Can kids ‘Bant’?

By Tamzyn Murphy

BSc Med(Hons) Human Nutrition and Dietetics, RD

 

We await the verdict of Prof Tim Noakes’ HPCSA trial over a tweet in which he “advised” a mother to wean her child onto LCHF food. In the meantime let’s take a closer look at the evidence regarding Banting and kids…

 

Today’s children are the first generation expected to live shorter lives than their parents [1]. We are seeing more overweight children and adolescents than ever before [2, 3]. And we know that overweight children are likely to grow up into overweight adults, with associated health risks (e.g. heart disease and diabetes) [4]. It is clear that the way most children are eating is not doing their health any favours.

 

If we always do what we’ve always done, we’ll always get what we’ve always got

 

Sickly sweet South African kids

Eating too much sugar is associated with dental caries and increased obesity risk [3]. Both of which are prevalent health concerns amongst South African children.

 

We know that children and adolescents in South Africa, and across the globe, eat more sugar than adults. In fact one study reported that South African children eat about 50g (12.5 teaspoons) of sugar each day, while South African adolescents consume as much as 100g (25 teaspoons) per day [3]. This represents 10-20% of daily calorie consumption [3]. South African adults on the other hand, are thought to be eating approximately 38-51g (9-13 teaspoons) of sugar each day, contributing 10-15% of their calories [3].  The World Health Organisation’s guidelines recommend a maximum of 5% of daily calories from sugar – that’s no more than 7 teaspoons daily from all sources. Reducing or even eliminating our children’s added sugar consumption can only be good for their health.

 

Most medical practitioners and scientists will agree that drastically reducing or even cutting out children’s sources of added sugar can only be good for them. But the question remains, can children safely following a low carbohydrate, high fat (LCHF) diet (popularly known as Banting in South Africa), that’s devoid of starches and wholegrains as well as sugar?

 

Evidence: very LCHF diets in children

Although, very little research has been done on LCHF eating in children, a few studies have shown that overweight  kids and teens (6-18 years of age) who followed a LCHF, containing less than 60g of carbs each day, successfully lost weight, without negatively affecting the levels of fat and cholesterol in their blood [5, 6]. The authors suggest that reducing dietary carbohydrate may be a possible treatment for insulin resistance in children and adolescents.

 

Of note, a very low carbohydrate, ketogenic diet has been successfully used to treat childhood epilepsy for almost a century [7]. A modified version of the Atkin’s diet, also very low in carbohydrates (it only contains 10g), but easier to follow than the ketogenic diet (as, unlike the ketogenic diet it doesn’t also limit calories and protein), has been used successfully for the same purpose for over a decade. Unlike protein and certain fats, dietary carbohydrates are not essential nutrients – our bodies can make them from scratch to use as fuel. So it’s not surprising that both the ketogenic and modified Atkin’s (probably more so than the ketogenic diet, which also limits protein and calories) diets are considered safe when used in conjunction with multivitamin and calcium supplementation [8, 9].

 

“Banting” for children needn’t be very low carb

It’s important to bear in mind that most children who follow a LCHF don’t need to drastically restrict carbohydrates to the ketogenic levels (<60g per day) investigated in the studies discussed above (A LCHF diet typically provides 20-120g of carbohydrate daily or 5-30% of total energy intake). So, while added sugar, starches and grains will be eliminated from their diets, other wholefood sources of carbohydrates won’t be excluded (e.g. dairy, starchy vegetables, nuts, seeds, fruit and even properly prepared legumes).  I recommend that children only restrict their carbohydrates to below 60g under the supervision of a dietitian or knowledgeable medical doctor.

 

Provided that a child consumes the recommended 3 portions of dairy daily and eats enough vegetables, supplementation shouldn’t be any more necessary on this diet than with any other. While I don’t suggest being too restrictive about children’s starchy vegetable, fruit and nut consumption, excluding starches (in the form of grains) and added sugar from children’s diets shouldn’t pose any health risk and will likely come with a host of benefits. Especially considering that these restrictions are done in the context of a diet that emphasises avoiding processed food, while eating REAL, nutrient dense foods.

