The document discusses changing nutrition guidelines and recommendations over the past 30 years as well as trends in obesity, diabetes, and childhood obesity in the United States. It notes that obesity rates have risen significantly in most states over the past decade and that obesity-related diseases continue to be highly prevalent. While current recommendations generally focus on reducing calorie intake and increasing exercise, some clinical studies have shown low-carbohydrate, high-fat diets can promote greater weight loss and improve health markers compared to low-fat diets. The document argues that lifestyle changes including adopting a paleo/low-carb diet, focusing on whole foods, sufficient sleep, and regular exercise are needed to lose weight and prevent obesity-related diseases.

1. October 4, 2012

2. What are we
recommended to eat?
Time Magazine, September 2011

3. Nutrition Guidelines
 Began in 1980: Food Guide Pyramid

4. Nutrition Guidelines
 MyPyramid 2005

5. Nutrition Guidelines
 MyPlate 2011

6. Do we see huge changes in
nutrition recommendations over
the last 30 years?
What do you think?

7. Are we a healthy nation?

9. ―F‖ as in Fat Report 2012
 Adult obesity rose in 16 states over the
past year (2008-2010 data). No
decreases.
 12 states have obesity rates over 30%.
 Mississippi highest (34.4%); Colorado
lowest (19.8%).
 Obesity related diseases: diabetes, heart
disease, hypertension, cancer still high.
 2030? Obesity rates will reach 44%, and in
13 states it will be over 60%!

11. Trends in Obesity
Nutrition Science Initiative

12. Trends in Diabetes
Nutrition Science Initiative

13. Trends in Childhood Obesity
Nutrition Science Initiative

14. Side Effects
 Angina (Chest pain)
 Inflammation
 Cancer
 Hypertension
 Joint pain
 Heart Attack/Stroke
 Amputations
 Blindness
 Pre-mature Death
 Mental Health

15. Side Effects

16. But…
 Obesity and obesity-related diseases
can be prevented and reversed!
 Best method?
CHANGE IN LIFESTYLE!!!

17. Are the current
recommendations correct?

18. Evidence Report NIH 1998
 In 1995, the NIH convened the first
Expert Panel on the Identification,
Evaluation, and Treatment of
Overweight and Obesity in Adults to
develop clinical practice guidelines for
primary care practitioners.
 What do they recommend?

19. Treatment of
Overweight/Obesity
 ≥ 55% energy from carbohydrates
 ≤ 30% energy from fat
 Roughly 15% energy from protein
CHO
FAT
PRO

20. What are we currently told?
 CDC: ―you must use up more calories
than you take in… since one pound [of
fat] equals 3,500 calories reduce 500-
1000 calories per day to lose 1 to 2
pounds per week.‖
 Mayo Clinic: ―when it comes to weight
loss, it’s calories that count.‖

21. What are we currently told?
 NIH Weight-control Information Network:
―to lose weight you need to take in fewer
calories than you use.‖
 ADA: ―you must eat or drink fewer
calories than you body burns off.‖
 ―Eat less, exercise more.‖

22. The issue?
 Recommendations are for general
population.
 Calories, calories, calories.
 Eat less, and exercise more!
 Too general!
 If it’s that simple why are we continuing
to gain weight? Why do people struggle
with weight loss? Why are we sick?

24. What do clinical studies show?
 Low-Carb, High Fat (LCHF) vs. Low-Fat,
high Carb (LFHC) diets.
 Randomized, controlled—not
observational.
 Challenging conventional wisdom
 Just because it’s popular belief does not
mean it’s true.

25. Low-carb Diets
 Yancy et al., 2004: 7-8 months LC
(<20% CHO/day) lost 20.7 lb. LF group
lost 10.58 lb.
 LC group:  serum Triglycerides,  HDL
 Krauss et al., 2006: in absence of weight
loss LC improve antherogenic lipid
status.
 Brehm et al., 2009: 4-6 months eating
LC (<20% CHO/day) lost 13.16 lb. LF
group lost 7.12 lb.

26. A to Z study: Weight loss
 4 ―fad‖ diets
 Atkins: low carb + high fat/protein
 Zone: 40/30/30
 Ornish: low fat; at high carbs- as much
as you want
 LEARN: health-professional diet- low-fat

27. A to Z study: findings

28. Low-Carb, Low-Fat and
Mediterrean Diet

29. Why do low-
carbohydrate, high fat diets
work?

30. Terms…just so you know
 Insulin: storage hormone; fat synthesis;
insulin resistance; anabolic
 Glucagon: release stored energy; inhibit
fat synthesis; high in fasted state
 Leptin: decreases appetite; obese are
leptin resistant
 Other shifts in metabolic hormones &
substrates based on diet.

