowing WHY you are doing it. Do you want to be healthier so you can:
– Be around to see your kids get married?
– Go for a hike with your grandkids?
– Be able to go dancing without being short of breath?
– Run 5km?
– Get off your blood pressure medication?

Avoid having heart problems that run in your family? Once you known you WHY, can you put a reminder of that WHY where you will see it every day? (Maybe in many places?) Can you put a photo of your kids on the fridge? The date for your grandchild’s graduation? The schedule for the community dances? It is important that you keep your WHY in mind. This will help you stay dedicated when your motivation may be lacking.

Identify challenges you might face & come up with solutions. For example, if you know you have some busy days in your week, can you plan to exercise in the morning or at lunch? Can you prep the food you will need for that day so you are not stuck grabbing whatever is quick and easy (and usually unhealthy?). If you are going out to eat, can you check the menu beforehand so you can see what the healthiest options are?

Monitor your progress. This could be in a journal or calendar, on a smart watch or fit bit, etc. When we keep track of how/what we do, we tend to be more motivated to accomplish our goals

Recruit a support team. Let others know what your goals are and see if anyone wants to join you. We would love to know about any changes you are making to become healthier, stronger and happier! Let us cheer you on!

Celebrate your success! Making sustainable lifestyle change is much easier if we break it down into small, manageable steps. Be proud of the steps you are taking to lead a healthier life, and build upon your successes!

If you are not sure how to set a SMART goal, come see us so we can help set you up for success!

Nutrition

Food Groups: Nutrition Labels & Ingredients Lists
Summary & Suggestions
Ignore claims on the front of packages

Use these TOP 6 THINGS TO LOOK FOR on ingredient lists:

NUMBER OF INGREDIENTS: Usually the fewer the better.

WHOLE FOODS: Look for “whole” foods as the first ingredient.

WHAT IS THAT?: Avoid products that contain ingredients you don’t recognize or don’t have in your kitchen.

SUGAR: Look for items with no sugar added or ones that have sugar low on the list of ingredients.

SALT: Same as sugar, look for no salt added, or have salt low on the list.

FAT: Avoid any product with “partially hydrogenated” oils (trans fats). Any added fat should be near the bottom of the list

Top 6 Things To Look For On The Nutrition Label:

SERVING SIZE: What is the serving size? The nutrient amounts that follow tell us how much of each nutrient is found in that amount of the food.

CALORIES

FAT: Note that there will usually be three numbers here.

TOTAL FAT: (should be less than 30% of total calories)

SATURATED FAT: (should be less than 10% of total calories)

TRANS FAT: should be avoided.

FIBER: Daily recommendations are for 14g/1000calories, or 28g/day for woman and 35g/day for men.

SUGAR: Remember that we should be consuming less than 10% of calories from ADDED sugars

SODIUM: Remember that the day limit should be less than 2000mg of sodium.

Learn how to calculate what percentage of the food product is made up of fat so you can easily stay within dietary guidelines.
GENERAL SUGGESTIONSS
With so many products available in supermarkets these days, choosing healthy options can be daunting. So much so, that people often give up, and just “pick something”. I’d like to try and simplify things by giving you a few tips on what to look for on a package to help in our decision making.

My first suggestion would be to have a lot of our food be the kind that don’t come with labels and ingredient lists. Foods like fruits, vegetables, whole grains, dried beans and peas, nuts and seeds. Buying from local farmer’s markets can be a great place to start. Shopping the periphery if the supermarkets is also a good idea most of the highly processed foods are in the aisles in the middle (except for the frozen section which does contain a lot of premade foods).

When examining package information, keep in mind the following recommendations for healthy eating:

FAT

Less than 30% calories from fat

Less than 10% calories from saturated fat

0 calories from saturated fat

PROTEIN

1525% calories from protein (or 0.81.5mg/kg/day)

SODIUM

Less than 15002300mg of sodium/day

SUGAR

Less than 10% of calories from ADDED sugar*

FIBER

Aim for a MINIMIM of 14g per 1000 calories OR 25g/day for women and 38g/day for men

*Note that the recommendations for sugar are for ADDED sugar, not sugars naturally found in fruits, vegetables, beans etc.

It is important to know that these recommendations may change for specific populations (people with certain medical conditions, pregnant or breastfeeding women, athletes, children, the elderly etc). If you are unsure what your needs are, come see us so we can help you find out!
IGNORE CLAIMS ON THE FRONT OF THE PACKAGE

These claims are generally there to grab our attention and encourage us to buy the product, but they can be misleading. They do not indicate that a product is nutritious or a healthy choice. Have a look at the tables below for examples of how front package claims can be misleading.
(https://fabdelta.com/food-labels-made-simple-a-practicalguide-to-better-choices/)

READ THE INGREDIENT LIST
We can tell the difference between the quality of most processed foods if we look at the ingredients. Ingredients are listed in descending order of quantity- meaning that the first ingredients make up most of the food. (So if we are trying to avoid sugar, make sure there is no sugar added, or if there is, make sure it is as low on the list as possible).

Here are my TOP 6 THINGS TO LOOK FOR ON THE INGREDIENT LIST that can help us make better choices:

NUMBER OF INGREDIENTS: The fewer the ingredients the better.

“WHOLE” FOODS: Look for products that have “whole” or “sprouted” foods (i.e.“whole wheat” or “whole oats”) as the first ingredient.

WHAT IS THAT??: Products that include ingredients you don’t recognize or wouldn’t be found in an average kitchen should be avoided.

SUGAR: Sugar (or any forms of “sugar”): should either be absent or very low on the list of ingredients. Learn more at: Notes From Your Doctor: SUGAR”

SALT: Ideally no salt added. If there is salt, the further down on the list, the better. Get more information about salt at: “Notes From Your Doctor: SALT”

FAT: Any product with “partially hydrogenated” oils (trans fats) should be avoided. Also, items that have added fat near the top of the list may not be the best choice
READ THE NUTRITION LABEL
NUMBERS

Nutrition labels will tell us exactly how much of the major macronutrients are in each product. There will also usually be a list of some of the micronutrients. Let’s use a sample nutrition label below to see what to look for on the nutrition label

Just like for the ingredient list, here are my TOP 6 THINGS TO LOOK FOR ON THE NUTRITION LABEL:

SERVING SIZE: What is the serving size? The nutrient amounts that follow tell us how much of each nutrient is found in that amount of the food.

CALORIES

FAT: Note that there will usually be three numbers here. TOTAL FAT, SATURATED FAT and TRANS FAT.

FIBER: Daily recommendations are for 14g/1000calories, or 28g/day for woman and 35g/day for men

SUGAR: Remember that we should be consuming less than 10% of calories from ADDED sugars.

SODIUM: Remember that the day limit should be less than 2000mg sodium.

In our example, the serving size is 5 crackers, or 19 grams of crackers.
This means if we eat 5 crackers, we will get:

90 calories

3.5g of fat, 0.3g saturated fat, no trans fat

0g of fiber

2g of sugar

160mg of sodium/salt

On the other hand, if we eat 10 crackers (2 servings) we will get double the amount of all the nutrients. So that means 180 calories, 7g of fat (0.6 saturated), ) 0g of fiber, 4g of sugar and 320mg of sodium

This is why knowing the serving size is important! Most people do not eat “one serving size” of many foods, especially snack foods, pastas, rice, potatoes etc. By keeping in mind serving sizes, we are better able to estimate/calculate what we are taking in.

% DAILY VALUE

The % DAILY VALUE on the right tells us what percentage the RECOMMENDED DAILY VALUE of that nutrient is found in that one serving. As a general rule:

less than 5% is “a little “

more than 15% is “a lot”

One of the challenges with this value is that it is a percentage based on a 2000 calorie diet, which is not what we all eat. It can still be helpful at a glance to see if an item is high in a certain nutrient. These values can also be used to quickly compare the nutrient content of different foods.

% OF CALORIES

We often see guidelines for nutrients in “% of calories”. For example, if we are looking at recommendations for how much fat we should have in our diet, we may see “less than 30% of calories from fat” or “less than 10% calories from saturated fat”. But how do we figure this out from the nutrition label? This is actually pretty simple to calculate once we know how. After we have done it a few times, it becomes so much easier to interpret the numbers. Let’s see how it’s done!

CALCULATING % CALORIES FROM FAT:

What is the % of calories from fat in the crackers? First we need to remember how many calories per gram each macronutrient provides:

1 gram of carbohydrate = 4 calories
1 gram of protein = 4 calories
1 gram of fat = 9 calories
1 gram of alcohol = 7 calories

From there, we need to remember some basic math:

n our sample nutrition label, we see that there are 90 calories and 3.5g of fat in one serving. What percentage of the calories come from fat?

First let’s calculate how many calories come from fat: If 1g fat=9 calories, then 3.5g fat=3.5×9 calories/gram= 31.5 calories from fat in 1 serving of crackers. We now know that 31.5 of the 90 calories are coming from fat. What percentage is that? To get the answer, we divide the number of calories from fat by the total number of calories: 31.5/90=0.35 or 35% of the calories in the crackers come from fat.

This is a very useful calculation because we have learned that 35% of the calories in this food come form fat. If we are trying to limit fat intake to less than 30%, this food is too high. If we had only looked at the %DV, (shown as 5% (or low) on the label), we might be deceived into thinking this is a low fat food.

Let’s try to calculate the % of calories from saturated fat in the crackers. The label tells us that there are 90 calories and 0.3g of saturated fat in one serving.

First calculate how many calories come from saturated fat: If 1g of fat=9 calories, then 0.3g fat=0.3×9 calories/gram=2.7 calories from saturated fat in 1 serving of crackers.

We now know that 2.7 of the 90 calories are coming from saturated fat.

What percentage is that? To get the answer, we divide the number of calories from saturated fat by the total number of calories:

2.7/90=0.03 or 3% of the calories in the crackers come from saturated fat.

This tells us that the crackers have less than the maximum 10% calories from saturated fat.

Using % calories from fat (or protein, carbohydrate, etc) is an easy way to compare nutrient content in products without getting confused by serving sizes. It is also a helpful tool if you are trying to ensure you are not eating more than the recommended proportion/percentage of nutrients like fat.

Working Towards a Healthier Diet
Summary & Suggestions

Know where you are starting from with your diet.

Choose to either add healthy options or decrease unhealthy options at a pace that works for you.

Create a SMART goal & track your progress.

Stay active to encourage healthy eating.

Get enough sleep & manage stress to help you make healthier food choices.

Avoid risky substances which will make it harder for you to stick to your eating plan.

Eating (and cooking!) with others can help with healthier food choices and meal planning.

RECAP OF WHAT WE ARE WORKING TOWARDS

The American College of Lifestyle Medicine uses the infographic above to show that diet falls on a spectrum. ANY MOVEMENT from the Standard American Diet (SAD) shown on the left towards the Whole Food Plant Based (WFPB) diet on the right is an improvement!
HOW DO WE MAKE HEALTHY DIETARY CHANGES?

1) KNOW WHERE YOU ARE STARTING

The first step is to have a good look at what you are already eating so you know where you are starting from. For an accurate assessment of your current diet, a food journal would be a great idea.

1 – Keep a 3-7 DAY FOOD JOURNAL where you write down everything you eat/drink.

2 – Look at what you’ve eaten and decide which foods are promoting your health in the “EVERY DAY FOODS” group and which might be putting you at risk for disease in the “VERY RARELY FOODS” group.

3 – Highlight the health promoting foods in GREEN, and make the less healthy options RED. What is the predominant colour on your journal page? Is it mostly green? Mostly red? A combination of the two?

Have a look at the “Notes From Your Doctor: FOOD GROUPS” for more clarification on the different food groups, and examples of foods within each group. (If you’re not sure on how to do this – and you are a part of my family practice, please come see me – I’d love to help!)

2) CHOOSE A CHANGE YOU THINK YOU CAN ACCOMPLISH

Now you have an idea of where your eating pattern falls on the spectrum. Are there any ways you can move closer towards a Whole Food Plant Based Diet? There are two options you can use to move your diet towards the target.

1 – One option (maybe the easier option?) is to INCREASE intake of the “EVERY DAY FOODS” that are known to promote health (shown on the right in the above image). Are there any foods in the “EVERY DAY FOODS” group that you like? Can you incorporate more of those in your diet? (Can you make your journal page contain more green?)

Can you add a fruit to your breakfast?

Can you add a vegetable to your supper?

Can you add nuts to your snack?

Can you add beans, lentils or spinach to your soup?

2 – The other option is to DECREASE your exposure to the “VERY RARELY FOOD PRODUCTS” that have been shown to decrease health and longevity. (Shown on the left above). When starting dietary changes, the easiest way to decrease intake of these harmful products is to replace them with something that may be similar, but healthier. Are there any foods that you have marked RED that you would be willing to swap for a GREENER option?

Can whole-grain bread be used instead of white bread?

Can you make chilli with beans instead of beef?

Can you swap soda pop for sparkling water?

Can you have air-popped popcorn instead of chips?

For more swapping ideas, check out “Notes From Your Doctor: HEALTHY FOOD SWAPS”

FOOD FOR THOUGHT: “WITH WHAT” or “INSTEAD OF WHAT”

Keep in mind that how foods are prepared and what they are served with, may move them from one category to another. To explain this a little further, I’d like to introduce a concept that I am borrowing from Dr. Christopher Gardner, (Stanford Professor of Medicine, and one of the world’s leading researchers in human nutrition). When asked about whether a food is healthy or not, Dr. Gardner often uses the framework: “WITH WHAT?” or “INSTEAD OF WHAT?”.

So, “are eggs healthy?” …. ask: “With What?” Eggs that are fried in butter with bacon and cheese may not be the best choice. But if you scramble the eggs (without added fat) and add some peppers, tomatoes and spinach that turns into a different (healthier!) option altogether, doesn’t it?

Now, “are eggs healthy?”…. ask: “Instead of What?” Eggs…instead of a bowl of steel cut oats with some nuts, seeds and berries may not be the better choice. But if you have scrambled eggs instead of a bacon, ham and fries the eggs are a healthier option!

You can choose to go about making changes in small steps, medium steps, or big steps. You don’t have to make huge changes all at once to see benefit. In fact, we know that if we adopt changes slowly in a way that they can be more easily incorporated into our daily lives, they are more likely to continue and become a part of our lifestyle. Sustained healthy behaviours over time will give us the biggest health benefits down the road.

Small steps could include:

Adding one serving of fruit to your breakfast

Swapping one serving of soda pop per day with one glass of water

Changing white rice to wild rice

Changing white bread to whole grain/multi grain bread

Medium steps could include:

Cooking one more meal at home every week

Revamping one meal at a time, for example making your breakfasts contain healthier options

Making your own soup/pasta sauce instead of buying pre-made

Big steps could include:

Jumpstart programs

Programs like Veganuary

Cutting out processed/red meats altogether

3) CREATE A SMART GOAL

Once you have an idea of what you would like to change, create a SMART goal for the change you want to work on. See “Notes From Your Doctor: SETTING A SMART GOAL”

One of the most important parts about setting a goal is knowing WHY you are doing it. Do you want to be healthier so you can:

Be around to see your child get married?

Go for a hike with your grandchildren?