 

“Banting” for kids simplified

  • Eat real food. Avoid processed food.
  • Eat freely: Avocados, olives, other vegetables, dairy, fish, poultry, meat (including organ meats), eggs, butter, olive oil, coconut oil
  • Eat moderate amounts: Fruit, nuts, seeds, properly prepared legumes (beans, peas, lentils)
  • Exclude: Added sugar (in all its forms), processed food, grains (although it’s likely fine to include limited amounts of the less irritating grains such as oats or quinoa)

 

References 

[1] Olshsky SJ, Passaro DJ, Hershow RC, et al. A Potential Decline in Life Expectancy in the United States in the 21st Century. N Engl J Med 2005; 352:1138-1145 

[2] Gupta N, Goel K, Shah P, Misra A. Childhood Obesity in Developing Countries: Epidemiology, Determinants, and Prevention. Endocrine Reviews. Jan 2012;33(1) 

[3] Steyn N, Temple NJ et al. Evidence to support a food-based dietary guideline on sugar consumption in South Africa. BMC Public Health. 2012;12:502

[4] Singh AS, Mulder C, Twisk JWR, et al. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity Reviews. Sep 2008;9(5):474-88 

[5] Gow ML, Ho M, Burrows TL, et al. Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obesechildren and adolescents: a systematic review. Nutr Rev. 2014 Jul;72(7):453-70. 

[6] Sondike SB, Copperman N, Jacobson MS. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr. 2003 Mar;142(3):253-8. 

[7] NICUS. The Ketogenic Diet…Fa(c)t or fiction? 2007

[8] Tonekaboni SH, Mostaghimi P, Mirmiran P, et al. Efficacy of the Atkins diet as therapy for intractable epilepsy in children. Arch Iran Med. 2010 Nov;13(6):492-7. 

[9] Suo C, Liao J, Lu X, et al. Efficacy and safety of the ketogenic diet in Chinese children. Seizure. 2013 Apr;22(3):174-8. 

Best first food for baby: Meat vs cereal

By Tamzyn Murphy

BSc Med(Hons) Human Nutrition and Dietetics, RD

 

South African personality, sports scientist and Emeritus UCT Professor Tim Noakes is making news headlines again as the second and last day of the closing arguments of his “Baby Banting” trial before the Health Professions Council of South Africa (HPCSA) commences. The council is investigating Noakes for giving unconventional and un professional advice. The complaint laid by Association for Dietetics (ADSA) president, Claire Julsing-Strydom, is over ‘advice’ that Noakes tweeted in response to a mother’s query regarding the best food to introduce to her baby. Noakes advised the mother to introduce low carbohydrate, high fat (LCHF), Banting-friendly foods (which include meat and vegetables) to her baby from 6-month of age.

While the HPCSA will determine whether babies should or shouldn’t Bant, it is clear that Noakes is right about at least one thing: meat is far superior to cereal as babies’ first food. Health authorities’ recommendations that meat, meat alternatives (like eggs) and iron-fortified cereal are the best first food for babies imply that these are options are nutritional equals [1]. They are not. Here’s why meat beats cereal hands down.

 

Meating babies’ nutritional needs

Iron deficiency is very common in children in South Africa [2,3], and across the globe [4]. Many infants also don’t eat enough iron [2]. Infants with iron deficiency have impaired growth, mental development and problem solving ability [4]. Iron deficient babies score worse for mental and motor functioning when they’re older too [4]. By 6 months of age babies run out of iron stores [4]. Meat, fish and poultry are rich sources of the most readily absorbed heme form of iron. The iron contained in iron fortified cereal on the other hand, is in a non-haem form that is very poorly absorbed [4].

Meat, liver, poultry and fish – given as babies’ first foods in many traditional societies [1] – were the obvious iron-rich first foods to be introduced to babies before iron-fortified cereals were available. Since iron-fortified cereal was introduced it has replaced meat as the first food of choice for babies [4]. Not only is it a poor replacement as a source of bioavailable iron, but it also contains anti-nutrient phytates, which interfere with iron absorption, thereby reducing its bioavailability even further [2]. Therefore, cereal, even if it’s fortified with iron, may not be able to provide the iron that 6 month olds so desperately need.

Interestingly, zinc deficiency is also very common in babies and children. Meat is an excellent source of zinc. Introduction of meat as opposed to cereal as an early complementary food for exclusively breastfed infants is associated with improved zinc, iron and protein intake.  Babies fed meat instead of cereal have a higher head circumference and possibly also improved psychomotor development [5].

 

A weighty issue

Dietitian text books recommend that sugar and salt are not added to babies foods. Yet in the same breath they say that fortified infant cereal – usually packed with added sugar – is the first food to be introduced to babies [4].