31. Reasons for Low Carb
 Low insulin response
 High glucagon
 Increase satiety (leptin)
 Lower GI/GL
 Increase MUFA/PUFA
 Increase weight loss + fat loss
 Structuring our body’s energy production
around ―fat burning‖ rather than ―sugar
burning.‖

32. Why fat is better?
 Stores more energy
 Efficient fuel
 Preferred fuel in every day situations
 Quick to mobilize
 Need machinery to use it

33. Becoming Keto Adaptive on Low
Carb
 Ketone bodies: byproducts of fat
metabolism
 Keto adaptive vs ketosis vs ketoacidosis
 What are the benefits?
 Brain fuel,  ROS,  insulin sensitivity,
protein sparing, better recovery, improve
body composition
 Any side effects?
 Initial: fatigue, headache, alcohol breathe

34. Conclusion
 Short-term (4-8 months): LCHF diets are
effective and safe for weight loss.
 Long-term(>12 months): Effective but
weight regain occurs over the long-term.
 Keto adaptive is beneficial.

35. Now…time for the good
stuff!

36. Steps for change
 Step 1: Evaluate Lifestyle
 Step 2: Strengths + Weaknesses
 Step 3: Implement change
 Step 4: Success + Evaluate what works
(and doesn’t work)
 Step 5: Continue Awesomeness

37. Lifestyle Checklist for weight
loss
 Look at 5 things:
 Nutrition
 Sleep
 Exercise
 Family/work/social
 Psychology/Emotional
Weight loss is a team effort–
trainers, family, friends, doctors and
therapists, etc. Just find the right ones!

38. Nutrition: Tips and Tricks
 Paleo/LCHF
 50-100g of carbs/day
 Learn to cook/make your
own meals!
 Family cooking
 Eat Whole Foods
 Bag, box? More than 5
ingredients?

39. Paleo

40. What does a 100g Carb day
look like?
Food CHO (g)
1 kiwi 5.4
½ cup blueberries 10.0
2 tbsp salsa 2.0
1 cup broccoli 11.2
1 cup kale, steamed 7.3
1 cup apple suace 28
½ cup sweet potatoes 18.7
1 cup green beans 9.8
Total: 92.4 g

41. Nutrition: Tips and Tricks
 Shop the perimeter of grocery store

42. Nutrition: Tips and Tricks
 Eat every 3-4 hours
 Intermittent fast (IF)
 Don’t drink your meals
 No fruit juices, sports drinks, diet pop, skim
milk
 Fish Oil: at least 2g DHA/EPA per day
 7g of standard fish oil or 2-3 g concentrated
 High-dose: increase weight loss
○ I recommend at least 10 g per day; cycle for
4-6 weeks

43. Read a Fish Oil Label
Fish Oil 1: Good or Bad Fish Oil?

44. Read a Fish Oil Label
Fish Oil 2: Good or Bad Fish Oil?

45. Read a Fish Oil Label
 Fish Oil 1: One soft gel= 1,000 mg fish
oil (or 1g). EPA= 180mg; DHA = 120mg
 2g EPA/DHA recommended
 Let’s look at DHA specifically so use (.120g
=120mg)
 So… 2g/0.120g DHA = 17 soft gels!
 Fish Oil 2:
 4 capsules = 4,000 mg (or 4g). EPA
=1600mg; DHA =800mg.
 So…2g/.800g = 2.5 x 4 = 10 capsules

46. Fish Oil 1: Fish Oil 2:

47. Nutrition: Tips & Tricks
 Eat slowly and stop at 80% full
 Include protein dense foods with each meal
 Consume 1- 2 vegetables with each meal
 Eat diary if you tolerate it—if so, go full-fat.
 Fat: eat it!
 Avocados, olive oil, nuts (once/day), animal fats,
bacon (mmmm), cheese, grass-fed butter, ghee.

