Posts

LCHF and kidney function

Except from MSc (Med) Physiology Dissertation (UCT), by Tamzyn Murphy (RD)

 

Safety concerns have been raised over low carbohydrate high fat (LCHF) diets’ relatively high protein content, for renal function [100]. While protein intake on LCHF diets may be higher than on conventional diets, it seldom exceeds 30 % total daily energy intake (TDEI) [10, 101]. Critics theorise that high protein intake (> 25% of TDEI or > 2 g. kg body weight (BW)-1 [102])  may chronically increase glomerular pressure and hyperfiltration, thereby damaging the kidneys [103] – particularly concerning in Type 2 Diabetes (T2D) with its high nephropathy risk. Indeed protein restriction helps preserve renal function in pre-existing kidney disease [104]. However, evidence doesn’t support the theory that high protein diets impair renal function in the absence of kidney disease [100, 102, 103, 105], even in obese individuals with T2D [106].  In fact, very low carbohydrate high fat (VLCHF) diets may improve renal function [107], as indicated by results showing reversal of diabetic nephropathy in rodents [108] and reduced creatinine concentrations in an intervention study in overweight and obese humans with and without T2D [109].

 

References

  1. Crowe, T., Safety of low‐carbohydrate diets. Obesity reviews, 2005. 6(3): p. 235-245.
  2. Adam‐Perrot, A., P. Clifton, and F. Brouns, Low‐carbohydrate diets: nutritional and physiological aspects. Obesity Reviews, 2006. 7(1): p. 49-58.
  3. Møller, G., et al., Higher Protein Intake Is Not Associated with Decreased Kidney Function in Pre-Diabetic Older Adults Following a One-Year Intervention—A Preview Sub-Study. Nutrients, 2018. 10(1): p. 54.
  4. Martin, W.F., L.E. Armstrong, and N.R. Rodriguez, Dietary protein intake and renal function. Nutrition & metabolism, 2005. 2(1): p. 25.
  5. Rhee, C.M., et al., Low‐protein diet for conservative management of chronic kidney disease: a systematic review and meta‐analysis of controlled trials. Journal of cachexia, sarcopenia and muscle, 2018. 9(2): p. 235-245.
  6. Brinkworth, G.D., et al., Renal function following long-term weight loss in individuals with abdominal obesity on a very-low-carbohydrate diet vs high-carbohydrate diet. Journal of the American Dietetic Association, 2010. 110(4): p. 633-638.
  7. Tay, J., et al., Long-term effects of a very low carbohydrate compared with a high carbohydrate diet on renal function in individuals with type 2 diabetes: a randomized trial. Medicine, 2015. 94(47).
  8. Azar, S., H. Beydoun, and M. Albadri, Benefits of ketogenic diet for management of type two diabetes: a review. J Obes Eat Disord, 2016. 2(2).
  9. Poplawski, M.M., et al., Reversal of diabetic nephropathy by a ketogenic diet. PLoS One, 2011. 6(4): p. e18604.
  10. Hussain, T.A., et al., Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition, 2012. 28(10): p. 1016-1021.

4-WEEK HEALTHY WEIGHT CHALLENGE: The Low Carb Way

We are excited to be launching our August  4-WEEK HEALTHY WEIGHT CHALLENGE: The Low Carb Way! An online support program for people wanting to lose weight, achieve a healthier lifestyle and combat metabolic disease.

Prepare to reclaim your body and your health, as our Registered Real Food Dietitians, Bridget and Tamzyn, guide you every step of the way: This program has been specially designed to provide the individualized dietary interventions that help our individual clients achieve weight-loss and health success, as well as heaps of information and resources used in our follow-up consultations and trainings. Plus more exclusive content designed just for this challenge! We want to do everything we can to help you succeed, so goal setting and monitoring, and support and accountability, are also key components of this challenge.

 

Start date:

12 August 2019

Entries close on Wednesday 2 August 2019

 

Here’s a rough guideline of what the program entails

  • Health and lifestyle assessment: To start off with, you will fill in a questionnaire so that we can get to know you and your concerns and goals. Your answers will also let us know about any medical conditions or health concerns that you may have.
  • Diet assessment: You will be complete 1.) an online questionnaire telling us which foods you eat and how often, as well as 2.) a 3-day online food diary. We will analyse this diet data to see how and what you eat, to help us design your individualised diet plan.
  • Individualized meal guideline: You will be given an individualized meal guideline (based on the assessment from the questionnaires and food diary).
  • Weekly menu and shopping list: Will be emailed to you each Friday to prepare for the week ahead.
  • “Hot seat”: Each Wednesday evening we will have a “hot seat” period where you can ask us questions on our private Facebook page and we will be available to answer them immediately.
  • Weekly virtual talk given by Tamzyn or Bridget: Each week you will also have a virtual talk to prepare you for the week ahead.
  • Goal setting: Weekly.
  • Monitoring: Tamzyn and Bridget will monitor your progress by analysing changes in your body composition and meal records and the achievement of your goals.
  • Support: You will receive bi-weekly emails from Tamzyn and Bridget to keep you on track and offer support. You will also have access to others on the program, as well as Bridget and Tamzyn, via the closed Facebook group for trouble shooting and support. You will also have live direct access to Tamzyn or Bridget to answer all of your questions during the weekly Hotseat.
  • Resources: You will be given interesting articles/TED talks to read / watch to help you along your journey.
  • Individualised report: At the end of the program you will receive an individualised diet report and assessment, as well as helpful tips for the way forward.

 

The following topics will be covered during the program

WEEK 1

  • What to expect
  • Goal setting
  • How to use your individualised meal plans and shopping lists
  • Low Carb 101: How to get started on your low carb eating plan

WEEK 2

  • Trouble shooting and avoiding side effects
  • Macros: A deeper dive into carbs, fats and protein – what’s enough/too much
  • Hurdles: Eating out/ social eating, and more
  • Psychology of comfort and addictive eating patterns and getting around them

WEEK 3

  • Exercise
  • Intermittent fasting: what are the benefits, how to implement it, and which regimen should you choose

WEEK 4

  • Addressing questions and concerns that have come up during the program
  • Wrapping up – interpreting your report, have you achieved your goals, sustainability, what next

 

The cost

R1200

Medical aid

As this program is being run by registered dietitians, it is covered by many medical aids. Contact your medical aid to inquire about your whether you can be reimbursed on your plan. We can give you a quote to submit to them.

 

We hope to instill in everyone that this is not a diet but a lifestyle change to achieve a healthier weight and improve your health.

 

To book your place in our Challenge or for any questions please do not hesitate to contact us.

 

Yours in Health

Bridget and Tamzyn

Real food Dietitians

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.