Be able to go dancing without being short of breath?

Run 5km?

Get off your blood pressure medication?

Avoid having heart problems that run in your family?

Once you known your “WHY?”, can you put a reminder of that WHY where you will see it every day? (Maybe in many places?) Can you put a photo of your child on the fridge? The date for your grandchild’s graduation? The schedule for the community dances? It is important that you keep your WHY in mind. This will help you stay dedicated when your motivation may be lacking.

4) TRACK YOUR PROGRESS

With any behaviour change/goal, I aways recommend having a way to keep track of what you do. A notebook, a small calendar… anything that works for you. It can be very helpful & motivating to see your progress!

Keep your book somewhere handy & visible. (It will serve as a reminder of your goal every time you see it!)

For every day that you meet your goal (say eating fruit with breakfast), put a mark on that day (a tick mark, a happy face, a heart, etc). When you look back after a few weeks, it will feel so good to see your success!

If you did not meet your goal one day, what happened? What went wrong? This is the other reason tracking is so important. To find out WHAT DIDN’T WORK SO YOU KNOW HOW TO DO BETTER. (We can learn more from what didn’t work than from what did!) For example, if you didn’t eat your fruit, was it because you didn’t have any in the house? (How can you fix that?) Was it because you ran out of time? (What can you do differently the next day?)

5) SHARE YOUR PLANS

Letting people in your life know what you are doing can be a great way to remain accountable. It can also be a way to find others who may want to join you in your healthy lifestyle change. We would love to know all about your goals and efforts to be the healthiest version of you! Please share your plans with us, we can help if needed, or we can be very enthusiastic cheerleaders!
TIPS AT THE GROCERY STORE

Look for most of your food in the produce section (or find fruits/ veggies in the freezer section for a cost effective alternative).

Buy dried beans and lentils for cost savings.

When buying pre-made/packaged products, ALWAYS READ THE INGREDIENT LIST.

Look for:

The order of ingredients. Ingredients are listed in order from the highest amount to the lowest amount in a product. So the first ingredients make up most of the product. Choose the product with the healthiest first ingredients.

As few ingredients as possible. Long ingredient lists may mean more processing.

Ingredients that you may have in your home (as opposed to a list of additives and chemicals that you don’t even recognize as food).

Look for low salt or no salt added options. This lets you be in control of how much salt (if any) you want to add. Avoid items that have:

Sugar (or some form of it) as one of the first 3 ingredients.

High Fructose Corn Syrup. This is a fancy name for an artificial sweetener that is widely used because it is cheap. Learn more at “Notes From Your Doctor: SUGAR”

Any “partially hydrogenated oil”. This is a Trans fat the worst type of fat that we can eat. Trans fats are associated with cardiovascular disease and cancers.

Be suspicious of:

Items that have health claims on the packaging. Often, when salt, sugar or fat is reduced in a pre-made food, companies will increase one of the other 2 to ‘maintain taste’. Do not get fooled by what package marketing read the ingredients!
PRACTICAL ADVICE FOR BUSY PEOPLE (… EVERYONE?)

Changing our eating patterns to healthier options can seem like a daunting task. It does take a lot more work to plan & cook meals than it takes to buy something pre-made at the grocery store. However, the time is an investment in our health. We are not just adding days to our lives, we are adding life to our days! The first few weeks/months of change are usually the hardest. This is when we are learning about different foods/ingredients and how to cook and combine them in tasty ways!

Here are a few things that I do in my house to make sure I have healthy options readily available when I am busy and need something quickly:

I use a recipe app to keep all my recipes together. The one I use is called “Recipe Keeper”. I can add recipes from websites or photos. The recipes can be sorted by the type of meal, but also by categories. I changed the categories to ingredients, so that if I have left over spinach one day, I can just type in “spinach” and all of my recipes with spinach will come up. The app will also let me make meal plans and create grocery shopping lists. It has simplified my life in the kitchen significantly! The link to the app I use is below. Note that there are many recipe apps available look around and find one that you like! https://apps.apple.com/ca/app/recipe-keeper/id974683711

On the weekend (or any day off), I try to pick one soup, one salad and one spread/dip/sandwich filling that I can make and have in the fridge for the week. I make sure my soups and salads have lots of vegetables and a bean/lentil/grain. My spread/sandwich filling/dip can be made of beans, chickpeas, tofu, mushrooms, etc.

If I’ve been too busy to pick recipes and cook them, my go to is to cook a batch of grains (bulgur is the easiest!), roast some chick peas & veggies (sweet potato, broccoli, cauliflower, carrots and onions) and make a dressing/sauce that I can use to combine them all into tasty meals later in the week.

Having cut up fruit/veggies ready to go in the fridge is also helpful. It is easy to grab some to add to a meal at home or on the go.

There are loads of resources on-line offering recipes and plant based eating tips. I have shared a few of my favourites below.

https://www.forksoverknives.com/

https://www.drveganblog.com/

https://nutritionfacts.org/recipes/
HOW CAN MY OTHER HABITS AFFECT MY EATING?

As we have seen in other sections, our habits tend to be interconnected. How we do with one tends to affect how we do with the other.

GET MOVING!

Being physically active improves sleep and mental health. When we are rested and feeling well, we are better able to make healthier food choices, and have more energy to plan, shop, prep and cook.

SLEEP WELL

Healthy sleep is linked with healthy eating: -Healthy sleep decreases cortisol. Cortisol is often called a stress hormone, and long term high levels have been linked to (among other things) overeating and obesity. -We also know that good sleep increases levels of LEPTIN, which is a hormone that tells us when we are full, so we are less likely to overeat. In fact, impaired sleep has been shown to decrease daytime LEPTIN levels, which can increase the amount we eat by up to 20%- most of the extra calories being high in fat and refined carbohydrates.

MANAGE STRESS

Emotional distress can make it more difficult for us to make healthy food choices. We are less likely to plan menus, buy groceries or meal prep. Sadly, eating unhealthy foods is also more likely to worsen our mental health, which means we eat more poorly, which makes us feel worse… on and on into a vicious downward spiral. If you are feeling anxious, depressed, or just don’t feel right, don’t ignore it. Talk to a health care professional and get the help you need!

AVOID RISKY SUBSTANCES

Just like being tired or stressed can make it harder to make good food choices, so can being under the influence. Limit your intake so that your judgement is not impaired. Note that alcohol also contains calories (7cal/ g alcohol), so keep that in mind.

SOCIAL CONNECTION

Eating with friends and family is a great way to connect and enjoy food together. Cooking together can also bring us closer. Having pot-luck dinners is a fun way to get together and share new recipes. Do you have any friends who would be interested in cooking or eating healthy meals?

OTHER FOOD FOR THOUGHT

Enjoy your food! Take time to sit and savour what you eat.

Chew. (Seems obvious, but we are often so busy, that even if we have the extra time, we are so used to rushing that we gulp our food down).

Cook at home more often, eat out less often.

Be aware of your eating patterns. If you know you are going to be in a situation where sticking to your goals will be a challenge, what can you do to increase your chances of success?

Be aware of food marketing.

“Breakfast like a king, lunch like a prince and supper like a pauper”. It can be healthful to eat your biggest meal in the morning and your smallest meal in the evening. This is usually the opposite of what a lot of us do in North America.

Taste changes over time. If you are moving from a diet high in processed foods with a lot of fat, sugar and/or salt, you may think food with less of these ingredients tastes bland at first. Give it time. Your taste buds will adapt. Once they are no longer bombarded with sugar, salt, and fat, they will become more attuned to the natural taste of foods. You will develop a newfound appreciation for the diverse and delicious flavors naturally found in foods! Be patient and look forward to all the new tastes you will experience.

Break the rules sometimes!

Food Groups: Every Day Foods, Sometimes Foods & Very Rarely Food Products
Summary & Suggestions
ALL fresh fruits, vegetables, whole grains, beans, lentils & peas, and MOST nuts & seeds are “EVERY DAY FOODS”

ALL pre-made foods, red & processed meats (and products that contain them), and ALL high fat dairy (and products made from them) are “VERY RARELY FOOD PRODUCTS”

Remember that not all products in each list is equally healthy or unhealthy. Use the tools we have learned to learn which items are more nutritious:

Read the Nutrition label

Read the Ingredients list

Apply the “WITH WHAT” or “INSTEAD OF WHAT” concepts when deciding if a food/meal is healthy.
Below are lists of food items that fall into the above categories. Sometimes it may be difficult to tell whether something is a “healthy option” or not. These are by no means comprehensive lists. I have them here because I have had many conversations with patients over the years and and am trying to provide a little guidance when there is confusion.

For the sake of completion, let’s remember that:

“Every Day Foods” are foods that have a broad base of evidence for being health-promoting.

“Very Rarely Food Products” are those that are widely known to be harmful and disease-promoting. This group includes almost ALL ULTRAPROCESSED FOODS. All COMMERCIALLY PREPARED breads, rolls, bagels, breakfast cereals, sweets, pizzas, frozen dinners, pop and candy fall into this category. For more information, check out: “Notes From Your Doctor: PROCESSED FOODS”

“Sometimes Foods” are those that are somewhere in the middle, with no clear evidence for or against.

To jog your memory about these groups, please see: “Notes From Your Doctor: WHAT DOES A HEALTHY DIET LOOK LIKE?”

“WITH WHAT” or “INSTEAD OF WHAT”

Keep in mind that how foods are prepared and what they are served with, may move them from one category to another. To explain this a little further, I’d like to introduce a concept that I am borrowing from Dr. Christopher Gardner, (Stanford Professor of Medicine, and one of the world’s leading researchers in human nutrition). When asked about whether a food is healthy or not, Dr. Gardner often uses the framework: “WITH WHAT?” or “INSTEAD OF WHAT?”.

So, “are granola bars healthy?” ….ask the question: “With What?” A granola bar with a coke and a bag if chips may not be the best option. But if you have a granola bar with an apple and some nuts, it becomes much more nutritious! (Let’s not forget that what the granola bar is made of is a huge factor- check the nutrition label and ingredients list so you can pick the healthiest granola bar that you would like!)

Now, “are granola bars health?”…. ask the question: “Instead of What?” A granola bar…instead of a fruit salad with nuts &seeds and berries- may not be the better choice. But if you have a granola bar instead of a a chocolate bar and cheesies- the granola bar is a healthier option!

WHAT WAS DONE TO THE FOOD BEFORE I BOUGHT IT?
One of the most important factors when deciding if a food product is healthful, may not be the actual food or the nutrients it originally contained, but what and how much, has been done to the food (and it’s corresponding nutrients) before we eat it. For example:

Eating a fresh apple will be better for your health than eating apple sauce.

Eating an orange will be better than drinking orange juice.

Eating beans that have been boiled is better than a can of beans that has added fat and sugar.

Eating plain yogurt that you top with fresh fruit is better than eating sweetened yogurt with proceed fruit.

Make sense?

One of the guiding principles would be to never choose highly processed goods over naturally occurring/lightly processed, or freshly prepared meals. For example, instead of a soft drink, Big Mac and cookies, try water, a bean burger and fruit. And if you really want the hamburger or cookies—make them at home! They will not only taste better, but they will also be better for you since you will know exactly what is in them and what is not (no industrial additives used to enhance taste, texture, appearance and shelf life).
EVERY DAY FOODS

This includes:

ALL FRESH FRUITS AND VEGETABLES
ALL WHOLE GRAINS
ALL BEANS, LENTILS & PEAS
MOST NUTS & SEEDS

(Keep in mind that these foods are high in calories, so eating them in moderation is best. Even if you are trying to watch your weight, you should still aim to include some of these into your diet on a regular basis!)

Some examples are included below:

FRUITS

Apples (many varieties!)
Apricots
Bananas
Blackberries
Blueberries
Boysenberries
Cantaloupe
Cherries
Clementines
Cranberries
Currants
Figs
Grapefruit
Grapes
Guava
Honeydew melon
Kiwi
Lemons
Limes
Mangos
Nectarines
Oranges
Papaya
Passion Fruit
Peaches
Pears
Persimmons
Pineapples
Plantain
Plums
Pomegranate
Quince
Raspberries
Rhubarb
Strawberries
Tangarines
Watermelon

VEGETABLES

Artichoke
Asparagus
Beets
Beet greens
Bell peppers (all colors!)
Bok choy
Broccoli
Broccoli rabe
Brussels sprouts
Cabbage (many colors/varieties)
Carrots
Cauliflower
Celery
Chili peppers
Cilantro
Collard greens
Corn
Cucumbers
Dandelion greens
Dill
Eggplant
Endive
Green beans
Green onions
Lettuce (many varieties!)
Jicama
Kale
Kolhrabi
Leaks
Lettuce (many varieties!)
Mushrooms (many types!)
Mustard greens
Okra
Onions
Parsley
Parsnips
Snow peas
Spinach
Swiss chard
Tomatoes
Zucchini
Watercress

WHOLE GRAINS

Barley
Buckwheat
Farrow
Millet
Oats
Quinoa
Rice (brown, wild- NOT WHITE)
Rye
BEANS & PEAS
Black beans
Black Eyed Peas
Butter beans
Chickpeas
Edamame (Soy beans)
kidney beans (many varieties)
Lentils
Lima beans
Navy beans
Peas
Pigeon peas
Pinto beans

WHOLE GRAINS

Almonds
Brazil nuts
Cashews
Chia seeds
Flaxseeds
Hazelnuts
Hemp hearts
Pecans
Pumpkin seeds
Sunflower seeds
Walnuts

VERY RARELY FOODS/ULTRA PROCESSED FOODS
This includes:

ALL premade foods.

ALL red/processed meat & products that contain them.

ALL high fat dairy & products that are made with them.

However, not everything on this list is equally healthy or unhealthy. Remember the tools we have learned to help us determine how nutritious an item is:

Read the nutrition label

Read the ingredients list

Apply the “WITH WHAT” or “INSTEAD OF WHAT” concepts above. For more information, check out: “Notes From Your Doctor: NUTRITION LABELS & INGREDIENT LISTS”

If you are looking for suggestions on how to swap out some of the items below for more healthy options, please see: “Notes From Your Doctor: FOOD SWAPS”

Lastly, if you really love something on this list, can you still enjoy it but eat it less frequently? Can you eat it with something from the EVERY DAY FOODS group to increase the nutritional value of your meal? Can you learn to make it at home?
BREAKFAST FOODS:

Sugary breakfast cereals (including granola and instant sweetened oatmeal)

White bread, white bagels, white pita, white English muffins, etc Pre-made breakfast sandwiches/burritos

Pre-made muffins, cinnamon rolls, donuts, danishes, rolls, biscuits

Granola bars

Frozen waffles/pancakes

Pop tarts/toaster strudels

Pancake mixes

Pre-made egg products

Bacon

Sausages

Pre-made hash browns

Flavored yogurt

Cottage cheese cups

Chocolate (or other flavoured) milk

Fruit drinks

Pre-made smoothies

Protein shakes

LUNCH oR SUPPER FOODS:

White bread products
Pre-packaged sandwiches/wraps
Deli meats/cold cuts/sandwich meats
Cheeses
Frozen meals
Pre-made: hamburgers, hot dogs, donairs, pizzas, chicken/fish sticks
Fried chicken
Fried fish
Plant-based meats
Plant-based burgers
French fries
Onion rings
Frozen appetizers
Instant/Ramen noodles
Packaged soups
Lunchables
Pre-packaged salads
Pre-cooked rotisserie chicken
Canned tuna or chicken
Soda pop
Energy drinks

CONDIMENTS, SAUCES, DIPS & DRESSINGS

Most of these would fall in this category, but not all: Check the nutrition label & ingredients list!

