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Eat less Fat or Carbohydrate for Good Health? The Crucial piece of the Diet puzzle

Important findings from nutrition research in the last few years has turned 20 years of dietary advice for heart disease and weight loss on its head. The new findings have been difficult to digest by many who are have been trained to think a certain way – that carbohydrate is GOOD and saturated fat is BAD. In this blog post, I hope to dispel some of the outdated recommendations for heart disease that are still very common and discuss some recent guidelines that are backed up by strong research and being endorsed by health organisations around the world as we speak.

The latest evidence from a Meta Analysis (1) tells us that the risks for coronary heart disease associated with saturated fat and carbohydrate are the same. In other words, if you take carbohydrate (for eg. rice) and exchange half the calories for saturated fat (for eg. as in cake), there is no detriment or benefit. This isn’t saying that cake is better than we thought; it’s that rice is worse.

In fact, it is particularly challenging to accept based on the evidence that high GI carbohydrate may actually lead to greater coronary risk than saturated fat. (2)

This is not to say that saturated fat is not a problematic nutrient. It most definitely is. What needs to happen is that saturated fat in the diet should be replaced by unsaturated fats, not carbohydrate. Unsaturated fats, especially polyunsaturated fats, have been shown in numerous studies to lower LDL cholesterol and increase HDL. As a consequence, healthy diets should be moderate in fat, not low in fat.

But how do we know which carbohydrate foods to cut out and which to keep?

Not all carbohydrates are created equal. Two things that will affect the quality of carbohydrates are its GI and its nutrient density. Low GI carbohydrates are digested slowly and released slowly into the blood stream allowing insulin to do its work steadily. High GI foods (where the carbohydrate is broken down very quickly causing a huge spike in the bloodstream) will require large amounts of insulin to clear up. It is therefore best to choose low GI carbohydrates are whenever possible.

Another factor that will determine which carbohydrates we need to choose is its nutrient density. Nutrient density is important because at the end of the day, the fundamental nutritional role of food is to provide the body with essential nutrients.

Both nutrient density and glycaemic index are important criteria to determine whether or not the carbohydrate is a ‘good’ one.  Both of these were used in a new model published a few months ago in the journal of Nutrition and dietetics to assess the quality of carbohydrate-rich foods. (For detailed information on the new model and recommendations, please go here: http://scepticalnutritionist.com.au/?p=369)

The model brought to light some surprising issues while confirming some familiar trends. To simplify the results, I separated them into two distinct groups, those of high quality and those of poor quality.

Carbohydrate foods of high nutritional quality – have more often

  • Legumes (eg. kidney beans, soya beans, baked beans, split peas)
  • Milk (skim milk better than full fat or flavoured milk)
  • Yoghurts (low fat yoghurt better than the full fat alternatives)
  • Vegetables (carrots, peas were better than starchy vegetables like potato)
  • Fruits (top rated fruits include orange, nectarine, mango, banana and peach)
  • Cereals like All bran, special K and sustain

Carbohydrate foods with very poor nutritional quality – have only sometimes/in small amounts

  • White rice
  • Polenta
  • Couscous
  • Biscuits
  • Donut
  • Croissant
  • Sugary drinks (cordial, soft drinks, even apple juice!)
  • Chocolate (like mars and snickers)

So how will this new model translate into how we eat on a day to day basis? It really comes down to these guidelines:

1) Decrease saturated fat intake.

Ways to do this include choosing reduced fat dairy like skim and low fat milk. When cooking meats, make sure you trim the fat. Replace butter with soft, plant based margarines.

2) Decrease carbohydrate intake 

Cut out the unnecessary carbs found in the limit list. They have very poor nutrition and are simply empty calories. If you are someone who has a lot of rice, choose the rice variety with the lowest GI, basmati rice, and have LESS of it. 1/2 – 1 cup of cooked rice is plenty.

3) Replace what you have cut back on by having more unsaturated fats.