Dietary sugar is linked to dental caries and the development of obesity and other lifestyle-related diseases. Even if parents do find baby cereal options that don’t include added sugar, they are still very refined (processed) and incredibly high in fast-release (high GI) carbohydrates.

Introducing cereals and fruit as babies’ first solid food is linked to the development obesity later in life [6]. Meat contains no carbohydrate and is high in fat and protein. A high fat intake during babies’ complementary feeding period doesn’t appear to increase their risk of becoming obese later [7]. There has been concern that high protein intake during infancy promotes weight and fat gain. However, a recent study indicates that this only holds true for high levels of protein from cow’s milk in formula fed infants. Breastfed babies who were fed meat instead of cereal, gained more weight and grew taller than those fed cereal, but they didn’t get fatter [8]. This indicates that higher protein levels from meat may not be linked to fatness after all.

Parents and health professionals await the outcome of Noakes’ HPCSA trial with bated breath. For now though, at least one aspect is clear: introducing ‘Banting-friendly’ meat to babies is a far better option than introducing cereal. From 6 months of age, babies should be offered pureed meat, liver, poultry, fish and eggs, progressing to the introduction of a variety of foods from family meals, such as vegetables mixed with pasture-fed butter, olive oil or breastmilk. Breastmilk continues to be the main source of nutrition throughout the first year. Breastfeeding is recommended for at least one year whenever possible, and preferably for up to two years or beyond.

 

References

[1] Health Canada. Nutrition for health term infants: Recommendations from six to 24 months. 24 Mar 2014

[2] Faber M, Wenhold F. Nutrition in contemporary South Africa. AJOL. 2007;33(3):393-400

[3] Visser J, Herselman M. Anaemia in South Africa: the past, the present and the future. S Afr J Clin Nutr. 2013;26(4):166-167

[4] Mahan LK, Escott-Stump S. Krause’s Food & Nutrition Therapy. International Edition 12. Saunders Elsevier. 2008

[5] Krebs NF, JE Wescott, N Butler, et al. Meat as a First Complementary Food for Breastfed Infants: Feasibility and Impact on Zinc Intake and Status. J Pediatr Gastroenterol Nutr. Feb 2006;42(2)

[6] Caroli M, Mele RM, Tomaselli MA, et al. Complementary feeding patterns in Europe with a special focus on Italy. Nutr Metab Cardiovasc Dis. Oct 2012;22(10):813-8

[7] Michaelsen KF, Larnkjaer A, Molgaard C. Early diet, insulin-like growth factor-1, growth and later obesity. World Rev Nutr Diet. 2013;106:113-8

[8] Tang M, Krebs NF. High protein intake from meat as complementary food increases growth but not adiposity in breastfed infants: a randomized trial. Am J Clin Nutr. Oct 2014;ajcn.088807

Diets that do and diets that don’t: Part 1 – The New Atkins Diet

By Tamzyn Murphy

BSc Med(Hons) Human Nutrition and Dietetics, RD

 

People across the globe are getting fat and desperate – a profitable situation for those peddling fad diets. Obviously conventional nutritional wisdom has failed us – eating fewer calories (particularly less fat) and burning more by exercising doesn’t cut through the flab. It appears that our will-power just isn’t strong enough to overcome the hunger that goes with this kind of advice. Authorities’ recommend that we base our eating on carbohydrate-filled food, with less than 30% of calories from fat and about 15-20% from protein. Much of these carbs come from refined starches and sugar, making our insulin levels skyrocket, which puts our bodies into fat-storage mode and makes us even hungrier. But before that sends you running into the arms of the latest diet, make sure you know which ones work and which are doomed to failure.

 

New Atkins Diet[i]

Atkins is a low carb diet – one of the stricter versions. You shouldn’t be hungry on this diet though and calories aren’t restricted. Most people think low carb diets are high in protein and low in fat. Thankfully this isn’t usually the case – fat keeps hunger at bay and the right types promote good health; while excessive protein could be dangerous. Low carb diets are typically high in fat (60% or more) and moderate in protein (about 25%). The aim is to keep insulin levels low by restricting carbs, thereby reducing hunger and fat-storage, and retraining the metabolism to burn fat instead of carbs.  They’re great for weight loss. And recent evidence indicates they may also reduce heart disease, diabetes and metabolic syndrome risk.[ii] They’re particularly beneficial for those with insulin resistance or pre-diabetes.[iii]

There are four phases to the New Atkins diet – an updated version of Atkins. Phase 1 is really strict, allowing only 20g of carbs a day – mainly from low carb veggies. As you move through the phases you gradually increase the amount of carbs you’re allowed according to the “Carb Ladder” – adding nuts, seeds, low carb fruits, certain dairy products and some legumes. During this process you’re supposed to learn what your individual carbohydrate tipping point is – eat less carbs and you lose weight, more and you gain weight. By the end you should have lost all of your excess weight and know how to make this diet a permanent lifestyle fixture to maintain your weight and optimise health.