SNACKS oR TREATS

Chocolate bars
Candy
Chips, cheesies
Pretzels
Pre-packaged trail mix
Pre-popped popcorn
Crackers
Salted or flavoured nuts/seeds
Packaged cookies, bars, squares, donuts, pies, cakes
Jerky
Sausage or pepperoni sticks
Fast food burgers and fries
Flavored yogurt
Pudding cups
Fruit cups
Yogurt parfaits
Ice cream
Ice cream sandwiches
Frozen yogurt
Popsicles
Energy bars
TV dinners
Plant-based meats

SOMETIMES FOODS

Low-fat dairy

Eggs

Lean chicken

Fish

Processed Foods
Summary & Suggestions
“If it came from a plant, eat it; if it was made in a plant, don’t.” – Michael Pollen

Starting with a fresh food item, the more processing it undergoes, the less nutritious it becomes.

Use these TOP 6 THINGS TO LOOK FOR on ingredient lists:

NUMBER OF INGREDIENTS: Usually the fewer the better.

WHOLE FOODS: Look for “whole” foods as the first ingredient.

WHAT IS THAT?: Avoid products that contain ingredients you don’t recognize or don’t have in your kitchen.

SUGAR: Look for items with no sugar added or ones that have sugar low on the list of ingredients.

SALT: Same as sugar, look for no salt added, or have salt low on the list.

FAT: Avoid any product with “partially hydrogenated” oils (transfats). Any added fat should be near the bottom of the list

Processing is not the only factor in determining how healthful a food is: even unprocessed animal products can increase risk for many diseases.
WHAT ARE PROCESSED FOODS?

Food can be processed for a number of reasons. Producers might want to increase how long it lasts, change its texture or flavor, or even combine peel, chop, cook or even season food, it is by definition processed. Such minimal processing can be relatively harmless and even necessary to make some of our foods edible. However, the more a food is processed, the more likely its nutritional value may have decreased.

Most “ultra processed foods” are barely even foods. This is why I referred to them above as “food products”. An even more precise term (which I first learned from author Michael Pollen) is “edible food-like substances”. These items often do not contain much actual food. They are products made from cheap sources of dietary energy with additives and preservatives, and sometimes added nutrients.

To make matters worse, these unhealthy products are formulated to be hyper palatable (meaning very tasty), visually appealing, and convenient to consume any time, anywhere. They are actually often designed to make us eat more and more. Processed foods have become a regular and increasing parts of our diets. This is a problem because highly processed food products are not nutritious options. They are high in all the elements that increase risk for disease: empty calories, unhealthy (saturated/trans) fats, processed carbohydrates, added sugars and salt. They are also low in the health promoting elements like healthy protein, complex carbohydrates, dietary fiber and nutrients

CLASSIFICATION OF PROCESSED FOODS

“If it came from a plant, eat it; if it was made in a plant, don’t”
-Michael Pollan

Here is a handy table taken from EatRightPro, Academy of Nutrition and
Dietetics:

https://www.eatrightpro.org/news-center/practice-trends/examining-the-nova-food-classification-system-and-healthfulness-of-ultra-processed-foods

Learn more about the classification of processed foods here: https://pmc.ncbi.nlm.nih.gov/articles/PMC10261019/

The more a food is altered from its original state, the more processed it is. As a general rule, the more processing a food has undergone, the less healthful it becomes. Note that removing or adding something to a food are forms of processing. Ingredient lists can help us see what was added to a food.

For example:
MEAT: Fresh meat from the butcher that has not been “brined” or “seasoned” is a healthier option than the same piece of meat that has been brined/salted. But, that same seasoned piece of meat from the butcher is a healthier option than chicken nuggets, bacon or deli-slices, all of which have been highly processed/altered

FRUITS & VEGETABLES: Fresh or frozen fruits/vegetables will be the best option when possible, followed by canned. This is generally because canned food needs to have a preservative added to keep it from going bad. (One of the most common preservatives is EDTA, which has been declared safe for consumption by Health Canada, however it is still a chemical additive). Note that not all canned items are equal. Some canned items will have salt, sugar or fat/oils added, which makes them more processed/less healthful than the options that do not have these added ingredients. Fruit or vegetable purees, leathers and bars are often more processed than canned fruits or veggies. Reading the ingredients list is an effective way to learn what has been added to a product.

BREADS & CEREALS: Not all cereals are equal. Steel cut or rolled oats have been minimally changed before you buy them. Quick cooking oats have been altered for our convenience. Sweetened instant oats are even more processed.

Similarly, the nutritional value of other cereals will vary depending on their processing/ingredients

Here are a couple of examples:

The photo on the left has two packages of oats. One only has steel cut oats in the ingredient list, wheres the other has a list that includes sugar as the second ingredient. Which would you hink is healthier?

On the right, we have two breakfast cereals. Look closely at the two lists of ingredients. Which would be the better option? (Answer: the 2 packages with the least ingredients are both healthier choices!).

YOGURT: Note that plain unsweetened yogurt is listed in Group 1, but flavoured yogurt drops all the way dow to Group 4. Buying plain yogurt and adding your own fruit/nuts/seeds would be a healthier option.

INGREDIENT LISTS HELP – USE THEM!
We can tell the difference between the quality of most of these items if we look at the ingredients. Ingredients are listed in descending order of quantity- meaning that the first ingredients make up most of the food. Here are my TOP 6 THINGS TO LOOK FOR on the ingredient list which can help you make better choices:

NUMBER OF INGREDIENTS: The fewer the ingredients the better.

“WHOLE” FOODS: Look for products that have “whole” or “sprouted” foods (i.e.“whole wheat” or “whole oats”) as the first ingredient.

WHAT IS THAT??: Products that include ingredients you don’t recognize or wouldn’t be found in an average kitchen should be avoided.

SUGAR: Sugar (or any forms of “sugar”) should either be absent or low on the list of ingredients. Learn more at: Notes From Your Doctor: SUGAR”

SALT: Ideally no salt added. If there is salt, the further down on the list, the better. For more about salt, check out “Notes From Your Doctor: SALT”

FAT: Any product with “partially hydrogenated” oils (transfats) should be avoided. Also, items that have added fat near the top of the list may not be the best choice.

Learn more about the amount of sugar, salt and fat by looking at the nutrition label. For more information, check out: “Notes From Your Doctor: NUTRITION LABELS & INGREDIENT LISTS”
Let’s use these 6 THINGS TO LOOK FOR in another example. Look at the photo above which has the ingredients for two types of commercially made bread. Which do you think is less processed/healthier? The list of ingredients on the TOP or the BOTTOM?

Starting from the beginning:

1- NUMBER OF INGREDIENTS: They both have a long list of ingredients.

2- “WHOLE” FOODS: The first has quite a few sprouted/whole grains and seeds at the top of the list. The second has “enriched wheat flour” listed first. “Enriched” can’t be bad, right? And it says “wheat”, which makes us think it might be good for us. “Enriched wheat flour” just means the wheat was processed, (which removes nutrients, fiber and protein), but then had some of the nutrients added back. Whenever you see this, you can be sure it is not a “whole grain” product. To learn more, please see: “Notes From Your Doctor: WHOLE GRAINS”.

3- WHAT IS THAT??: The first is mostly a list of different grains and seeds until the end, where we see “vital wheat gluten” and “enzymes”. The second has more ingredients that we may not recognize or have in our kitchens: “amylase”, “Acetylated tartaric acid testers of mono and diglycerides”, “calcium carbonate”, “Xylanase”, “calcium propionate”, “vegetable mono and diglycerides” “guar gum”. It is reassuring that these are listed low on the ingredient list, however they do indicate that this is a significantly processed food item.

4- SUGAR: The first has sugar as one of the last ingredients. The second has sugars listed much higher up on the list, meaning there is more sugar in that item

5-Salt: The first has sea salt as the third to last ingredient. The second has salt listed in the middle.

6-FAT?: Neither have any hydrogenated oils or trans fats. The first has no oil/fat added. The second has vegetable oil listed in the middle

So which these bread products do you thinks is the healthier option? (Answer: The first one!)

IS IT REALLY THAT SIMPLE? NO.

Processing is just one of the factors to consider when determining the healthfulness (or lack thereof) of a food. Are the least processed foods ALWAYS the healthiest choices? Not really. As with most rules, there are some exceptions to keep in mind.

ANIMAL FOODS (particularly red & processed meats and high fat dairy) ARE KNOWN TO HAVE NEGATIVE HEALTH EFFECTS, especially if eaten in excess without other whole foods (like fruits, vegetables, beans, lentils and whole grains) in the diet. Just because a steak hasn’t been somehow altered, thereby being unprocessed, doesn’t make it a healthy choice… but it may make it healthier than a frozen dinner of beef skewers in BBQ sauce. (This brings us back to Dr. Gardner’s “INSTEAD OF WHAT?” concept when determining if a food is “healthy” or not. See “Notes From Your Doctor: WORKING TOWARDS A HEALTHIER DIET”)

On the other hand, WHOLE FOODS (like fruits, vegetables, beans, legumes, whole grains, nuts & seeds) ARE KNOWN TO BE HEALTH PROMOTING. However, if we coat healthy sweet potato slices in salty batter, fry it in butter, then serve it with a fatty ranch dip… it is hardly a health promoting option. (BUT, if we were to use the “INSTEAD OF WHAT” concept above, battered sweet potato fries would be a healthier choice than battered fried cheese sticks. Get it?)

For example:
MEAT & CANNED VEGETABLES: Meat is listed in Group 1 above, which means it is unprocessed or minimally processed. Canned vegetables are listed in group 3, as processed foods. If we were ONLY looking at processing, we would think that meat is a better option than canned vegetables. However, there are other things to consider. Meat is known to be high in fat and other pro-inflammatory compounds that are linked to chronic disease. Vegetables on the other hand are high in fiber and other health promoting nutrients. So even though the meat may be less processed, the canned vegetables are a healthier option.

So when we are trying to decide how healthy a food product is, consider
2 questions:

1 – What is the initial food product?
Is it a health promoting whole food (like a fruit, vegetable, whole grain, bean, lentil, nut or seed)? Is it a product that is associated with disease like red meat or high fat dairy?

2 – What has been done to the food (and it’s corresponding nutrients) between when it was grown and when you are buying it?
What has been taken away? What has been added?

One of the guiding principles would be to never choose highly processed goods over naturally occurring/lightly processed, or freshly prepared meals. For example, instead of a soft drink, Big Mac and cookies, try water, a veggie burger and fruit. And if you really want the beef burger or cookies- make them at home! They will not only taste better, but they will also be better for you since you will know exactly what is in them and what is not (no industrial additives used to enhance taste, texture, appearance and shelf life).

EXAMPLES OF PROCESSED FOODS
Almost ALL commercially made pre-packaged foods are processed. I’ve listed the common ones I see below. Keep in mind that within processed foods, some can be healthier than others, and looking at the ingredient list and nutrition labels is a great way to help tell the difference.

PACKAGED BREAD PRODUCTS: WHITE breads, rolls, bagels, pitas, English muffins

PACKAGED BREAKFAST FOODS: cereals, granola, sweetened oats, waffles, bacon, breakfast sausages, breakfast sandwiches, flavoured yogurt, yogurt tubes

MEAT PRODUCTS: deli slices/lunch meats/cold cuts, bacon, sausages, hamburgers, hot dogs, chicken wings, chicken nuggets, fish sticks, canned meats

PACKAD FROZEN MEALS: pizzas, frozen dinners

PACKAGED SALTY SNACKS: chips, crackers, popcorn, salted nuts

PACKAGED SWEETS: muffins, cookies, bars, pies, cakes, ice cream, frozen yogurt, popsicles

DRINKS: chocolate milk, fruit or vegetable drinks, soda pop

ALL FAST FOOD: burgers, hot dogs, fries, onion rings, pizzas

Remember:

1-Making any of the above at home will instantly make it a better option than buying it pre-made.

“Eat all the junk food you want- as long as you cook it yourself” – Michale Pollan

2-If we really crave one of the highly processed or “less healthy” items above, we can increase the nutrient value of the meal by adding some whole foods like fruits, vegetables, whole grains, beans or legumes!
A NOTE ABOUT TASTE

When we first start moving away from processed foods (that are high in sugar, salt and fat), to eating whole foods with natural herbs and spices, (with less sugar, salt and fat) it may take a while of our taste buds to adjust. The less salty/fatty/sugary stuff may not taste as good. Our taste buds have been bombarded with these intense tastes and it may take a bit of time before they can appreciate the wonderful natural flavours of more subtle herbs and spices. (Similar to coming inside from a bright sunny day… at first everything seems dim and dull, but after a little while our eyes adjust and we can see clearly again!) So when changing our diets to include healthier, less processed options, let’s be patient!

Whole Grains
Summary & Suggestions
Whole grains provide more vitamins, minerals, fiber and protein than their processed counterparts.

Since whole grains retain these nutrients, they take longer to digest, resulting in lower and slower rises in blood sugar and insulin. They have a lower Glycemic Index.

Check the ingredients list to see if a product is made of whole grains.

The first ingredient should begin with “whole…” (as in ‘whole wheat’ or ‘whole oats’).

If the first ingredient says “refined” or “enriched”, it is not a “whole grain.”

Look for ways to add whole grains to your diet:

Switch white rice to brown or wild rice

Switch white rice to quinoa or bulgur

Switch potatoes to a whole grain

Switch pasta to a whole grain
IS A WHOLE GRAIN?

All grains start out as whole grains. A whole grain is the entire seed (or kernel) of a plant which is made up of three main parts.

The Bran: which is the outer layer and contains a lot of anti-oxidants, B vitamins, and fiber.

The Germ: which is the inner core, also packed with B vitamins, protein, minerals, and healthy fats.

The Endosperm: which is the food supply for the germ, this middle layer is the largest part of the which has starchy carbohydrates and proteins.

WHAT IS A REFINED OR ENRICHED GRAIN?

When a grain is refined (or processed), the bran and the germ are usually stripped away which means it loses protein, fiber and many nutrients, leading to a LOW QUALITY carbohydrate. To make up for the nutrients lost in refining, many refined grains have a small portion of their lost nutrients added back. These are called ENRICHED.

https://wholegrainscouncil.org/sites/default/files/atoms/files/WGCWhatIsWholeGrain.pdf

This table illustrates the difference in nutrients between whole, refined and enriched flour. Some nutrients are added in excess of what was in the original grain: vitamins B1, B2, B3, iron and folate. Some others are left in short supply: vitamin E, B6, Magnesium, fiber, potassium and protein.

WHY ARE WHOLE GRAINS IMPORTANT?

