Saturday, 28 May 2011

Diet Transforms Canadian Community or there's more than one way to skin a cat

A little local trouble on a diabetes forum caused me to look the blog of a Canadian doctor. This particular blogger advocates the low carb/high fat approach. He has been working with groups from the Canadian First Nations.
On this blog I also noticed a favourable account of a doctor helping large numbers of people in his small community to loose weight. Stefan du Toit,a South African doctor now working in rural Canada is using a diet that is low carbohydrate, but at the same time not high in fat .The blog told me that he has so far helped over one hundred of his patients to, between them, loose over 3000lbs . Some have lost over 90lbs and many have managed to reduce medicines. Success indeed.

I thought I'd investigate this diet a bit more.
and second shorter video from CBS adds a bit more information

Looking elsewhere ,I found a short article on the British Columbian Medical Journal. The results are impressive and there was a chart for one man with diabetes. It showed an HbA1c dropping from over 10% in January 2009 to about 5.4% in November 2010. His total cholesterol/HDL ratio dropped from over 6 to about 3.5 and his blood pressure also fell..
I learned that the diet had 1100 calories allocated for women and 1500 calories for men. Apparently, in spite of the fairly low calorie intake there is only about a 10% drop out. And it appears that some people at least have stuck to it for 2years.

The details of the diet are rather sparse , the doctor deliberately doesn't reveal very much . He stresses that it needs to be followed under medical supervision and of course that's really important if people need to reduce medications. He also suggests that the changes of diet may lead to electrolyte imbalances in some people
Nevertheless, as an exercise I had a go at working out what the diet might 'look' like.

From the info in the article and videos
it's a healthy eating programme
It's a low GI/low carb diet
Avoids processed /refined carbs
Its not a high protein diet or a' ketosis' diet.
It's a balanced diet that conforms to the Canada Food guide. Therefore can't be high in sat fat
Exercise isn't included whilst the person is losing weigh.(The doctor claims this is because it stimulates appetite but when the person has lost weight exercise is started. I assume this may help with maintenance.)
There may be some sort of induction, the man interviewed talks about the first month
In the original blog the author said he thought that people are started off with 80g carb per day.
It has a high success rate and seems sustainable for up to 2 years
I found an article that said it included 3 meals and no confirmation of that though

The Canadian recommended dietary intakes are very much the same as elsewhere in the world
Recommendations for macronutrients for people over 19
45-65% carbohydrates
estimated average requirement is 100g .
The RDA and AI ( adequate intake) is 130g
10-30% protein
The EAR for protein is .66g per kilo,
the RDA and AI is 0.80g per kilo
25-35% fat
men should eat 45g unsaturated fat, women 30g.
Saturated and trans fats plus dietary cholesterol should be kept low.

I did some figure juggling, using the woman's calorie intake example.
I tried 80g carb
80g carb = 320 calories : 29% of 1100 so already below guideline minimum, to get the rest of the calories would require either protein or fat to be above the levels of the guidelines: it wouldn't be a balanced diet. The figures don't work. So if the diet does start at this low level it is perhaps only for a short time.

A bit more juggling comes up with a distribution that seems to fulfil the criteria I found. (aprox figures)
130 g carb = 47% of 1100 calories = 520 calories
34g of fat = 28% of 1100 calories = 306 calories
68g protein = 25% of 1100 calories = 272 calories
That (if I haven't made a mistake) works out at 1098 calories and conforms to the guidelines and is low carb, low fat and not high protein..
(though protein is higher than that often suggested for people with reduced kidney function as it would work out at more than 0.8g/k of most women's ideal weight)

The Canadian guidelines also include advice on eating lots of fruit and veg , some grain with a preference for whole grains, plus fish/meat/alternatives's suggested that pulses replace meat/fish for some meals, dairy and unsaturated fat (oil dressings)
It wouldn't be too difficult to work out the types of meals that you could eat. (my guess is that it will include lots of veg, some fruit, smaller portions of meat/fish and that he might make good use of low GI beans/lentils ) .

The difficulty with dieting; whatever the diet is sticking to it, to be honest I think a 1100 calorie would be hard for many people . Some people can stick with diets by sheer determination, you meet many such people on diabetes forums, the risks of high blood glucose levels forms the motivation. Not all people are that 'strong' though . I'm sure a charismatic doctor and the group sessions play a prime role in helping people maintain their diet. If a lot of people in a small community are following the diet, then this type of eating pattern becomes the norm. It must be much easier to stick t
Actually if I've got the type of diet right,(and this is only a paper and pen exercise to examine what it might look like.. Don't try it , I'm not a dietitian!), it doesn't seem that different to many commercial low calorie diets with support for example weightwatchers or Rosemary Conley.There are also lots of similar diets on the internet including one by Amanda Ursell, a well known member of the BDA, writing in the Times

Dr du Toit deserves big credit though, getting his community on board and been instrumental in improving so many of his patient's overall health. It would be great to see this sort of approach being tried elsewhere.
(I'm still not sure about the lack of exercise element though)