It’s not about restriction . . . 8 simple principles for life
- Focus on eating good meals (to optimally fuel and protect your ‘engine’)
- Don’t snack between meals* (apart from a piece of whole fruit or a handful of unprocessed nuts)
- Reduce refined and non-wholegrain carbohydrates and replace them with fibre-rich carbohydrates (this is not low carb)
- Watch your sugar intake — especially hidden or added sugars in processed foods
- Cut out regular sweet drinks (includes fruit juice, smoothies and squash) and we would even stay away from diet or low calorie alternatives
- Don’t go low fat but favour plant and marine based unsaturated fats — the right fats are protective and keep you feeling full
- Limit alcohol — remember a glass of wine has the same calorie content as a doughnut
- At least 20 mins of cardiovascular exercise everyday (or 5 times a week minimum) — for most of us this can be as simple as a brisk walk
*Unless you do a lot of cardiovascular exercise
These are simple principles which are supported by the balance of current evidence. They may not seem as exciting as a new miracle diet, Amazonian super-fruit and the headline is not sensational (certainly won’t attract the mass media or sell newspapers) but you will achieve longterm sustainable lifestyle gains. You will also notice they are just as much about what you should eat (i.e. a focus on protective foods) than what you shouldn’t eat (damaging foods). In simple terms focusing on eating 5 portions of fruit or veg per day and 3 portions of whole grains in itself is quite a lot of food . . . you will not go hungry or need to count calories as long as you are eating the right balance of foods.
After a month (or two) of discipline to kick start your new lifestyle revolution you will be in a position to balance this out with occasional indulgences. Eating should always be about enjoyment or optimally fuelling and protecting your body (and these are not mutually exclusive) — you should never waste your food opportunities or calories. Overall we advocate a natural, seasonal, whole-food diet which avoids weird supplements and processed foods — the main culprits for principles 2, 3 and 4.
Eat good meals to optimally fuel your body
(i) Eat breakfast, lunch and dinner — eat these meals at consistent times, don’t skip them and try not to eat your evening meal too late (not later than 8pm ideally).
(ii) Use a medium sized meal plate — have one good portion and avoid seconds.
(iii) Imagine your plate split into quarters. Half of your plate should be beautiful, colourful seasonal vegetables and salads. A quarter of your plate a whole grain carbohydrate and a quarter of your plate a healthy protein (roughly). We will be bringing you recipes and ideas that follow this principle.
(iv) Use your meals as an opportunity to ‘fuel’ your cardiovascular engine with high quality and protective ingredients.
If you are lucky enough to own a beautiful, classic Aston Martin DB5 then its likely you will obsess about maintaining that car in perfect condition — this usually means putting in the best fuel, best oil and best products. You probably won’t have it serviced in your local Kwik-Fit or use the cheapest low octane supermarket petrol. This is an analogy that I often use with my patients who are putting low quality ‘fuel’ into their body — the first principle of a healthy diet is to eat well and fuel your body with high quality protective ingredients. Cardiovascular risk factors and obesity are predominantly driven by eating badly — either too much or more usually the wrong foods.
This is the problem with restrictive diets. Fine, they help you remove the bad bit from your diet but the focus is all wrong — we should displace the bad bits with the good bits (‘trade-ups’). Most restrictive diets promote a type of modern malnutrition. Lets look at it another way . . . if food A actively causes illness but food B protects you from illness then you will get the best health outcome if you replace food A with food B (rather than just cutting out food B, which probably makes you hungry and you end up eating convenient food C instead which is also bad).
Eating good meals will not only insure you are fuelling your body with protective foods but it will also ensure you are full, satisfied and therefore less likely to eat bad things (avoiding principle 2 — don’t snack). It’s likely to improve your energy (especially if you are tired all the time) and general mood — immediately improving your quality of life. Its not about total daily calorie counting — 100 calories of Broccoli does not equal a 100 calories of Coca Cola. This is one major problem with the 5:2 diet — our observation is that most people end up eating bad calories on their restrictive days as well as their indulgence days. There are differences in the way our bodies process different foods and the overall effects on our health and weight which goes beyond the simple energy content.
Don’t snack between meals
Snacks are a killer and add up when it comes to putting on weight and cardiovascular risk factors — clever marketing campaigns by the food industry over the years have introduced these unnecessary and excess processed foods into our dietary subconscious. Not only are they extra useless calories but they are usually the worst type of calories — perfect for storing as fat or effecting out cholesterol profiles. When we analyse the snack calories of obese patients over a day we often find that they total more than the meal calories. The odd biscuit or chocolate or pack of crisps here and there builds up insidiously.
This is one of the reasons why dieting works (at least in the short term). No matter how they are packaged and promoted most fad diets that work have the same fundamental principles — one of which is that you become aware and scrutinise what you eat. By following a strict regime (whatever that may be) one immediate consequence is that you avoid these hidden extra foods because you are conscious to follow the diet. If we were to start the next big celebrity fad diet tomorrow — lets call it ‘The Hot Dog Diet’ (with the likely arbitrary tag-line “scientifically proven”) — and ate 3 meals of hots dogs everyday you would more than likely lose weight because you would avoid other foods between meals. Clearly with this diet although you lose weight, you do not gain the full benefits of optimising your weight because you are not eating health promoting ingredients (as described above). The reality is that most of these diets provide a short term solution which is not sustainable — both anecdote and evidence reveal a pattern of yo-yoing weight change with longterm failure in the majority.