Aside from the fact that REFINED/PROCESSED GRAINS contain less of the healthy nutrients we need, they are also metabolized differently in our bodies. Refined (or processed) grains have already been partially digested (processed). We don’t have to break down the whole kernel, it has already been done. We don’t have to breakdown the fiber, most of it is already gone. There is less protein to breakdown too. This processing means that refined/enriched grain products are digested/metabolized faster, so our blood sugar and insulin levels will rise higher and faster. (They have a higher Glycemic Index). We will feel hungry more quickly. The lack of fiber does nothing to help our cholesterol or microbiome.

On the other hand, WHOLE GRAINS increase gastrointestinal motility, decrease cholesterol, stabilize blood glucose, increase feelings of satiety, decrease cravings, decrease inflammation, support a healthy microbiome, and decrease risks of chronic conditions like diabetes, heart disease, obesity and colon cancer.

HOW CAN WE FIND WHOLE GRAIN PRODUCTS?

We can find dried, packaged whole grains at the grocery store or online.

When looking for pre-made products like bread, it is very important to CHECK THE INGREDIENTS:

The first ingredient should begin with “Whole…”, if it begins with “Enriched” or “refined” then we know the product has been primarily made from a processed/refined grain and not from a whole grain.
(Note that some items have brown coloring added to make them look like it’s a healthier choice, but does not mean they are whole grain products).

To identify a whole grain product in Canada, the first ingredient should say “Whole grain….” (followed by whatever the grain is). For example, “whole grain oats” or “whole grain wheat”.

For example, the first two images shown are whole grain products. The last 2, are not.

To learn more, visit: https://wholegrainscouncil.org/whole-grains-101/identifying-whole-grainproducts

EXAMPLES OF WHOLE GRAINS

Different grains contain different nutrient profiles, so it is a good idea to try and eat a variety of whole grains. Here are a few examples of whole grains that can be used in cooking:

wheat

quinoa

rice

bulgur

oats*

millet

barley*

buckwheat

farro

corn

*Oats and barley are especially good for lowering cholesterol.

EASY WAYS TO ADD WHOLE GRAINS

One of the easiest ways to add a healthier food item to our diets, is to find something similar and swap it out. For example, we can:

switch white rice to brown or wild rice

switch white rice to quinoa or bulgur

switch potatoes to a whole grain

switch pasta to a whole grain

For me, the easiest whole grain to prepare is bulgur. Bulgur has a rich, nutty flavour and does not really require cooking. Just soak in boiling water/broth and its good to go! I love to make a batch of bulgur and keep it in the fridge for easy add ons to salads or as a side dish. This is how I make it:

EASY BULGUR RECIPE:

1 cup bulgur (rinsed)

1.5 cups boiling water/broth

Combine in a medium bowl.

Check out “MY FAVORITE RECIPES” for more options, or look on-line for many other tasty recipes!

Carbohydrates
Summary & Suggestions
Eat lots of: COMPLEX (WHOLE) CARBOHYDRATES

Found in whole or minimally processed foods like beans, lentils, peas, whole grains, or fresh fruits & vegetables.

Come packaged with lots of fiber, vitamins and minerals.

Tend to lead to a lower rise in blood sugar (lower glycemic index) compared to simple carbs.

Very healthy!

Limit: SIMPLE (REFINED) CARBOHYDRATES:

Found in WHITE products (white flour, white bread, white rice, white pasta), most sugary treats, salty snacks and processed foods. Have either been processed and separated from their whole food source, or they have been made in a lab (like high fructose corn syrup).

Do not contain the nutrients they would come with if eaten as part of a whole food, which is why they are often called “empty calories”.

Often lead to blood sugar going up faster and higher (higher glycemic index) than it would if eaten as part of a whole food. Not healthy options!

If there is a simple carb food that is your favourite thing in the world, try adding one of the following to decrease decrease the impact on your blood sugar/insulin:

some protein (i.e. nuts, soy, beans, lentils) some fiber (i.e nuts, beans, lentils, soy, fish)

a healthy fat (i.e. nuts or nut butter, avocado, soy)
Carbohydrates (or “carbs”) seems to be a bad word when talking about diet these days. It is probably the most misunderstood (and overused) word on social media when talking about nutrition. Let’s set the record straight. Not all carbohydrates are created equal! In fact, complex carbohydrates that are naturally occurring in fruits, vegetables, beans, whole grains, nuts and seeds are very nutritious and should make up the the largest part of a healthy diet. On the other hand, carbs found in white breads, pastries, french fries, sugary drinks and other processed foods are among the most unhealthy things we could eat. Why is that?

Understanding How Carbohydrates Are Metabolized: What Do Carbs Do In Our Bodies?

In order to understand what makes a carbohydrate heathy or unhealthy,let’s go through how these nutrients affect our bodies.

When we eat carbohydrates, the digestible ones are broken down intosugar which then enters the blood stream.

When blood sugar rises, our pancreas secretes insulin (a hormone that tells our cells to absorb the sugar), which makes blood sugar levels fall.

When blood sugar falls, our pancreas secretes glucagon (a hormone that tells the liver to release stored sugar), to prevent blood sugar from falling too low.

The balance between insulin and glucagon tries to ensure that our blood sugar levels remain relatively stable, making sure we have a steady supply of energy.

This is especially important for our brain cells which rely on blood glucose as their primary source of energy.

**It is important to understand that it is not only sugar (or sweet foods) that become sugar (glucose) in our blood stream. Even salty foods like white bread, potatoes, chips and crackers become sugar our bodies!

WHY IS IT IMPORTANT TO KEEP BLOOD SUGAR AND INSULIN FROM
SPIKING?

If blood sugar goes up too high too often, it can damage insulin receptors on our cells making them less effective. One if the ways this can happen is that high blood sugar leads to accumulation of fat in tissues like the liver and skeletal muscle. The extra fat interferes with insulin signals and insulin This can lead to “insulin resistance”, which means that the insulin we have does not work properly and our cells do not absorb sugar from our blood as they should. This can lead to diabetes.

Since high blood sugar stimulates the pancreas to release insulin, it is possible that excessively high sugars can eventually “burn out” the pancreas, meaning it can no longer keep up with the high insulin demands. This can lead to diabetes requiring treatment with insulin.

Besides leading to diabetes, high sugars can lead to heart disease, stroke, kidney problems, nerve damage (neuropathy), vision loss/blindness,and obesity.

TYPES OF CARBOHYDRATES

Different types of carbohydrates take varying amounts of time/energy for our bodies to digest and enter the blood stream.

Look at the chart below, from the Canadian Sugar Institute, where we see the different types of carbohydrates according to their chemical structures.

Courtesy: https://sugar.ca/sugar-basics/carbohydrate-and-sugars-terminology

Carbohydrates are broadly classified in two types: simple/refined carbohydrates and complex/whole carbohydrates.

The SIMPLE (REFINED) carbohydrates (on the left) are made up of one sugar molecule (monosaccharide) or two sugar molecules (disaccharides). Due to their simple structure, these simple carbs are easily digested and enter the blood steam quickly, causing a rapid rise in blood sugar and insulin release. Examples of these simple carbohydrates include:

WHITE products (white flour, white bread, white rice, white pasta), most sugary treats, salty snacks and processed foods.

The COMPLEX (WHOLE) carbohydrates (on the right) are made of three or more sugars linked together (oligosaccharides or polysaccharides).

These complex carbohydrate foods usually contain fiber and some protein, making them take longer to digest, which means there is a slower rise in blood sugar. The slower rise in sugar then results in a slower & lower insulin spike.
Examples of complex carbohydrates include:

whole or minimally processed foods like beans, lentils, whole grains, or fresh fruits & vegetables.

The infographic below from the American College of Lifestyle medicine serves as a good illustration of the different types of carbs.

GLYCEMIC INDEX (GI)

To understand how different foods affect blood sugar, we can use the GLYCEMIC INDEX, which ranks foods based on how quickly and how much they raise blood sugar. The scale goes from 0-100.

LOW GI is 55 or less

MEDIUM GI is 56-69

HIGH GI is 70-100

Simple/refined carbs, like white bread, potatoes or sweets (the items on the right of the image above) lead to a fast & high rise in blood sugar. They would have a high glycemic index index.

Complex/whole carbs (shown on the left in the image above), have slower & lower rise in blood sugar. They would have a lower glycemic index.

WHAT DETERMINES THE GLYCEMIC INDEX OF A FOOD?

There are many factors that determine the glycemic index of a food.

Generally, foods that are easier and faster to digest, will have a higher GI. Those that take longer, will have a lower GI.

Refined grains that have had their bran and germ removed will have a higher GI than a whole grain. (They have already been partially “digested” before we even put them in our mouths!) Along the same lines, finely ground grains will have a higher GI than coarse grains. This means that whole grains like bulgur or oats may be healthier than eating processed whole grain bread made from bulgur or oat flour. For more information about grains, see: “Notes From Your Doctor: WHOLE GRAINS”

Foods that are high in fiber and protein will take longer to digest so they will have a lower GI.

The more ripe a fruit or vegetable, the higher the GI.

Foods that have some fat (like nuts) and acidic foods (like vinegar) have a lower GI.

ADDING FIBER, PROTEIN AND HEALTHY FATS TO LOWER GLYCEMIC INDEX
It is important to note that the blood sugar and insulin response we get from a meal is not just dependent on the GI of the individual foods, but how they are combined.

So if there is a simple/refined carbohydrate that you LOVE and cannot live without, can you combine it with something to lessen the rise in blood sugar? You could try:

complex/whole carb

a protein

some fiber

a healthy fat

For example, we know that white bread has a high GI. But we also know that nut butter has a lower GI (due to the presence of protein, fat and fiber), so if we combine the two, we end up with a lower spike in blood sugar and insulin than we would have with just the bread alone.

Along similar lines, can we have

nuts with our cereal?

fish with our mashed potatoes?

beans with our white rice?

hummus with our chips?

avocado with our crackers?

This reminds me of the “WITH WHAT” concept that we discussed in:

“Notes From Your Doctor: FOOD GROUPS: EVERY DAY FOODS, SOMETIMES FOOD & VERY RARELY FOOD PRODUCTS”

For more information, and a GI chart, go to Diabetes Canada:
https://www.diabetes.ca/resources/tools-resources/understanding-theglycemic-index-(gi)

For more information about sugar, have a look at “Notes From Your Doctor: SUGAR”

To learn more about whole grains, please see “Notes From Your Doctor: WHOLE GRAINS”

To learn more about fiber, check out “Notes From Your Doctor: FIBER”

Fiber
Summary & Suggestions
There are 2 types of ﬁber: soluble and insoluble ﬁber – Women need 25g ﬁber/day, men need 38g ﬁber/day.

Fiber can help:

lower blood sugar and risk of diabetes

lower cholesterol

treat constipation & chronic diarrhea

with weight control

decrease the risk of heart disease and colon cancer
WHAT IS FIBER?

Fiber is a type of carbohydrate that our bodies cannot digest. There are two types of fiber: Soluble fiber and insoluble fiber. Most plants contain potty soluble and insoluble fiber, but in different amounts.

Types of Fiber

SOLUBLE FIBER dissolves in water and forms a gel like substance on your intestines. It can help lower blood sugar and cholesterol, and may help with chronic diarrhea. Soluble fiber is mostly found in fruits and vegetables, (although their skins may be high in insoluble fiber), psyllium, oat bran and beans.

INSOLUBLE FIBER does not dissolve in water so it passes through our intestines undigested. Even though it does not dissolve in water, insoluble fiber draws water into the intestine, making it softer and easier to pass. Insoluble fiber also helps to relieve constipation by making food go through our digestive system more quickly. Insoluble fiber is mostly found in wheat bran, whole grains & cereals, vegetable skin and seeds.

Have a look at the table below from West Suffolk NHS Foundation Trust for examples of which foods are good sources of fiber. They also have a handout that you can access here: https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/ ColorectalandStomaCare/5147-2Fibre.pdf
NOT JUST FOR CONSTIPATION! THE HEALTH BENEFITS OF FIBER

FIBER REGULATES INTESTINAL TRANSIT TIME

Insoluble fiber prevents constipation by speeding up how fast food moves through our intestines. This means less water is reabsorbed from the food so we are less likely to end up with hard stool.

Soluble fiber actually draws water into the intestine and increases stool volume, making it softer and easier to pass.

FIBER IS A PREBIOTIC

Soluble fiber is a pre-biotic. It serves as food for the healthy bacteria in our intestines and promotes a healthy microbiome. When we do not have enough fiber in our diets, there can be increased growth of more harmful bacteria which increases risk for constipation and intestinal cancers.

FIBER LOWERS CHOLESTEROL IN THREE DIFFERENT WAYS

1) Fiber has a low glycemic index. It lowers insulin spikes by increasing digestion/absorbtion time of sugar from our food. Insulin normally signals the liver to make cholesterol. With less insulin spikes, there is less stimulation of the liver to produce cholesterol. To learn more about sugar, insulin and glycemic index, please see: “Notes From Your Doctor: SUGAR”

2) Soluble fiber binds to cholesterol in bile acids in the intestine and eliminates them from the body. Cholesterol is used by the liver to make bile acids. When there are fewer bile acids around, the liver will take cholesterol from the blood to make new bile acids, therefore reducing blood cholesterol levels.

3) Soluble fiber is fermented in the intestine by healthy bacteria producing short chain fatty acids like butyrate. Butyrate inhibits the enzyme that promotes cholesterol production in the liver.

FIBER HELPS WITH WEIGHT CONTROL

Fiber (especially soluble fiber) increases feelings of fullness which can control appetite and reduce calorie intake.

FIBER REDUCES RISK OF DIABETES, HEART DISEASE AND CANCER

1) Diabetes: As we learned in “Notes From Your Doctor: SUGAR”, fiber slows down the absorption of sugar when we eat, which then decreases how high our post meal sugar peak goes. It also make the sugar go up more slowly. This is why eating high fiber foods can decrease our risk of developing diabetes (type 2), and help control blood sugar for those who already have diabetes.

2) Heart disease: Higher intakes of whole grains high in fiber are associated with a lower risk of heart disease.

3) Colorectal cancer: Fiber can decrease the effect of toxins in our intestines by:

drawing water in and increasing volume which decreases the concentration of toxins.

making toxins pass through the intestine more quickly.

sticking to some toxic compounds preventing them from coming into contact with wall of the intestine and inhibiting their absorption.

feeding the healthy bacteria in the gut which produces a protective microbiome that keeps intestinal walls healthy.

producing short chain fatty acids when they are fermented in the intestine. Some of these fatty acids increase the activity of enzymes that help in the breakdown/elimination of toxins.

HOW MUCH FIBER DO WE NEED?

Current recommendations for fiber intake include:

WOMEN: at least 25g fiber/day

MEN: at least 38g fiber/day OR 14g of fiber/1000 calories

For recommendations by age, have a look at these tables from the Canadian Digestive Health Foundation:

What are the Best Sources of Fiber?

Fiber only comes from plant foods.

LEGUMES, NUTS & SEEDS

(These have the highest sources of fiber.)