48. Put into Practice
 Time course:
 Today: evaluate lifestyle
 Next 2-3 weeks:
○ Educate yourself: books, blogs, websites
○ See doctor- blood work: fasting insulin,
Hba1c, Lipid panel (esp. apoB and small-
dense LDL), CRP, kidney & liver, Vitamin D,
calcium
○ % body fat + Lean Body Mass- get checked
 See me!
○ Paleo + LCHF: 4-6 Months

49. Nutrition: Things to Avoid
 Do not consume the following:
 Sugar, brown sugar, sugar
cane, HFCS, honey, maple syrup, etc.
 Anything label ―enriched,‖ ―low-fat‖ or ―reduced.‖
 Eating out
 Artificial Sweeteners: Splenda, Sweet n
Low, Equal (Aspartame)
 Grains: whole grains, cereals
breads, muffins, scones, cookies, baked
goods, even gluten-free
 Legumes: beans, peanuts, soy
 Alcohol: all forms (except wine & 100% agave
tequila)
 Vegetable Oils: canola oil, rapeseed oil.

50. What foods should I buy?

51. Proteins
 Grass-Fed red meat
 Wild Game: bison, elk, deer, bear
 Salmon (wild)
 Eggs (cage-free, free-range)
 Chicken, duck, wild turkey
 Plain Greek yogurt, cottage cheese (full
fat), coconut milk yogurt

52. Vegetables
 Spinach, Kale (all kinds), mustard
greens, collards
 Tomatoes, peppers, cucumber
 Cruciferous vegetables
(Broccoli, cabbage, cauliflower)
 Brussel Sprouts, mushrooms
 Tubes/Root Vegetables*:
parsnips, turnips, sweet
potatoes, beets, carrots

53. Fruits
 Raspberries
 Blueberries
 Blackberries
 Kiwi
 Oranges (whole)
 Cantaloupe

54. Fats
 Extra virgin Coconut oil
 Palm kernel oil
 Avocados
 Extra virgin olive oil
 Fish oil (EPA/DHA)
 Flax seeds (ground)
 Raw, mixed nuts & seeds
 Hidden fats in fish/meats

55. Liquids
 Coffee (black
preferred)
 Tea – no
sweetener
 Water
 Alcohol - leave it
to a minimum

56. Design the Right Meal
 Step 1: pick a protein
 Lean/fatty cut? Fish?
 Step 2: pick 1-2 vegetables
 Step 3: pick your fat
 Avocado? Cooking oil?
 Step 4: pick your Liquid
 Step 5: grub!

57. Lifestyle Checklist for weight
loss
 Look at 5 things:
 Nutrition
 Sleep
 Exercise
 Family/work/social
 Psychology

59. Exercise: Fuel to Perform
 Idea ―Burn Fat during Exercise‖ – needs
to be forgotten (one exception)
 Fuel to perform—body prefers CHO at
high intensities (no oxygen around)
 ―Anaerobic state‖
 Eat CHOs around your workout.
 Fruits + Vegetables
 Pre-WOD honey/applesauce

60. Exercise as a Tool
 Wellness and weight loss tool.
 Functional, constantly varied
movements.
 CF + nutrition = (fast) results
 ―Cherry-picking‖ workouts
 If you suck at something, continue to do it.

61. m

62. Websites to Visit…
Mark’s Daily Apple – Mark Sisson
Livin’ La Vida Low Carb – Jimmy Moore
Wellness Fx
Mother Nature Obeyed – Chris Masterjohn
Paleo Solution- Robb Wolf
Chris Kresser – Chris Kresser
Whole 9 Life- Dallas & Mellissa Hartwig
Paleo Physicians Network
Ground Up Health – Collin Popp

63. Overall: Weight Loss Keys
 Evaluate lifestyle
 Paleo + LCHF
 Keto adaptive
 Avoid sugar, grains, legumes, processed
crap
 Exercise as a tool
 Constantly varied, functional diet!
 If you eat crap, your body will turn into
crap. Don’t turn into crap!

64. Questions???

65. Worksal.Cited
Yancy et ―A low-carbohydrate, Ketogenic Diet versus a
low-fat diet to treat obesity and hyperlipidemia.‖ Ann Inter
Med. 2004, 140: 769-777
 Krauss et al. ―Separate effects of reduced carbohydrate
intake and weight loss on atherogenic dyslipidemia.‖ Am
J Clin Nutr 2006, 83(5):1025-1031
 Brehm et al. ―A randomized trial comparing a very low
carbohydrate diet and a calorie-restricted low fat diet on
bdoy weight and cardiovascular risk factors in healthy
women.‖ J Clin Endocrinol Metab. 2003;88:1617-1623
 Gardner et al. ―Comparison of the Atkins, Zone, Ornish
and LEARN diets for change in weight and related risk
factors among overweight premenopausal women.‖
JAMA 2007; 297:969-977.
 Shai et al. ―Weight loss with a low-
carbohydrate, mediterranean or low-fat diet.‖ N Engl J
Med 2008;359: 229-241.