Add unsaturated oils (such as canola, sun flower or olive oil) when cooking. Add olive oil to salads and when baking or roasting. Have a small handful of nuts everyday. Choose more fish, especially fatty fish like salmon and tuna. For a good list of unsaturated fats, go here:

http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/unsaturated-fats/

Do keep in mind that the goal is to REPLACE the saturated fats with the unsaturated, not to go overboard on oils.

In conclusion, strong evidence suggests that such a diet that is MODERATE in fat, LOW in carbohydrate, and moderate-high in protein would assist in improving your lipid profile, preventing chronic diseases like CHD and diabetes, assist in good sugar control and no doubt an ideal way to go for weight loss.

References:

1) Mozaffarian D. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials.

2) Jakobsen MU et al. Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. Am J Clin Nutr. 2010 Jun;91(6):1764-8.)


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Make this Ramadan your healthiest one yet!

Ramadan is the most spiritual month during the year for every muslim. In order to obtain the maximum spiritual and physical effects from Ramadan, it is essential that you eat well during the non fasting hours. As explained in my previous post, the fast of Ramadan can improve a person’s health but if the correct diet is not followed, it can possibly worsen it! The deciding factor is not the fast itself but rather what is consumed in the non-fasting hours.

Overeating can not only the harm the body but it is also thought to interfere with a person’s spiritual growth during the month. A diet that has less than a normal amount of food, but is sufficiently balanced will keep a person healthy and active during the month of Ramadan.

So what should the ideal ramadan diet look like? The diet should be simple and not differ too much from one’s normal everyday diet. It should contain foods from all the major food groups as shown in the plate model below.

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Many of the foods which are mentioned and encouraged are in the Holy Quran and the Sunnah also correspond to modern guidelines on a healthy diet. These will help to maintain balanced, healthy meals in ramadan.

The most commonly consumed foods by the Prophet Muhammad (peace be upon him) were milk, dates, lamb/mutton and oats. Healthy foods mentioned in the Holy Quran are fruit and vegetables like olives, figs, onion, cucumber, dates, grapes as well as pulses such as lentils. Fish is also encouraged as the Islamic law spares fish from any specific slaughter requirements, making it easy to incorporate fish in our diet.

That’s all easier said than done you say! Here are some practical tips and recipes that you can use to make your next Ramadan a more healthful one.

  • For suhoor time, make sure you include some complex carbohydrates which are found in foods like barley,wheat, oats, millets, semolina, beans, lentils, wholemeal flour, basmati rice, etc. Complex Carbohydrates are foods that will help release energy slowly during the long hours of fasting.
  • Fibre-rich foods are also excellent for suhoor time as they are also digested slowly. Examples of fibre rich foods include bran, cereals, whole wheat, grains and seeds, potatoes with the skin, vegetables such as green beans and almost all fruit including apricots, prunes, figs, etc
  • For iftaar time, nothing beats dates to break the fast. Dates provide a refreshing burst of energy and are of course an important tradition of the Prophet (pbuh). Fruit juices and milk drinks (like sherbet/faluda) will also have a similar, revitalising effect and are much more nutritious than sodas and cordials. Fruit salads, low fat yoghurt and ice cream are also ideal snacks. Don’t have to say no to the delicious fried snacks by try not to go crazy on them either. Consider alternate ways of cooking them like baking instead of deep frying. Keep in mind that the meal should remain a meal and not become a feast! (See table below for more tips for Iftar time).

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Table: Courtesy of NHS CIA guide

  • Overeating during iftaar time will leave you sluggish and unable to concentrate in prayers at night.
  • During the night, limit caffeinated drinks like coke which can dehydrate you causing headaches the next day. If you are a regular tea or coffee drinker, having them at suhoor time can prevent withdrawal headaches during the day. Or even better, use this opportunity to un-addict yourself by gradually reducing the number of cups of tea or coffee you have.
  • Lastly, make sure you drink plenty of water to ensure you are adequately hydrated during the day.

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All the best with Ramadan this year!