Split peas, 1c cooked 16g fiber

Lentils, 1c cooked 15.5g fiber

Black beans, 1c cooked 15g fiber

Cannelini, Navy, 1c cooked 13g fiber

Chia seeds, 1oz 10g fiber

Almonds, 1oz 3.5g fiber

FRUITS

Raspberries, 1c 8g fiber

Pear, with skin, 1 med gum 5.5g fiber

Apple, with skin, 1 medium 4.5g fiber VEGETABLES

Green peas, 1c boiled 9g fiber

Broccoli, 1c boiled 5g fiber

Brussel sprouts, 1c boiled 4.5g fiber GRAINS

Spaghetti, Whole Wheat, 1c cooked 6g fiber

Barley (pearl), 1c cooked 6g fiber

Quinoa, 1c cooked 5g fiber

Oats 1c, cooked 4g fiber

Check out more sources of fiber here: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/ in-depth/high-fiber-foods/art-20050948

For more information about fiber, have a look at The Nutrition Source of Harvard T.H. Chan School of Public Health. https://nutritionsource.hsph.harvard.edu/carbohydrates/fiber/

FREQUENTLY ASKED QUESTIONS

How can eating fiber help constipation?

Eating fiber helps with constipation by:

increasing the bulk of stool

improving consistency of stool

making stool pass through the gut more quickly

SOLUBLE fiber, like PSYLLIUM, form gels that hold water which increases stool bulk and moisture. This stimulates the bowels to move and makes the stool easier to pass. INSOLUBLE FIBER, like WHEAT BRAN, also holds onto water and therefore increase stool bulk. The bulkiness of the stool stimulates bowel movements.

Some fibres also enhance production of short chain fatty acids in the gut which speeds up intestinal transit time.

The most effective fibres for treating constipation are those that resist fermentation in the gut. (Highly fermentable soluble fibres like inulin tend to cause increased gas production and can aggravate bloating. Foods highest in inulin which may aggravate gas/bloating include: chicory root, Jerusalem artichokes and dandelion greens. Other more common sources include: garlic, onions, leeks, asparagus, bananas (especially when slightly green), wheat, soybeans, oats).

How can eating fiber help with chronic diarrhea?

Eating fiber helps with chronic diarrhea by:

absorbing excess water

forming bulkier stool

promoting a healthier gut microbiome

Soluble fiber, like PSYLLIUM, forms a gel-like substance in the gut which can absorb extra water and thicken stool.

Fibers that are fermentable are metabolized by gut bacteria into short chain fatty acids (SCFAs). These SCFAs can increase watering sodium absorption in the colon which helps to make stool more solid.

Fiber can also promote a healthier microbiome, which means it enhance healthy bacteria in the gut. This can reduce inflammation and improve the barrier of the intestinal wall.

Salt/Sodium
Summary & Suggestions
Aim for less than 2000mg of sodium per day.

75% the salt in our diet comes from premade/processed and restaurant foods. Saying “I don’t add salt to my food” does not mean you have a low salt diet.

Read nutrition labels to see how much sodium is in a serving of the product.

Read the ingredients list to see how high up on the list you can find salt.

Look for “no salt added” or “low sodium” versions of your favourite products while you are working towards reducing salt in your diet.

Be careful with ALL processed/packaged foods, including:

breads, rolls, pizzas, sandwiches

cold cuts/lunch meats/cured meats

cheeses

soups/canned goods

savory snacks: chips, crackers, cheesies, etc

condiments and sauces

store-bought salad dressings/dips/spreads

Try adding lemon, lime, herbs, spices, garlic, onions and white pepper to add more flavour without adding salt.

Be patient when transitioning to a lower salt diet. Your taste buds will adapt!
Salt in our diet serves many purposes. We need sodium for basic functions like contracting our muscles and regulating fluid balance. Salt helps to preserve foods so they last longer. Salt also tastes good! But, like many other nutrients, too much salt can lead to health problems.

HOW MUCH SALT DO WE NEED?

Current Canadian guidelines recommend a maximum of 2300 mg of sodium per day. Hypertension Canada guidelines and the World Health Organization advise a lower limit of 2000 mg per day. The American Heart Association recommends an even lower limit of 1500 mg per day. Sadly, our average intake is a whopping 3500 mg per day

WHY IS TOO MUCH SALT BAD FOR OUR HEALTH?
Too much dietary salt can lead to a variety of medical problems,
including:

high blood pressure (hypertension). High blood pressure is a risk factor for:

heart disease

heart attack

circulatory problems

stroke

kidney failure

blindness (retinopathy)

For more information about hypertension, please see: “Notes From Your Doctor: BLOOD PRESSURE”.

Excess salt intake can also cause:

water retention (edema)

heart failure

kidney failure

increase insulin resistance/risk of diabetes
WHERE IS ALL THE SALT COMING FROM?

Only about 5-7% of the salt in our diet is coming from our salt shakers! Fresh fruits and vegetables only contain modest amounts of sodium. The majority (75%Read ) of salt in our diets comes from processed, packaged and restaurant foods.

Manufacturers don’t only add salt to food because it tastes good, they also use salt to increase the shelf life of their products. This means that there is added salt in almost everything we buy. Even in products you would not think of as “salty”.

Have a look at this image comparing sodium in bread vs chips (courtesy: https://foodrevolution.org/blog/salt-vs-sodium-facts/).

We all know that chips are salty, and we would assume that chips would Have more salt per serving than bread. But do they? According to the nutrition labels, 160 calories worth of chips provides 170mg of sodium, whereas 120 calories of bread provides a staggering 230 mg of sodium!! Surprised? I know I was!

It is very important to read nutrition labels so we can see how much sodium is in the food we are buying. To learn more about nutrition labels, please see: “Notes From Your Doctor: NUTRITION LABELS & INGREDIENT LISTS”

FOODS TO WATCH OUT FOR

As mentioned above, the main sources of salt in the standard North American Diet are ALL processed/packaged foods including:

breads, rolls, pizzas, sandwiches

cold cuts/lunch meats/cured meats

cheeses

soups/canned goods

savory snacks: chips, crackers, cheesies, etc

condiments and sauces

store bought salad dressings/dips/spreads

CLUES THAT THERE IS ADDED SALT

When buying meat from the grocery store/butcher, look for words like “brine”, “cured”, “pickled”, “smoked” that indicate the product has been processed and likely contains salt.

Other ingredients like: broth, miso, fermented, teriyaki sauce, soy sauce and MSG are also high in salt.

FLAVOR WITHOUT SALT
Keep in mind that when we first start moving away from highly processed foods to more natural whole foods, our taste buds will take time to adjust. We can retrain our palate to be more sensitive to other flavors (including salt), by eating less salt! There are so many flavors we can add to our dishes. Experiment with new ideas and recipes to see what you like!

Here are some suggestions:

Try nutritional yeast. This has a nutty salt flavour, but contains no sodium.Use fresh/dried herbs and spices.

Use low salt varieties of some of our favorite sauces (soy, hoisin, black bean, fish).

Cook veggies, grains and potatoes in low sodium stock (or even a 50:50 blend of stock and water) instead of adding salt.

Add chilli, hot peppers or ginger for some heat.

Use citrus zest, lemon or lime juice.

Add garlic, shallots, chives, onions.

Experiment with spice mixes (preferably no added salt), like harissa, zataar and curry powders.

Try white pepper.

For more information, check out:

https://hypertension.ca/wpcontent/uploads/2019/01/SodiumFactSheetFINALJan232019.pdf

To learn more, listen to this podcast from The Canadian Nutrition Society to learn more about sodium in our diet:

https://podcasts.apple.com/ca/podcast/nutritionconversations/id1683925108?i=1000681861007

Sugar
Summary & Suggestions
Not all sugar is unhealthy. Sugar that is found naturally in whole fruits, vegetables, grains and dairy does not increase risk of disease. The WHO recommends less than 10% of calories come from ADDED sugars, with an end goal of getting less than 5% of calories. For an average 2000 calorie diet, this equals less than 12 teaspoons per day (with less than 6 teaspoons as the end goal). Excess sugar can increase the risk for many different health problems including:

overweight/obesity

insulin resistance and diabetes

metabolic syndrome

heart disease

stroke

cancer (especially breast, pancreas and prostate)

fatty liver disease

decreased bone health

cognitive decline

inflammatory bowel disease

Be aware of other names for “sugar”that appear in ingredient lists. Most commonly, words that end in “one” (like fructose, sucrose), and ingredients that end with “juice”, “syrup”, “concentrate” and “nectar”.

Think of ways to decrease sugar intake:

decrease intake of processed, premade foods

switch sugary breakfast cereals to unflavoured oatmeal & add fruit/nuts/seeds to make it tasty (bananas are especially sweet)

instead of flavoured yogurt, buy plain and add your own garnishes

switch soda pop to water as your drink of choice

instead of drinking fruit juice, eat the fruitinstead of chocolate milk, drink white milk or unsweetened soy/plant based milk

try fruit for dessert

instead of chocolate bars, try dark chocolate (at least 70% coco)

make your sweet treats at home, and try decreasing the sugar content by using 1/2 the sugar the recipe calls for replacing sugar with unsweetened apple sauce or mashed banana
DID YOU KNOW?

Eating too much sugar or refined carbohydrates can almost DOUBLE your risk of cardiovascular mortality? (3)(4)

A FEW DEFINITIONS

CARBOHYDRATES: include sugars, starches and fibres. SUGARS: The term “sugars” describes all mono and disaccharides. Sugars are found naturally in fruits, vegetables and milk products, or are added to food and drinks.

See the table below from the Canadian Sugar Institute:

https://sugar.ca/sugar-basics/carbohydrate-and-sugars-terminology

Sugars, oligosaccharides and starches can all be broken down in the small intestine during digestion. These provide us with 4 calories per gram. Fiber cannot be broken down, so it is either fermented in the large intestine into other compounds (like short chain fatty acids) (2 calories per gram), or excreted in our feces (0 calories).

ARE ALL SUGARS UNHEALTHY?

No! Sugars that are found naturally in whole fruits, vegetables, whole grains and dairy do not seem to cause the same health problems as added sugars. This is good to know because these foods also contain many healthy nutrients like vitamins, nutrients, phytochemical and fiber. The sugars that have been added in processing are the ones that are harming our health.

HOW MUCH ADDED SUGAR IS SAFE TO EAT?
The World Health Organization (WHO) recommends that less than 10% of our calories come from ADDED sugars (with an end goal of achieving less than 5% of total calories from added sugar). This does not include naturally occurring sugars in foods, like the sugar found in an orange, a tomato or beans.

For a 2000 calorie diet:

10% calories= 200 calories

Since 1g of sugar/carbohydrate=4 calories

then 200 calories = 50g of added sugar

50g of sugar is approximately 12 teaspoons

The end goal is only half of that: 6 teaspoons per day!

Image courtesy of https://www.heartandstroke.ca/healthy-living/healthyeating/reduce-sugar

We can see that even if we go with the higher limit of 12 teaspoons of sugar/day, just one small can of pop almost meets the limit at 10 teaspoons. Special coffee is not much better.

For information on the (shocking) amount of sugar found in many common foods, see “The Sugar guy” at https://www.joeywellness.com/.
WHAT HARM DOES TOO MUCH SUGAR DO?
There are a number of very serious health problems that come with eating too much sugar:

Overweight and obesity. This is a risk factor for many other chronic diseases like diabetes, heart disease, stroke, breathing difficulties, mental health problems, physical inactivity and mobility issues.

Increase risk of insulin resistance and diabetes.

Increase risk for metabolic syndrome, which can lead to heart disease, diabetes and stroke.

Increase in cholesterol. This happens when insulin spikes stimulate the liver to produce cholesterol.

Increase risk for 7 cancers (including breast, prostate & pancreas).

Increase in fatty liver disease, which can lead to liver failure.

Increase in chronic inflammation (because sugar has been shown to trigger the immune system), which is linked to increased risk of:

Obesity

Diabetes

heart disease

stroke

cancer

decreased bone health

cognitive decline

inflammatory conditions like rheumatoid arthritis

inflammatory bowel disease

Sugary foods can also replace more healthful foods in the diet which means we may not be getting enough beneficial nutrients. The first to go is often fiber.

Dental cavities and tooth decay.
HOW TO FIND SUGAR IN THE INGREDIENT LIST

Note that added sugars are not always listed as “sugar” in the ingredient list. Check out the list below for some other names that added sugar goes by:

https://media.lanecc.edu/users/powellt/FN225OER/Carbohydrates/FN225Carbohydrates7.html

We don’t need to memorize all these names, but there are some key words that are good too know. If we see any of these in the ingeedients, there is sugar in the product!

Words that end in ”ose” (fructose, glucose, dextrose)

Ingredients that end with the word “juice”, “syrup”, “concentrate” or “nectar”.

DON’T FORGET ABOUT NUTRITION LABELS

Have a look at nutrition labels to see how much sugar is in each serving of what you are eating. Unfortunately, our labels do not differentiate between added or naturally occurring sugar, but if we combine the information from the nutrition label with the ingredients list, we can make a good educated guess.

If there is no sugar of any type listed as an ingredient, we can be fairly certain that all the sugar on the nutrition label is naturally occurring.

If there is a type of sugar in the list if ingredients, the higher up it is on the list, there of the sugar on the nutrition label comes from “added” sugar.

Keep in mind that some items like honey, maple syrup and agave nectar are actually sugar! They do not need to have anything added to their ingredients list for us to know this!

TIPS TO DECREASE SUGAR INTAKE

BREAKFAST:

Take a look at breakfast cereals. Try to avoid cereals that have more than 5g of sugar per serving. Switch cold cereal to oatmeal. Use the unflavoured and add fruit/nuts seeds. (Bananas and strawberries are tasty fruits that can give a bite of sweetness). A bit of nut butter (unsweetened), a pinch of cinnamon/ nutmeg and a dash of vanilla can go a long way to add flavor. If it is not enough (while our taste buds are getting used to less sugar), try adding a little honey or maple syrup. It is still added sugar, but at least we are in control of how much (or how little!) we add.

Just like for oatmeal, switch flavoured yogurt to plain yogurt and garnishes to taste.

Swap jam/jellies/chocolate spreads for unsweetened nut butters, avocado or low fat cottage cheese with berries.

Replace fruit juice with water or milk as the drink of choice. Instead of drinking orange juice, eat the orange!

Instead of chocolate milk, choose plain milk, or even better yet, unsweetened soy or other plant-based milk.

DESSERTS:

On a daily basis, opt for fruit instead of sweets.

Apple slices dipped in unsweetened nut butter is very tasty.

Make homemade unsweetened apple sauce with cinnamon that can be eaten hot or cold.

If it is time for a sweet treat, try dark chocolate (at least 70% coco).

Make the sweets at home instead of buying them at the store. We can often cut the sugar in recipes by half and still make a tasty morsel! Substitute unsweetened applesauce or mashed bananas for some of the sugar in recipes.

RETHINK DRINKS:

On of the sneakiest sources of sugar in the North American diet is the sugar we drink! Soda pop, fruit drinks, commercial “frozen drinks” and socially coffees are loaded with the sugar. If one of these things is your favourite thing in the world and you cannot possibly go on with out it, go ahead and have it. But do it less often (maybe once per week instead of every day?), and in smaller quantities (a small instead of a large?). And keep in mind that it is a high sugar item, so make sure you are not eating too many other sugary foods the same day.-Try to make water your drink of choice, with unsweetened teas or coffees as other options.