The final problem with snacks is that they are usually convenience foods and therefore by definition processed. The usual ingredients are sugars, refined carbohydrates or generally ingredients with no nutritional benefit at all — wasted calories.
If you do get hungry between your high-quality meals (which is unlikely if you are eating the right foods) then you should eat things which are protective — a piece of whole fruit or a handful of unrefined nuts. Remember to drink water with your meals as well as this will help you stop getting hungry or misinterpreting thirst as hunger.
Reduce refined and non-whole grain carbohydrates and replace them with wholegrain carbohydrates (this is not low carb)
The classic refined carbohydrate is white flour and white flour products such as white bread, pastry and even white pasta. We would add white rice and skin-less potato to the list of easy to digest carbohydrates to limit — all perfect for storing as fat and raising your Triglycerides and bad cholesterol.
A wholegrain such as wheat is made up three essential parts — (1) Endosperm — the starchy energy store, (2) Bran — the fibrous outer coating, (3) Germ — the reproductive part that grows into a plant.
When the wholegrain is processed, usually by grinding, you remove the starchy, energy-rich endosperm which makes white flour and discard the fibrous bran and germ. White flour is popular because it makes light and fluffy breads and pastries which are easy and nice to eat (for obvious reasons) with a nice ‘mouth feel’. In the old days it was hard work to grind the whole grain to get white flour (hence ‘daily grind’) and so white flour products became associated with the affluent.
There are a number of health problems with this process and the subsequent white flour product (and it has nothing to do with gluten by the way). In simple terms it is specifically the bran and germ which have nutritional and health protective properties and these are discarded. The bran is rich in fibre and the germ is nutrient rich with vitamins and polyunsaturated fats. As a whole it works well to create a slow release energy package but when you remove the other bits the remaining white flour is just too easy to digest and energy rich. This results in a high glycaemic profile.
Lets consider what happens when you eat these refined or non-whole grain carbohydrates with a high glycaemic profile e.g. white bread:
(i) The white bread is easy to chew or swallow and breakdown. As it’s low in fibre its very quick to digest – the enzymes can rapidly penetrate the carbohydrate, do their work and break it down into is basic simple sugars.
(ii) Suddenly there are a lot of simple sugars available and this is absorbed rapidly causing a surge in blood sugar availability (as apposed to slow release sugars in wholegrains).
(iii) In response to this your pancreas releases a surge of insulin – the hormone which allows sugars to be utilised by cells and stored. But there is far too much simple sugar available too quickly and so the sugars are sent to the liver for packaging as fat for storage.
(iv) This fat is sent out to the common storage sites around the body such as the abdomen. These fats are packaged as Triglycerides and Very Low Density Lipoproteins (VLDLs) for transport which on their travels break down even further into Low Density Lipoproteins (LDL) – the essential ingredient which get trapped in the lining of the arteries and promote atheroma (furring of the arteries).
(v) Now because you have had a surge in insulin there is a see-saw effect on blood sugar which starts to dip (overshoot of steady state). As a result you start to feel you need to eat again (cravings for bad foods with immediate ‘sugar rush’) and a vicious cycle ensues.
(vi) If you do this on a regular basis and because of a number of mechanisms including the stored bad fat around your belly (which essentially acts as new evil hormone releasing organ), desensitisation to the swings in sugar and insulin pathways and overuse of your insulin producing cells you start to develop Type 2 Diabetes. Diabetes further accelerates and promotes the process of cardiovascular damage.
Watch your sugar intake, cut out regular sweet drinks and limit alcohol
There has been a lot of press and mass media attention regarding sugar recently but the problem is that the message has become sensationalised. Certainly the extreme swing from fat to sugar as the sole culprit for our modern illnesses is a good story but wrong. The intricacies of this debate are a discussion for another day but there are some clear, simple and established concepts which follow the refined carbohydrate principles as described above. Instead of rapid breakdown of carbohydrates into simple sugars via enzymes, you are directly delivering simple sugars into the digestive system. These sugars are easily absorbed into the blood stream and cause see-sawing blood sugar and insulin concentrations which results in fat storage unless you are very active.
Many of the recent popular fad diets such as Atkins and Dukan exploit this simple principle for weight loss but cloaked in special celebrity endorsed spin — both remove refined carbohydrates and simple sugars in favour of lower glycaemic profile alternatives, which coupled with an awareness of what you are eating, help you lose weight.
Sweet drinks are particularly dangerous and probably a significant contributor to our modern obesity epidemic. Its common-sense really — a drink is a perfect vehicle for delivering large amounts of bad calories quickly into the body. Drinks on their own do not tend to make you feel full and so there is room for more food — especially when you need a snack afterwards because of your sugar-dip.