Critics claim the high fat content, particularly saturated fat, of low carb diets is bad for heart health but recent evidence refutes this.[iv] Others worry that excessive protein puts strain on the kidneys and leaches calcium from the bones, but the protein content of these diets isn’t typically excessive and there’s no evidence that it negatively impacts on kidney[v] or bone health.[vi] Where casual Atkins dabblers go wrong is they use it as an excuse to pass up on vegetables, gorge in processed food and deep fry everything.

 

References

[i] New Atkins. 2011 

[ii] Azadbakht L, Izadi V, et al. Effect of a High Protein Weight Loss Diet on Weight, High-Sensitivity C-Reactive Protein, and Cardiovascular Riskamong Overweight and Obese Women: A Parallel Clinical Trial. Int J Endocrinol. 2013;2013:971724. Published online: Aug 2013 

and

Noakes TD, Windt J. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. Br J Sports Med 2017;51:133-139 

[iii] Feinman RD, Pogozelski WK, et al. Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition 2015;31:1-13

[iv] Siri-Tarino PW, Sun Q, et al. Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr 2010;91:502–9

and

Harcombe Z, Baker JS, et al. Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis. Open Heart 2015;2:e000196.

[v] Brinkworth GD, Buckley JD, et al. Renal function following long-term weight loss in individuals with abdominal obesity on a very-low-carbohydratediet vs high-carbohydrate diet. J Am Diet Assoc. 2010 Apr;110(4):633-8 

[vi] Farnsworth E, Luscombe ND, et al. Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women.

The first Prof Tim Noakes ‘Banting’ lecture that I ever attended

“At any given moment there is an orthodoxy, a body of ideas which it is assumed that all right-thinking people will accept without question… A genuinely unfashionable opinion is almost never given a fair hearing, either in the popular press or in the highbrow periodicals.” – George Orwell, Animal Farm, 1945

 

By Tamzyn Murphy Campbell

BSc, BSc Med(Hons) Human Nutrition and Dietetics, RD

 

It’s January 2013. Waiting for his talk to start, in his grey suit and Nike trainers, Professor Tim Noakes looks far trimmer than when I saw him last, five years ago at a talk on University of Cape Town’s medical campus. His weight loss should come as no surprise though, considering he’s been following his own advice, avoiding carbohydrates, which he claims is the key to solving our global obesity epidemic.

“I’ve been declared officially mad by my faculty,” begins Prof Noakes. Despite being shunned by his peers for his unconventional dietary advice, Prof Noakes appears happy and relaxed and impossible not to like with a big friendly smile stretched across his face. Maybe it’s insanity that’s got him so at ease in the face of scorn. Or perhaps he’s just calmly confident that he’s right. As he explains later in the talk, he has acted ethically by correcting the misconceptions responsible for our ill health as soon as he became aware of them.

Let me walk you through Prof Noake’s argument and then you decide on which side of the nutritional fence you’d like to sit.

 

WHY THE CONTROVERSY?

It’s accepted as fact that we get fat because we eat too much and exercise too little: the twin sins of gluttony and sloth. The prevailing belief is that a high fat intake promotes weight gain and heart disease. Authorities say that saturated fat (mainly from animal-derived food sources) raises cholesterol, which in turn clogs our arteries leading to heart disease. This knowledge stems from the Seven Country Study, published in 1963 and conducted by a scientist called Ancel Keys who found that men in countries with diets high in saturated fat suffered from more heart disease. What Keys failed to mention was that countries that didn’t support this finding were left out of his study. He also failed to report that heart disease incidence happened to increase with a higher sugar intake.

Flying in the face of what we accept as the fundamental truths of nutrition, Prof Noakes declares that fat doesn’t raise cholesterol and cause heart disease nor promote weight gain and we certainly aren’t getting fat because we’re eating too much and exercising too little. He doesn’t expect us to blindly believe him though, presenting us with statistics and cutting-edge scientific intervention and review studies that back up what he has to say. This unconventional opinion, especially from such a well-published and respected scientist, has thrown the South African scientific and medical community into a furor. But according to Prof Noakes, the most outraged are those scientists who are receiving funding from the food industry.