INVESTIGATE YOUR PANTRY:

We known there is sugar in the cookies or granola bars, but it is also in things like bread, broth, pasta sauce, mayonnaise, salt dressings and so many store bought dips and sauces.

Make what you can at home, and for the rest, look for lower sugar options at the grocery store. For example, spice rubs instead of BBQ sauce, salsa/humus or guacamole for dipping instead of ranch dip.

WHAT ARE ALTERNATIVE SWEETENERS?

“SUGARS” do not include no-calorie sweeteners, sugar alcohols or polydextrose.

ZERO CALORIE SWEETENERS are food additives. Examples include aspartame and sucralose.

SUGAR ALCOHOLS are also food additives. They are not completely absorbed in the small intestine, so they only provide 0.2-3 calories per gram (compared to 4 calories per gram for sugar). Sugar alcohols can cause bloating, diarrhea and gas.

To learn more, check out: https://www.wellnessletteronline.com/eat_well/added-sugars-time-for-a-subtraction-lesson/

Food Swaps

Summary & Suggestions

One of the ways work towards a healthier diet is to learn how to swap out foods/ingredients we already use and like, for similar ones that are better for us.

The list below contains just some of the suggestions I have found myself discussing with patients over the years. I have/will include recipes for some of the options when available. You can find these under “My Favorite Recipes” (which you can find under RESOURCE TYPES). Keep in mind, this is a work in progress, so if you are looking for something and can’t find it, please feel free to ask me next time you are in the office!

EASY FOOD SWAPS

Bacon… plant-based bacon, tofu bacon

beef (burger)… bean burger, veggie burger, plant-based meat burger

beef (ground)… ground turkey/chicken, tofu, lentils, beans, ground soy, soy curls, Texturized vegetable protein

bread crumbs…crushed nuts/seeds

bread (white) products… whole grain bread products, sourdough bread

breakfast sausage… soy-based veggie breakfast patties

butter (for baking): mashed bananas or unsweetened apple sauce

butter (for pan frying)… olive oil, vegetable oil

butter (for toast)… avocado, hummus, drizzle of olive oil, nut butter

cereal (breakfast)… oats, overnight oats, oat bran, All Bran buds, Shredded Wheat & Bran

cereal (breakfast) … replace part of your cereal with All Bran Buds

cheese (topping)… nutritional yeast

cheese (parmesan)… cashew parmesan chilli (with beef)… chilli with beans

chips… air popped popcorn, baked chips

chips… sliced veggies with hummus or guacamole

chips… roasted seasoned chick peas or soy beans

chicken soup… lentil soup

chicken… fish, tofu, beans, chick peas, lentils, plant-based meat alternative

chicken soup… lentil soup

chocolate bars… dark chocolate (70% to higher)

crackers & cheese… whole grain crackers with hummus/avocado/tofu dip

crackers & cheese… apple slices with nut butter

cream… coconut milk or cashew cream

creamy dressings… use vinaigrettes, tahini or yogurt based dressing

creamy sauces… thicken with coconut milk, cashew cream, blended silken tofu, cornstarch, or yogurt

deli meats… grilled/roasted tofu, soy based deli meat, chicken or turkey

eggs (scrambled)… tofu scramble

eggs (for baking): banana, flax egg

flour (white)… whole wheat flour, oat flour, almond flour

french fries… air fried/baked or roasted potatoes/sweet potatoes

fruit juice… whole fruit

granola bars… homemade bars with oats, nuts/dried fruit

ice ream… plain greek yogurt with fruit (fresh or frozen)

mayonnaise: avocado, greek yogurt, cashew cream, hummus, vegan Nayonnaise, mustard

milk (Cow’s milk/dairy)… soy milk/almond milk

milk (chocolate or flavoured)… white milk, soy/almond milk

muffins (store bought)… home made

pancake mix… homemade pancakes with almond flour/oats

pasta (white)… whole wheat/chick pea/lentil pasta

pasta (white)… spaghetti squash/zucchini noodles

pork… chicken, fish, tofu, beans, chick peas, lentils

potato (chips)… air popped popcorn, roasted chick peas

potatoes (fried/French fries)…zucchini/sweet potato fries (oven baked)

potatoes (mashed)… mashed sweet potato/mashed cauliflower

potato (white)… sweet potato pudding…chia pudding, black bean pudding

ranch dressing… yogurt with herbs/ranch seasoning

rice (white)…brown/wild/cauliflower rice or quinoa/barley/farro/bulgur

salad dressings (store bought)… homemade: olive oil, vinegar, herbs

salt (added at the table)…nutritional yeast, herbs, spices, lemon

Sandwiches…tofu spread, tofu egg salad, hummus, avocado, smashed

chick pea chick’n salad, veggie deli slices, crispy shredded ofu

soda pop… water, sparkling water, seltzer, green tea

soup (canned/packaged)… homemade soup

sour cream… yogurt

sugar (for baking)… apple sauce/banana/dates/agave syrup

sugar… try adding less than the recipe states, can add vanilla/cinnamon to enhance flavours

tacos/tortilla (wraps)… lettuce wraps

yogurt (flavored/sweetened)… plain yogurt with fresh fruit/honey

*Note: Grill/bake/roast anything instead of frying for a healthier choice!

Meal Swap Ideas

Chicken noodle soup… chicken/vegetable barley soup, tomato lentil soup

Chicken on top of a salad… canned beans, plain or roasted chick peas, falafel, grilled tofu, soy-based chick’n strips

Meat curries… replace meat with tofu cubes, chick peas, lentils or soy curls

Meat stir fries… marinated/grilled tofu, chick peas, soy-based meat, soy curls

Sloppy Joes… soy/tofu crumbles or lentils

Tacos… soy/tofu crumbles or canned pinto beans

Meatloaf… lentil loaf

Chicken nuggets/strips… seitan nuggets/strips, marinated roasted tofu, soy-based chick’n strips

Cholesterol
Summary & Suggestions

1Eat a healthier diet. Include lots of fruits, vegetables and whole grains. Eat high fibre foods like chick peas, beans and lentils regularly. Limit your sugar intake. Eliminate processed foods. Limit or cut out meat and dairy products. Increase healthy fats found in fish, nuts, seeds avocado and olive oil. Add soy and chick peas for the cholesterol fighting phytosterols..

Increase your physical activity. Aim for 20 minutes of exercise every day, or 150 minutes per week. Start where you are. Any increase in activity is better than none.

Work towards a healthier weight. You don’t have to be at your ideal
body weight to get then health benefits of weight loss!

Quit smoking.

Limit or avoid alcohol.

Optimize your sleep.

Manage stress.

WHAT IS CHOLESTEROL?

Cholesterol is a waxy fat-like substance that our liver produces to help our body make cell walls, hormones, and Vitamin D. It is important for our nervous system and proper digestion, including production of bile acids. We also get cholesterol from any animal products that we eat: eggs, meat and dairy. It is important to note that our liver makes all the cholesterol that our body needs, we don’t need any from our diets. About 80% of the cholesterol in our body is made by our liver. Our diet makes up the remaining 20%. Cholesterol can be “good” (High Density Lipoprotein-HDL), or “bad” (Low density Lipoprotein-LDL).

1) Bad (LDL) cholesterol is the one that tends to build up in our arteries if we have too much. This buildup can clog our arteries, making it harder for blood to flow through the arteries to the cells that need it. This increases our risk for heart attack, stroke and other serious diseases. (So we don’t want a lot of LDL!)

2) Good (HDL) cholesterol acts like a vacuum, cleaning up all of the bad cholesterol that is hanging around in our bloodstream. HDL also relaxes blood vessels, decreases inflammation and carries antioxidants that can help prevent damage to LDL. (We want to have a lot of HDL!)

3) In general, the lower our LDL and the higher our HDL, the better our chances of preventing heart disease, and other chronic conditions!

Triglycerides are another type of fat in our blood. When we eat, our body turns any extra calories, alcohol and sugar into triglycerides. The triglycerides are then stored in fat cells so we can use them for energy when we need it later on.

LIVER & CHOLESTEROL

The liver has an important role in regulating our cholesterol levels. Not only does the liver produce cholesterol, it also helps keep it in check. When cholesterol levels in the blood are too high, the liver will respond by decreasing its own cholesterol production, and increasing the production of bile acids, which helps to breakdown and eliminate extra cholesterol from the body. If we have more cholesterol in our blood, our livers have to work overtime to process it. When there is too much cholesterol passing through the liver, this leads to excess fatty deposits in the liver, otherwise known as fatty liver disease. Fatty liver disease can lead to liver cirrhosis (an advanced stage of liver disease, where the liver tissue is replaced by scar tissue) and even liver cancer.

WHAT IS A NORMAL CHOLESTEROL LEVEL?
There is no level that is considered normal for everybody. What is acceptable for each person depends on each persons specific risk for cardiovascular disease. Risk factors that are used to calculate your “Cardiovascular Risk” (CVD) include:

sex (men are typically at higher risk than women, and tend to be diagnosed with cardiovascular disease at earlier ages)

age

blood pressure and blood pressure medications

initial cholesterol levels

smoking

diabetes

family history of heart disease or stroke, especially before age 60

One popular Cardiovascular Risk Calculator is the “Framingham Risk Score”. You can come in to the office so we can calculate your risk, or you can do the calculation here:
https://ccs.ca/app/uploads/2020/12/FRS_eng_2017_fnl1.pdf

The Calculator will give you a score which puts you into a risk category of Low, Moderate or High. The higher your risk for cardiovascular disease (CVD), the lower we want your cholesterol—especially that nasty LDL type!

**Note that if you have Diabetes or Heart disease, you are automatically considered HIGH RISK.

An example of how to use the table above: If you were found to have a moderate risk of cardiovascular disease, that means that over the next 10 years, you have an 11-19% chance of developing some form of CVD. That means that we would want your LDL level to be less than 3.5 and your cholesterol/HDL ratio to be less than five. Make sense? If not, please ask us when you are in the office!

It is important to note that there are many other risk factors for cardiovascular disease that are not included in equations used to calculate risk, but are just as (or even more) important! These risks are lifestyle behaviours, which are hard to quantify and therefore difficult to use in calculations. These include:

diet quality

obesity

activity level

sleep

alcohol use

stress

social isolation
WHAT ARE THE HEALTH PROBLEMS CAUSED BY HIGH CHOLESTEROL?
If we have too much cholesterol, LDL cholesterol isn’t taken up by our cells from our blood, and it stays in our arteries. (Arteries are blood vessels that bring blood from your heart to the rest of your body).

A lot of cholesterol in our arteries can form “plaques” that narrow the arteries making it hard for enough blood to get to the muscles and organs that need it. (A good analogy is trying to get to work during construction… the roads are full of equipment & workers, and traffic moves very slowly, making it hard to get anywhere quickly!).

The other problem that can occur if LDL lingers too long in our bloodstream is that the LDL particles can become OXIDIZED or damaged (like rust on a car). These damaged LDL particles don’t look like their healthy counterparts and can trigger our immune system to get rid of them. When immune cells (macrophages) gobble up the damaged LDL, they become ‘FOAM CELLS’ that contribute to the plaque buildup in our arteries. (Antioxidants in our diets can help prevent LDL from becoming oxidized/damaged).

As high cholesterol continues, plaques can get bigger and can completely block our arteries. The other possibility is that plaques can get so big that they rupture. This can lead to a clot forming on the plaque which can also block the artery.

Narrow or blocked arteries can cause many health problems, depending on where they occur. For example:

a blocked artery in the heart can cause heart disease and heart attack

a blocked artery in the brain can cause a stroke.

Other problems due to high cholesterol include:

memory problems/dementia

vision problems

gall stones

fatty liver disease (a risk factor or liver failure and liver cancer)

poor circulation in legs causing problems walking
WHAT CAN YOU DO TO LOWER YOUR CHOLESTEROL (OR KEEP IT FROM GETTING TOO HIGH)?
1) LIMIT FOODS THAT WORSEN CHOLESTEROL LEVELS:

These foods increase cholesterol production in your liver.

Eliminate TRANS FATS. These fats are dangerous to overall health and raise your LDL. They are found in processed foods.

Limit SATURATED FATS. These are mostly found in processed foods and animal products and also raises LDL.

Limit ADDED SUGAR. Spikes in blood sugar can signal the liver to make more cholesterol. Added sugars are found in many processed foods including sweetened drinks, snacks and baked goods.

Avoid ALCOHOL. Alcohol increases production of cholesterol in the liver.

2) EAT LOTS OF CHOLESTEROL-FIGHTING FOODS:

FRUITS & VEGETABLES: Contain lots of antioxidants that reduce damage to LDL particles.

LENTILS, BEANS, BARLEY & OATS: Are very high in FIBER.

Soluble fiber binds to cholesterol containing bile acids in the intestine and eliminates them through stool.

The decreased availability of bile acids stimulates the liver to produce more. In order to produce more bile acids, the liver uses cholesterol from the bloodstream, thereby lowering cholesterol levels again.

Fiber also lowers cholesterol by decreasing the activity of an enzyme called HMG-CoA reductase. This enzyme regulates how much cholesterol our liver makes. Cholesterol lowering medications (called “Statins”) also work by down regulating the activity of this enzyme.

To see a list of foods high in soluble fiber, click here:
https://carleton.ca/healthy-workplace/wp-content/uploads/solublefibre.pdf

To learn more about fiber, check out: “Notes from Your Doctor: FIBER”

Eat HEALTHY FATS:

NUTS & SEEDS. Most nuts and seeds are heart healthy. Walnuts, almonds, flaxseeds, sunflower seeds and pumpkin seeds and their oils are particularly good for us. Try to have a daily serving of 20-30 grams as a snack. Choose raw or dry roasted varieties without added salt.

EXTRA VIRGIN OLIVE OIL helps lower LDL and raise HDL.

AVOCADO is another source of healthy fats.

Add OMEGA-3 FATS to your diet. Omega-3 fats can lower triglycerides. Walnuts, flax seeds, chia and hemp seeds are great plant sources of Omega 3. Fatty fish like salmon, anchovies, sardines, mackerel and herring can be helpful.

Add foods with LECITHIN PHYTOSTEROLS. Lecithin is a phospholipid found in various foods and can lower total cholesterol as well as increase your HDL while decreasing your LDL (improving your HDL/LDL ratio). Phytosterols are found in plants and have a similar structure to cholesterol. They interfere with the absorption of cholesterol in your intestines and can lower your LDL levels. Good choices include:

SOY products. Examples include: edamame (soy beans), tofu, tempeh, miso and soy curls.

SESAME seeds.

CHICK PEAS provide double benefit with soluble fiber and phytosterols, lowering both cholesterol absorption and cholesterol production.

To learn more go to

“Notes From Your Doctor: NUTRITION BASICS”

“Notes From Your Doctor: HEALTHY EATING”

“Notes From Your Doctor: WORKING TOWARDS A HEALTHIER DIET”

“Notes From Your Doctor: FOOD GROUPS”

3) INCREASE YOUR PHYSICAL ACTIVITY

Exercise can improve your cholesterol. Specifically, it can help raise your good cholesterol (HDL).