You also need to be careful with fruit juices and smoothies — when you remove the fibre content of fruit, the remaining sugary water affects your body in the same way as drinking other sweet drinks, although there maybe other nutritional benefits. However, if you want to lose weight then you need to limit fruit juices, smoothies, squash etc. (and in terms of ‘One Month to Change Your Life’ you need to avoid them completely). Our instinct is to also avoid diet drinks as there is some association with weight gain in the literature although this needs to be looked at in more detail.
Alcohol again follows the same principles. Alcohol is made by fermenting sugar and the resultant pathways and effects on the body are very similar to drinking surgery water. It’s high in the wrong type of calories — those that are easily stored as fat. Remember a large glass of wine has the same calorie content as a doughnut! In moderation its likely to have some protective effects on the cardiovascular system but once you go over this modest limit (14 units per week for ladies and 21 units per week for men) you are in the realms of contributing to weight, blood pressure and bad fats in your blood stream.
Don’t go Low Fat
There has been increasing attention on dietary fat, and specifically saturated fat, in the popular media in recent times and we are frustrated at most of the sensationalist reporting. This exaggerated trend has resulted in books, TV programmes and a lot of attention from the pseudoscience and lifestyle heath arena — headlines such as “Saturated fat is good for you” is a typical example.
Here is a balanced summary of the evidence both good and bad:
(i) Fats are energy dense with around 9 KCal/g compared to carbohydrate and protein 4 Kcal/ g (incidentally alcohol is second highest at 7KCal/g). What this means is that the equivalent weight of food in fat has double the calories than carbohydrate or protein. Therefore if you eat a lot of fatty food you are taking in more calories.
(ii) But remember its not all about calories — we are also interested in how our bodies utilise the calories. Fat is a relatively ‘slow release’ form of energy and also excellent at making you feel full (high ‘satiety’) — its difficult to eat a lot of rich fat but easy to drink the equivalent calories in sweet drinks.
(iii) Saturated fat was considered a major contributor to cardiovascular disease and this concept became popular and was increasingly promoted in the 1980s. This was mainly driven by a belief that dietary saturated fats directly increased your bad cholesterol. The problem is that our dietary patterns then shifted as a result towards more refined carbohydrate — and you now know why that is undesirable. The other direct effect was the production of partially hydrogenated vegetable oils (otherwise known as TransFat) which is now well recognised as being a very damaging thing to consume — a pure evil ingredient.
The reality is that saturated fat is probably not as bad as once considered but the overall health effects of foods are relative — at best we would consider it a neutral food (neither bad nor good) and clearly as we have discussed the best diet replaces bad foods with protective foods. In terms of health, you wouldn’t necessarily want a diet made up of neutral foods but equally you wouldn’t want to replace your neutral foods with bad foods (see below). This is exactly what happened when the Western world started to reduce total saturated fat content from our modern diets and replace them with refined carbohydrates and sugars.
(iv) The food industry has further confused the situation by promoting diet products which are ‘Low Fat’ or ‘Lighter’. These processed foods have normally sacrificed the fat content in favour of other and worse flavour enhancing ingredients such as sugar. We would avoid any products which have been marketed in this way unless you are clear about the ingredients. Unfortunately ‘Low Fat’ still communicates ‘healthy’ and this is engrained in the public subconscious. European food labelling laws also strictly limit food packaging health claims and unfortunately one of the requirements to promote or label a food as ‘healthy’ is a requirement to demonstrate low fats.
(v) Repeat evidence suggests that unsaturated fats are cardiovascularly protective. These fats which specifically come from oily fish (polyunsaturated), plants (e.g. monounsaturated from avocado and olive oil) and nuts and seeds (poly and monounsaturated) have effects on improving our cholesterol profiles and other direct protective effects. Therefore a low fat diet would remove these protective foods (and likely replace them with bad ones). A caveat to this is that we would avoid margarines (which is a essentially a highly processed food) or other processed vegetable oil products — you will find that lots of heart charities still encourage our patients to switch to margarine but you should also consider that companies like Unilever (which produce Flora) are very influential and contribute large amounts of sponsorship.
Bottom line — a low fat diet which replaces the fat food calories with refined carbohydrates, sugars or diet products is damaging to your health. Favour protective fats with marine based or plant based unsaturated fats in your diet.
20 mins of cardiovascular exercise everyday
A full appraisal of the effects of exercise on cardiovascular health is a topic for another day. However it has been repeatedly shown that consistent and relatively modest sustained cardiovascular exercise has phenomenal effects on health.
For most a 20 – 30min brisk walk a day (enough to get you breathing faster and a mild sweat) is an excellent baseline. The key is to elevate and sustain your heart rate. This should become an integral part of your life — in the same category as brushing your teeth. This will lead to improved blood pressure (through relaxation and improved flexibility of arteries), better cholesterol profiles (the triglyceride fats in your blood are immediately reduced by a third after exercise) and weight optimisation. In addition it is one of the best ways to improve exercise capacity and breathlessness if you have a chronic illness.