 

MONEY, POLITICS & CORRUPTION

“It is difficult to get a man to understand something, when his salary depends on his not understanding it,” quotes Prof Noakes when a member of the audience asks how we can possibly believe him when so many scientists disagree. The food industry’s lifeblood is tasty and addictive food and beverages, packed full of carbohydrates and sugar. According to Prof Noakes, if South Africa’s university departments who rely on industry funding – such as cardiology, pharmacology or nutrition – were to speak out against carbohydrates and sugar (or the efficacy of prescription medication in the case of pharmacology faculties) then their research funding would be pulled and their departments may as well shut down.

Prof Noakes says that a researcher who acts as industry’s mouthpiece stands to gain a lot of money and exposure: “These companies will support any researcher that will stand up here and punt exercise to lose weight [in order to avoid recommendations that’ll reduce their sales]”. He goes on to say that industry-funded study results are biased, misleading and often downright wrong. “Ninety-five percent of nutrition advice is based on association studies,” Prof Noakes explains, “and 85% of association studies are wrong.” Association studies show how factors change in relation to each other but are unable to show that one factor causes the other. For example, in Ancel Keys’ Seven Country Study heart disease increased in countries that had higher saturated fat consumption. This doesn’t mean that saturated fat caused the increased heart disease. Other factors could be to blame. As it turns out, sugar consumption happened to increase along with saturated fat in these countries and could possibly explain the increased heart disease risk.

According to Prof Noakes, the two biggest funders of US nutrition research, the National Institute of Health and the US government, will only fund studies that show that high carbohydrate intake is healthy.  This is following a decision made by the US senate, in 1977, to fund corn, soya and vegetable oil agriculture, and the development of US dietary guidelines in the same year recommending that Americans get 50–60% of their total daily energy from carbohydrates, while limiting dietary fat and cholesterol. Prof Noakes explains that these decisions were made to be in line with what grain farmers and the major industry-controlling food companies wanted.

 

CARBS MAKE US FAT

Prof Noakes explains that we’ve genetically evolved to eat a low carbohydrate diet, saying that we don’t actually need to eat carbohydrate to survive, whereas protein and fat are essential for survival. Also, it appears that our calorie and carbohydrate consumption has increased concurrently with obesity over the decades, but our fat intake has remained relatively constant. This implies that it’s not the fat that’s to blame for our ballooning waistlines.

So if Prof Noakes is right and carbohydrates really are to blame, then how do they do it? Prof Noakes claims that carbohydrates upset the body’s natural energy-regulation ability – your homeostat that’s supposed to balance your calories consumed with the calories you burn (calories in versus calories out).  Eating more carbs these days means we’re getting lots of glucose into our bloodstreams. Our bodies have to secrete more of the hormone insulin to keep these potentially damaging glucose levels under control. And as it turns out, insulin promotes fat storage and makes us eat more.

Prof Noakes says that insulin promotes liver triglyceride (fat) production and storage, leading to metabolic problems including diabetes and obesity.[1] Insulin also encourages fat storage in adipose tissue (fat stores), particularly in those who’re genetically predisposed, thereby promoting weight gain. According to Prof Noakes, those who are naturally carbohydrate resistant consistently oversecrete insulin in response to eating carbs. This consistently high insulin means that dietary carbs are continuously being converted to fat and stored away for a rainy day.

All of this carbohydrate conversion and fat storage leaves little energy available to your cells, so you quickly get hungry again, craving a quick-release energy source like, you guessed it, carbohydrates. And so the vicious cycle begins. Prof Noakes says that since he’s been on his low-carb diet he only gets hungry every 16–24 hours. To make matters worse it turns out that carbs are addictive. They temporarily boost the pleasure chemicals in your brain and your mood. Then they drop again, leaving you craving your next carbohydrate fix. “Addictive food choices cause obesity in those with insulin resistance,” says Prof Noakes, “it took me 14 months to stop adding sugar to my tea and coffee but it’ll take me one day to go back.”