How much exercise do you need?

We need 2.5 hours of moderate-vigorous aerobic activity per week which can be broken down into smaller sessions throughout the week (think 30 minutes 5 days/week, or a little more than 20 minutes/day). A walk during your lunch hour is a great way to start!

People who are not very active can sometimes be intimidated by these numbers. Remember that any activity is better than none! So start where you are and work up from there! Just 5 minutes per day adds up to 35 minutes per week- which is 35 minutes more than you would have if you didn’t do anything at all! Get moving in whatever way that works for you!

For some helpful tips, have a look at this handout from the American College of Sports Medicine Exercise is Medicine series: https://www.exerciseismedicine.org/wp-content/uploads/2021/04/EIM_Rxfor-Health_Blood-Lipids-Disorders.pdf

For more information, check out: “Notes From Your Doctor: PHYSICAL ACTIVITY”

4) LOSE WEIGHT

Even a few extra pounds can contribute to high cholesterol. You can make small changes that can add up to make a big difference! For example:

Drink water instead of sugary drinks like pop

Snack on fruit or air popped popcorn instead of chips

Look for ways to increase your physical activity throughout the day: take the stairs instead of the elevator, park farther from the door or walk during breaks at work.

You don’t have to get to your ideal weight to get the health benefits. Even losing 5-10 pounds makes a difference!

To learn more, have a look at this handout from the Physicians Association for Nutrition:

https://media2-production.mightynetworks.com/asset/f9a11979- f27b-4f92-8634-5e12b35592e3/PAN-factsheet-obesity-anddiet.pdf#_gl=1*1i704mv*_ga*NzMyMjk3MjI0LjE3MzQzNzc0MjA.*_ga_T49FMYQ9FZ*MTczNjk1NTU2Ny4zLjEuMTczNjk1NjE4Ni4wLjAuMA..*_ga_NEGJ2SXNP7*MTczNjk1NTU2Ny4zLjEuMTczNjk1NjE4NS41OS4wLjA

For more information on weight loss, see “Notes From Your Doctor:OVERWEIGHT & OBESITY“

5) QUIT SMOKING

Smoking improves your HDL and within three months of quitting, your lung function and circulation begin to improve. Within one year of quitting, your risk of heart disease is half of what it was when you were a smoker!

6) LIMIT ALCOHOL INTAKE

Doctors used to say that “excess” alcohol intake can lead to many health problems including blood pressure, heart failure, and stroke (High cholesterol is also a risk factor for these conditions). We now know that there is no “safe amount” of alcohol. To maintain general health and avoid chronic medical problems it is best to avoid alcohol intake.

If you don’t already drink, that’s great- don’t start.

If you do drink, less is better! Drink less frequently. Have fewer drinks when you do drink.

For more information on alcohol and health, please see information from the Canadian Centre on Substance Use and Addiction:https://www.ccsa.ca/alcohol

7) Get Adequate Sleep

There is increasing evidence that poor sleep is a risk factor for many chronic conditions like diabetes, obesity and heart disease. Sleep problems can also affect your cholesterol and triglyceride levels. If you need help with sleep, learn more here: “Notes From Your Doctor: SLEEP”

8) Manage Stress

Chronic stress can raise cholesterol levels. Look for healthy ways to manage stress, like exercise, spending time, outdoors, or relaxation techniques.
FAQ

Instead of changing my diet, can I just eat “low fat” versions of the foods I like?

Sadly, no. When a food that normally contains a lot of fat is changed to be “low fat”, the fat is usually replaced with carbohydrates from sugar or other starches. Your body will digest these processed carbohydrates very quickly, which will result in higher blood sugar and insulin levels. This may cause weight gain and worsening if other diseases like diabetes. Low fat foods often also have more added salt, what to compensate for the lower fat. Added salt can increase blood pressure and worsen some heart conditions

Nutrition & Health: What the Research Shows
This section was initially intended for my own use as part of a study guide as I prepare to write the certification exam for the American Board of Lifestyle Medicine. As I became aware the research, I found myself sharing it with patients, who often wanted me to write it down for them. As a result, I thought I would include it here in case anyone was interested.

Note that this is by no means a complete list of all the research supporting whole food plant based eating. I also don’t think that the specific numbers matter. What is important is that all the research points towards significant benefits in every aspect of health when we eat whole foods, mostly plants. The more our diets are built around healthy fruits, vegetables, whole grains, beans, lentils, nuts and seeds-the healthier we become. The converse is also true, the more we rely on animal foods and processed products that are high in sugar, fat & salt, the more likely we are to feel unwell and develop disease.

The data is first divided in sections, categorized DISEASES and how different food products effect that disease. I have started sections on specific nutrients after the disease section.

The numbers in () refer to the resources that follow at the end. Feel free to look up the papers if you are interested in more details.

DISEASES
Cardiovascular Disease (CVD)

MEAT (1)

INCREASE RISK with :

50 g of processed meat per day (2 slices of ham or bacon)

100g processed meat per day (2) Intake of 2 servings/week of processed red meat linked to increase risk of CVD and All cause mortality (even when other factors were controlled)

SUGAR

(3) (4) Excess sugar/refined carbohydrates can almost double risk of cardiovascular mortality

FRUITS/VEG

(5) Each 2.5 serving/day decreases risk of

coronary heart disease by 8%

stroke by 16%

all cause mortality by 10%

Most benefit is from 0-2.5 servings. Benefit continues up to 10servings/ day

NUTS/SEEDS

(5) Similar findings for nuts, seeds and whole grains

PLANT BASED DIET (PBD) (Putting all of the above together)

(6) (7) Healthy PBD (more Whole Foods) dec risk coronary heart disease by 25%

Unhealthy PBD had 32% inc risk (similar to animal centered diet) (8) (9) -400 people who had already had an MI asked to increase consumption of root & green vegetables, less red & processed meats, use olive oil & canola based margarine instead of butter and cream, fruit every day. Found to have 72% less non fatal MI & cardiac death

LIFESTYLE INTERVENTIONS (LIFESTYLE HEART TRIAL)

(10) 1 yr RCT, 48pts with established CAD

Plant based lifestyle vs physician’s advice and statin

Angiography performed at baseline, 1 & 5 yrs -No progression of stenosis in intervention group, 91% reduction angina

Cardiovascular events 2.5 higher in control at 5 yrs

HIGH CHOLESTEROL (11) (12) (13)

LIMIT or AVOID:

SATURATED FATS raise LDL (Bad cholesterol): red meat, poultry, cheese/butter/high fate dairy, coconut products, palm oil

DIETARY CHOLESTEROL can rate LDL as well: eggs, chicken, red meat, cheese/butter/high fat dairy

ADDED SUGARS increase triglycerides: added sugar, juices, refined grains (white bread/white pasta/white rice/), sweets (biscuits, cookies, cakes, pastries, pies), alcohol

INCREASE:

POLYUNSATURATED FATS lower LDL: Nuts and seeds DIETARY FIBER (especially soluble fibre) lowers LDL: Whole grains, legumes, fruits and vegetables

DM & INSULIN RESISTANCE (14)

MEAT

Regular intake of processed meat increases risk of diabetes by 37% and red meat increases risk by 17%

Contrast with what is widely known that sugar can increase risk of diabetes: sweetened beverages increase your risk by 21% (which is less than the risk by eating processed meat!)

Eating whole grains can decrease your risk by 13%

(15) (16)In fact, animal protein in general has been linked to an increase in diabetes with a 22% increase risk for the highest quintile protein intake (note this relationship doesn’t exist for plant sources of protein). But substituting 5% of the protein from animals to plant protein can decrease your risk by 23%.

SUGAR

Well known

FAT

(17) Plant derived poly unsaturated fatty acids (nuts and seeds) can decrease insulin resistance (even when compared with the same amount of fat from saturated fat), dose response relationship

ANIMAL PROTEIN & ANIMAL FAT (LOW CARB DIET)

(18) (19) (20) (21) (22) (23) This is why certain low carb diets (high in animal fat & animal protein) may be linked to a higher risk of type 2DM.

FRUITS/VEG

(24) Daily fruit consumption can decrease risk of diabetes by 12%

If you already have a diagnosis of diabetes and eat fruit three times per week, you can decrease microvascular complications by 28%, macrovascular complications by 13% and all cause mortality by 17%

WHOLE GRAINS

(14) Eating whole grains decreases risk of diabetes, likely due to the high fiber content which decreases post meal blood sugar & increased feeling of fullness. Fiber also lowers the calorie density of food.

FIBER

(25) (26) (27) Fiber is metabolized by gut bacteria to form short chain fatty acids which increase GLP1, increase insulin sensitivity, regulate cytokines (to decrease inflammation).

PLANT BASED DIET

(28) Healthy plant-based diet can decrease risk of diabetes by 30%.

Doesn’t have to be entirely plant based, every step towards plant-based helps decrease risk (dose response)

(29) Mounting evidence supports the view that vegan, vegetarian and Mediterranean dietary patterns should be implemented in public health strategies in order to better control, glycemic markers and individuals with type two diabetes

(30) Remission of Type 2 DM can be achieved the intensive lifestyle changes, particularly when duration of diabetes is short (<4-6 years) RECOMMENDATIONS -from the American Association of Clinical endocrinology (AACE) : increase fruits, veggies, whole grains, nuts, legumes, and fish while decreasing added sugars, refined grains, red, and processed meats

From the American Diabetes Association (ADA): choose nutrient, dense high fiber, carbohydrate sources, increase mono, unsaturated, and poly unsaturated fats, which usually come in nuts, seeds, and fish, drink water instead of sugar sweetened beverages

CANCER

MEAT

(31) In 2015 the world health organization labeled processed meet a Group 1 carcinogen which means it is known to cause cancer. Red meat was labeled a Group 2A carcinogen, which means it probably causes cancer.

(32) (33) Colorectal cancer has the strongest evidence: eating 50 g (2 pieces if bacon or lunch meat) of processed meat per day will increase your risk of colorectal cancer by 18%, and eating 100 g of red meat per day will increase your risk of colorectal cancer by 17%

FRUIT & VEG

(5) Decrease risk of cancer by 14% with 7.5 servings of fruit or vegetables per day (600g) Especially cruciferous and green/yellow veggies

(38) Can increase expression of genes used in cell defense and DNA repair in smokers

SUGAR

(55) Increase risk for 7 cancers, including breast, pancreas and prostate WHOLE GRAINS

(34) (35) (36) (37) Every three servings per day will decrease your risk of colorectal cancer by 17% and decrease all cause mortality by 18%.

For those who already have stage 1-3 colorectal cancer, every 5 g per day increase in whole grain fiber can lead to a 33% decrease in colorectal cancer mortality.

PLANT BASED DIET

(39) Decreases expression of tumor promoting genes in men with prostate cancer

RECOMMENDATIONS

By the American Institute for Cancer research and the American Cancer Society:

Eat mostly veggies (dark green, red and orange), beans, lentils, and peas, a variety of fruit, whole grains

Limit or avoid: red or processed meat, sugar, sugary beverages, highly processed foods

OBESITY

PLANT BASED DIET

(40)-(48)

People eating diets high in plant foods typically have lower rates of obesity (prevalence studies)

Diets low in fiber and high meat are strongly tied to weight gain (perspective studies)

Plant-based diets can be effective for weight loss (randomized studies)

FIBER

(49) (50)

A lot of the benefits from plant-based diet comes from the added fiber

Fiber intake is generally associated with lower calories, an average increase of 14 g of fiber per day leads to 18% lower calorie intake

Whole grain fiber increases metabolic rate

Fiber promotes beneficial gut bacterial patterns and production of short chain fatty acids

Fiber improves blood sugar response to food

Fiber reduces heart disease, diabetes, and cancer risk

(51) In contrast, ultra processed foods lead to increase caloric intake

(52) High fiber carbohydrates (compared to refined low fiber carbohydrates) are linked to 15-3-% decreases in: all causes mortality, cardiovascular, mortality, stroke, and stroke, mortality, type two diabetes, colorectal cancer

High fiber, carbohydrates, lower body weight, cholesterol, and blood pressure

PROTEIN

(53)Diets with higher animal protein intake have increased cardiovascular mortality. This is only in part due to the fact that animal proteins come with a lot of saturated fat and cholesterol.

Diets high in plant protein intake have lower cardiovascular and all causes mortality. This is likely due to the lower saturated fat intake, increased fiber and phytonutrients that come with the plant proteins.

For people with greater than one lifestyle risk factor, replacing just 3% of calories from animal protein to plant protein leads to a decrease mortality of:

-34% if the protein replaced was processed meat,

-19% if the protein replaced came from eggs,

-12% if it came from red meat, -8% of it came from dairy,

and 6% of it came from poultry and fish

FAT

(54) Higher intake of saturated fats is linked to increase in coronary heart disease. The risk is lowered when these fats are replaced with either polyunsaturated fats, whole grains, or plant protein

NUTRIENTS

SUGAR

(55) Inc risk for 7 cancers, cardiomatabolic disorders

(56) Inc risk for Non-Alcoholic Fatty Liver Disease

(57) Inc inflammation leads to decreased bone health: decreased BMD, increased fracture risk

(58) Sugar sweetened beverages, particularly soda linked to lower BMD (? Due to high fructose corn syrup impairing renal function and causing mineral imbalances?)

(59) Sugar increases osteoporosis risk by lowering Vitamin D (reducing calcium absorption from the GI tract) and by increasing blood sugar (which may impair bone formation). Can all cause fat cells to accumulate in the bone marrow, which weakens the structure off bones

(60) Long term over consumption of sugar linked with reduced cognitive function, specifically executive function and memory

(61) Drinking more than 1 sweetened beverage per day over 10 years leads to significantly higher risk of developing IBD. (No inc risk with artificially sweetened beverages or natural juices)

FIBER

(62) Regular consumption of fiber plays a role ion colon cancer prevention.

(63) Diets rich in fiber reduce the risk of breast cancer
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(44) Halkjaer J, Olsen A, Overvad K, et al. Intake of total, animal and plant protein and subsequent changes in weight or waist circumference in European men and women: the Diogenes project. Int J Obes (Lond). 2011;35(8):1104-1113.

(45) Roswell M, Appleby P, Spencer E, Key T. Weight gain over five years and 21,966 meat eating, fish, eating, vegetarian, and vegan men and women in. EPIC-Oxford. Int J Obes (Lond). 2006;30(9):1389-1396

(46) Barnard ND, Levin SM, Yokohama Y. A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets. J Acad Nutr Diet. 2015;115(6);954-969.

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(50) Karl JP, Meyadni M, Barnett JB, et al Substituting whole grains for refined grains in a six week randomized trial favorably affects energy balance metrics in healthy men and post menopausal women. Am J Clin Nutr. 2017;105(3):589-599

(51) Hall KD, Ayuketah A, Brychta R, et al. Ultra processed diets cause excess calorie intake, and weight gain: An inpatient randomized controlled trial of ad libitum food intake Cell Metabolism. 2019;30(1);67-77.e3

(52) Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 2019;393(10170):434-445

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(56) Jensen T, Abdekmalek MF, Sullivan S, et al. Fructose and Sugar: A Major Mediator in Non Alcoholic fatty Liver Disease. J Hepatol. 2018 Feb 2;68(5);1063-1075

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Sleep

Sleep
Summary & Suggestions
Make sure any medical and/or mental health problems that may be interfering with your sleep are treated.