 

SOME AND NOT OTHERS

Why then do only some of us get fat on a high-carbohydrate diet, while others can eat what they like and stay lean? Prof Noakes explains that if you’re genetically prone to carbohydrate or insulin resistance, as most of us are, then your body goes into fat production and storage mode in response to carbohydrates and insulin, resulting in constant hunger, inactivity and, consequently, weight gain. If you’re one of the lucky few who can eat what you like and stay lean then your body is better able to utilise carbohydrates as a fuel source rather than storing it as fat in response to insulin. Prof Noakes says that the amount of dietary carbohydrates different people can tolerate varies. “The difference between being lean, as I am, or fat is 25g of carbohydrates,” claims Prof Noakes. This amount is very low. Most people will be able to lose excess fat and maintain a stable healthy weight at somewhere between 20 and 120g of carbohydrates daily.

Prof Noakes also implicates carbohydrates in the dreaded middle-age spread: “As we get older we get more carbohydrate resistant”. So if you could eat what you liked in your youth but are now finding that a spare tire has settled around your middle, cutting all starches and sugars may help you maintain a svelte shape.

 

CARBS MAKE US SICK

“Eighty percent of diseases are caused by nutrition.” According to Prof Noakes, carbohydrates aren’t just to blame for the obesity epidemic but also for the chronic diseases that plague modern society. “There’s one cause [carbohydrates], one treatment [cutting carbohydrates] for all conditions,” reveals Prof Noakes – listing diabetes, cardiovascular disease, metabolic syndrome, high blood pressure, gout, cancer and even Alzheimer’s. Prof Noakes calls insulin the aging hormone, saying, “Alzheimer’s is caused by high insulin” and “cancer, specifically colon and breast cancer, is driven by high insulin”.

Prof Noakes addresses critics’ main arrow in the quiver against a low-carb diet, being that its high fat content increases heart disease risk. It turns out that well-designed, up-to-date research indicates that saturated fat appears to have no effect on death rates[2] and heart disease.[3] A higher carbohydrate intake, on the other hand, increases all the heart disease risk factors.[4] It boosts levels of fats, bad cholesterol (small LDL), insulin and glucose in the blood, while reducing the good cholesterol and boosting your belly.

“If you are eating these [starches] then that’s what you will die from,” Prof Noakes acknowledges with a sad smile.

 

TIPS

If you struggle with your weight, get hungry every three hours or so and dread exercise then Prof Noakes explains that you’re probably carbohydrate resistant and can benefit from cutting down on dietary carbohydrates. His advice? “If it doesn’t occur in nature, don’t eat it.”

A low-carbohydrate diet is typically high in fat and moderate in protein. You’ll need to cut out all grains, sugar and trans fats. Stick to meat, poultry, fish, eggs, vegetables (like spinach, broccoli, tomatoes, mushrooms, lettuce, cucumber, carrots), nuts, avocado pear and olive oil. Prof Noakes warns to stay away from most other vegetable oils though, specifically those high in pro-inflammatory and blood-clotting omega-6 fats like sunflower and corn oils. Full-cream or low-fat dairy products are acceptable in moderation. Depending on how much carbohydrate you can tolerate before you start to balloon, you may even be able to squeeze in a few legumes, a touch of starchy vegetables and low-sugar fruit (like berries and apples) – though it’s probably best to tread with caution when trying these food items on your low-carb diet. Prof Noakes cautions to watch out for sweet beverages, advising sticking to unsweetened water, tea and coffee. And he suggests that most people could benefit from supplementation with omega 3 fats and vitamin D (particularly if you have mid to low range vitamin D levels like he has), due to the strong scientific evidence supporting their use.

 

References include

[1] Petersen KF, Dufour S, et al. The role of skeletal muscle resistance in the pathogenesis of metabolic syndrome. PNAS. Jul 2007;104(31):12587-94 http://www.pnas.org/content/104/31/12587.full.pdf+html

[2] Schoenaker DA, Toeller M, et al. Dietary saturated fat and fibre and risk of cardiovascular disease and all-cause mortality among type 1 diabetic patients: the EURODIAB Prospective Complications Study. Diabetologia. 2012 Aug;55(8):2132-41 http://www.ncbi.nlm.nih.gov/pubmed/22526612

[3] Howard BV, Van Horn L, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. Feb 2006;295(6):655-66. http://www.ncbi.nlm.nih.gov/pubmed/16467234

[4] Siri-Tarino et al. Saturated fat, carbohydrate and cardiovascular disease. Am J Clin Nutr. Mar 2010;91(3):502-9 http://ajcn.nutrition.org/content/91/3/502.full.pdf+html