Try using a sleep diary to identify were your problems might be.

NIGHTTIME IDEAS:

Establish a relaxing bedtime routine & try to do it at the same time every night. Try taking a bath, reading a book or listening to relaxing music.

Avoid all screens for 12 hours before you want to fall asleep.

Use low lighting.

Avoid stressful conversations/activities in the evening.

Only go to bed when you feel sleepy. If you are not asleep in 20 minutes, get out of bed.

Only use your bed for sleep, sex and sickness.

Make your bedroom dark, quiet and cool.

DAYTIME IDEAS:

Wake up at the same time every day (No matter how well/long you slept the night before).

Spend time outside every day. Especially early in the morning.

Exercise every day. Preferably outside.

Avoid napping.

Avoid caffeine at least 6 hours before bed.

Avoid nicotine after 23 hours before bed.

Try CBTi
WHAT IS INSOMINA?
Many people have trouble sleeping from time to time, and a lot of us worry about the amount or quality of sleep we are getting. Did you know that we don’t all need 8 hours of sleep every night? Did you know that waking up once or twice per night (more as we get older!) is normal? Did you also know that WORRYING about your sleep can actually make it harder for you to fall asleep and stay asleep?

So, how do you know if you have a sleep problem? Here are a few definitions:

INSOMNIA is defined as BOTH of the following:

Difficulty initiating or maintaining sleep despite an adequate opportunity.

Associated with distress or impairment of daytime functioning.

INSOMNIA DISORDER is considered chronic when you have insomnia three or more nights/week that lasts three months or more.

COMORBID INSOMNIA is when chronic insomnia exists with another condition (like sleep apnea, anxiety or chronic pain, etc).

If you are able to function perfectly well during the day, chances are (even though you may not be sleeping as much as you would like), you are sleeping enough! However, if you have trouble staying awake, need to take naps, or are too tired to perform your usual activities at home, work, school, etc., you may need help with your sleep.
WHAT HEALTH PROBLEMS ARE RELATED TO POOR SLEEP?
Sleep problems can make everything feel worse. You have less energy and a decreased ability to cope with whatever comes your way.

Recent research is also revealing how important sleep is for general health and well-being. Sleep is when the GLYMPHATIC SYSTEM clears waste products from the nervous system. Sleep is also when we consolidate learning. Not getting enough sleep can influence hormones that control hunger and appetite, which can lead to weight gain. Daytime fatigue from poor sleep can also make it harder for you to exercise or make good food choices, which will also put you at risk for weight gain and other health problems.

Poor sleep has been shown to cause a wide variety of health problems that include:

weight gain/obesity

diabetes

high blood pressure

heart disease and heart attack

stroke

mental health problems

increased mortality

You can learn more about sleep-related health problems here:
https://www.health.harvard.edu/healthbeat/how-sleep-loss-threatens-your-health
WHAT CAUSES SLEEP PROBLEMS?

It is possible that insomnia is your main problem, but more often, trouble sleeping is a symptom of other conditions.

The most common causes of insomnia include:

1) Stress & other medical problems: Worries about school, work, health, money or family can keep your mind going at night, making it hard for you to fall asleep. In fact, worrying about whether you will sleep or not is probably making it harder for you to sleep!

If do you think worry or stress is interfering with your ability to sleep, talk to us so we can help!

2) Poor Sleep Hygiene: Our brains and bodies need time to wind down at the end of the day. Watching TV, using screens or doing anything that is stimulating (like vigorous exercise) before bed can make it hard for you to fall asleep.

3) Poor daytime habits: Believe it or not, your ability to fall asleep and stay asleep, starts with what you do as soon as you wake up! Waking up at different times every day, taking naps and using stimulants like caffeine and nicotine well impact how will you sleep.

WHAT CAN YOU DO TO IMPROVE YOUR SLEEP?
It depends on what is causing the problem in the first place.

1) MANAGE ANY MEDICAL/MENTAL HEALTH CONDITIONS FIRST! Anxiety, depression or other mental health problems can interfere with sleep. In fact up to 80% of people with a mental health diagnosis have trouble sleeping.

To make matters worse, poor sleep can also make mental health problems worse. This can turn into a vicious cycle of fatigue and frustration! Make sure these issues are well controlled so you can optimize your sleep. If you think mental-health issues are making it hard for you to get a good nights rest, talk to us so we can help.

ANXIETY ABOUT SLEEP can also prevent you from sleeping. Lying in bed worrying about how tired you will be in the morning if you don’t fall asleep soon is a great way to make sure you don’t fall asleep!

Make this quiz see if your beliefs about sleep are interfering with getting a good nights rest:
https://mysleepwell.ca/cbti/beliefs-about-sleep/

THOUGHTS/RACING MIND. Our thoughts can often be an obstacle to sleep because we cannot seem to make them stop. This can be anything from health or financial worries, to going through the big list of things you have to do tomorrow. Here are some tips you can try if you feel your mind is racing and you cannot relax before bed:
https://mysleepwell.ca/cbti/cbti-components/thoughts/

OBSTRUCTIVE SLEEP APNEA is a condition where you stop breathing for short periods of time while you are asleep. This causes a drop in your oxygen levels, which then causes you to wake up (often without you realizing it) so you can start breathing again. The sleep disruption causes people with sleep apnea to wake up feeling tired. Most people with sleep apnea don’t know they have it.

You can learn more about sleep apnea here: https://www.sleepfoundation.org/sleep-apnea/obstructive-sleep-apnea

If you always wake up feeling tired, especially if you snore a lot, talk to us so we can organize a test for sleep apnea!

RESTLESS LEG SYNDROME is a condition that can cause your feet, ankles, knees, or even hips to repeatedly flex and extend while you are sleeping. This can cause you to wake up for short periods of time and interfere with your sleep. If you feel like your sleep is not refreshing, and you find yourself waking up throughout the night because your legs “keep moving” talk to us so we can help!

CHRONIC PAIN can definitely make it hard for you to stay and fall asleep. Let us know if pain is keep you awake to see if we can help.

DIABETES can affect your sleep, especially if your blood sugars are not under control. Learn more about managing your diabetes here:
“Notes From Your Doctor: Diabetes” Talk to us if you feel like your diabetes is causing nighttime symptoms that are making it hard for you to sleep. If you have these or any other problems (like frequent urination, heartburn etc.) that are making your sleep difficult, let us know so we can help.

2) START A SLEEP DIARY
A sleep diary can be a great way to find out what your baseline sleeping pattern is. A sleep diary can also help you calculate your sleep efficiency.

To start a sleep diary, click here:
https://mysleepwell.ca/cbti/sleep-diary/

To calculate your sleep efficiency, click here:
https://mysleepwell.ca/cbti/sleep-efficiency-calculator/

3) DEVELOP GOOD NIGHTTIME HABITS
There are some general guidelines for good “Sleep Hygiene” that could be helpful for anyone with sleep problems.

i) ESTABLISH A BEDTIME ROUTINE. Take an hour to allow your brain & body to unwind. Try different relaxation techniques. Reduce artificial lights: use dimmer switches, or low light lamps. Limit stressful conversations. Read. Take a bath. Try some herbal tea. Once you establish a routine and keep doing it every night before bed, that routine will start telling your brain and body that it is almost time to go to sleep and you will start to feel sleepy.

ii) AVOID ALL SCREENS FOR 1-2 HOURS BEFORE BED. The blue light will interfere with your body’s release of melatonin (a powerful hormone that regulates our sleep-wake cycle). If you have to use screens at that time, turn on night mode or reduce the brightness of the screen. Also, go outside in the late afternoon/early evening. Being exposed to natural light as the sun is going down will make you less sensitive to the effects of blue light later in the evening.

iii) STOP EATING AT LEAST 2-3 HOURS BEFORE BED. Eating too close to bed can affect sleep quality. Having a full belly can also lead to reflux or other discomfort which can interfere with sleep. Maintaining a regular eating schedule and finishing your last meal at least 2-3 hours before sleep helps align your meal timing with your body’s natural sleep-wake cycle.

v) ONLY GO TO BED WHEN YOU FEEL SLEEPY. When you start yawning, your eyelids feel heavy, etc. Going to bed before you are tired will cause you to toss & turn and feel frustrated. This will can make you associate your bed with stress instead of relaxation. If you have a bedtime routine, and you do it around the same time every night, eventually you will start to feel sleepy around the same time.

v) ONLY USE YOUR BED FOR SLEEP, SICKNESS OR SEX. Avoid working, reading, using devices, or watching TV in bed. Teach your brain & body that when you were in bed, it is time to sleep

vi) IF YOU ARE NOT ASLEEP IN 20 MINUTES, GET OUT OF BED. People who struggle with sleep can spend a lot of time in bed trying to fall asleep. This can cause sleep anxiety, and make it even harder to fall asleep. You can play a 20 minute meditation or playlist. Find some options here:
https://mysleepwell.ca/cbti/cbti-components/control/

If you are still awake when it ends, it’s time to get out of bed. Leave the room and do something extremely boring with low light: listen to soft music, color a picture or read a dictionary. Only go back to bed when you are feeling sleepy again.

vii) MAKE YOUR ROOM DARK, QUIET, UNCLUTTERED & COOL. Have blinds or shades that keep out the light and remove alarm clocks or anything else that emits light. Use a blindfold if you have to. Use ear plugs if your home can be noisy. Make the room temperature comfortable- but not too warm.

4) DEVELOP GOOD DAYTIME HABITS Many of us are aware of the sleep hygiene tips for bedtime. Few of us understand that our ability to fall asleep at night starts as soon as wake up!

i) WAKE UP AT THE SAME TIME EVERY DAY (OR EARLIER), no matter how late you were up the night before. In order to fall asleep, you need to be tired or have a HIGH “SLEEP DRIVE”. The longer it has been since you were last asleep, the more tired you will be, the higher your SLEEP DRIVE. This is why NAPS CAN BE A BAD IDEA for anyone who is struggling with sleep. When you nap, you wake up less tired which means you decrease you SLEEP DRIVE for that evening. If you have to nap, try to limit yourself to 10-20 minutes, and avoid napping after 3pm.

Try being exposed to bright natural light soon after you wake to help your body transition into wakefulness more easily.

ii) AVOID CAFFEINE AND NICOTINE. Both of these are stimulants and can interfere with sleep. Avoid caffeine for at least six hours before bedtime. Try to quit smoking. If you do smoke, avoid smoking at bedtime or in the middle of the night.

ii) AVOID ALCOHOL. Even though alcohol can help you fall asleep, it will likely cause you to wake in the night and have trouble falling asleep again.

iv) EXERCISE. OUTSIDE IF POSSIBLE. All exercise can help you sleep, particularly aerobic exercise. Spending time outdoors has also been shown to improve sleep. Keep in mind that intense exercise before bed can be too stimulating and make it hard for you to fall asleep, so limit intense exercise to earlier in the day.

v) EAT WELL. Having a light snack before bed may help you sleep, but if you eat a big meal, you’re less likely to have a good night sleep

Here is an infographic outlining some of the above tips.

5) COGNITIVE BEHAVIOURAL THERAPY for INSOMNIA (CBTi)

If you have tried all of the above on your own, and are not having any luck, perhaps it is time to consider formal cognitive behavioural therapy for insomnia (CBTi).

CBTi is a safe and effective approach to help you get your sleep back WITHOUT MEDICATION. It is the FIRST LINE recommended treatment for insomnia. Compared to sleeping pills, CBTi is safer, more effective, less expensive and loner lasting.

Have a look at the following comparison:

CBTi aims to break some of the bad habits that we all have around sleep and replace them with healthier strategies that will let us sleep more easily.

You can learn CBTi on your own using online resources/books, or you can work with a therapist or participate in a group.

There are 5 components to CBTi. You can use one or more of the components, depending on your specific situation.

STIMUUS CONTROL

SLEEP RESTRICTION

SLEEP HYGIENE

THOUGHT REFRAMING

RELAXATION TRAINING
FREQUENTLY ASKED QUESTIONS (FAQs)

I am having trouble sleeping. Would sleeping pills be a good idea?

The answer is almost always NO. Sleeping pills might help you fall asleep faster and help you stay asleep longer. But, using sleeping pills on a regular basis won’t work long-term. Eventually your body gets used to the sleepiness caused by the medication and it stops working. (This is similar to the first time somebody tries alcohol. The first time, it doesn’t take very much to feel giddy. But if you keep drinking, eventually you will need more and more alcohol to feel that same giddiness. Make sense?) Once the sleep medicine stops working, you will want a higher dose to be able to get your sleep. But eventually that dose won’t work either. See the problem?

To make things more complicated, if you have been using sleeping pills regularly and you try to stop, your sleep will be even worse than it was before! Your body may have become dependent on your sleeping pills in order to fall asleep… and will have trouble falling asleep without them. This is called WITHDRAWAL. (This can happen in as little as 3-4 days for some people!)

We also know that the sleep we get when using sleeping pills has different qualities than natural sleep. It is less restorative and does not promote healthy bodily functions in the same way.

This is why sleeping pills are generally not a good idea for most people in most situations. You can learn more about sleeping pills here: https://mysleepwell.ca/sleeping-pills/why-sleeping-pills-are-habit-forming/

To learn more about how to stop using sleeping pills safely, ask us to help! You can also use this “Stop Sleeping Pills Guide” here:

https://mysleepwell.ca/wp-content/uploads/2021/05/Stop-Sleeping-Pills-Guide-and-Planner-FILLABLE.pdf

https://mysleepwell.ca/wp-content/uploads/2023/11/CBTi-vs.-Sleeping-Pills.pdf

HOW TO GET A GOOD NIGHT SLEEP WITHOUT MEDICATION

Learn More Here:

https://static1.squarespace.com/static/5836f01fe6f2e1fa62c11f08/t/64a5b2b93e5ccd16a4c75d76/1688580795930/Sleep_brochure_05Jul2023.pdf

SLEEPING PILLS

You may be at risk if you are taking a sedative/hypnotic medication:

https://static1.squarespace.com/static/5836f01fe6f2e1fa62c11f08/t/65f8aa6e2c06f263a3ec0ace/1710795379736/EMPOWER+Brochure+-+Sleeping+pills+&+Anti-anxiety+medications.pdf

Re-evaluating the use of benzodiazepines: a focus on High risk populations: US Department of Veterans Affairs, 2016:

https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Benzodiazepine_Provider_AD_Educational_Guide.pdf

INSOMNIA

General Information about sleep

Sleep on it Canada

Sleep Disorders National Sleep Foundation

COGNITIVE BEHAVIOURAL THERAPY for INSOMNIA (CBTi)

How to get a good night’s sleep without medication Canadian Deprescribing Network, 2018

You can take this Sleep Disorders Questionnaire to learn more about your sleep issues.

It may be useful to learn how much you are actually sleeping by filling out a Sleep Diary here.

If you do have insomnia, this questionnaire can help you find out how severe it is.

Notes From Your Doctor

Contents

General

Nutrition

Sleep

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