This blog provides free information about the modern healthy food trends, not intended as a medical consult. Please seek appropriate advice from an accredited practising dietician with specialised interest in weight loss, nutrition and bariatric surgery, for an individual assessment, personalised advice, individual tailored management and diet plan.

Although this blog is written for our patients, it is recommended for most people in our Western society whether they have bariatric surgery or not.

The following learning objectives or points of interest are mentioned:

• To distinguish between selecting bad and good food choices
• To raise awareness of the sugar and carb addiction so prevalent in our Western society
• Low carbohydrate meal
• The Mediterranean diet
• The Paleo diet

 

 

Unhealthy foods to avoid

In essence the foods that we should avoid are:

• High GI index foods or foods with added sugars
• Food with a high carb content
• Foods with high animal saturated fats or trans fat content
• Highly processed foods that are also high in calories (convenience food)

 

 

Listed below are some examples of poor food choices selected from a typical Western diet.

White bread

Made from wheat flour, white bread is in the high GI index category. It causes rapid glucose release followed by a sudden drop, resulting in poor glycemic control and dumping syndrome in susceptible patients.

Whole meal bread is preferred to white bread because it has fiber and nutrients added.

Sweetened bread (eg. banana bread or berry muffins)

Sweetened breads are a source of carbs, added sugars and are also high in fat.

Soft drinks

There are vast quantities of added sugar in soft drinks, on average 9 teaspoons of sugar per can.

Lollies

Natural and artificial fruit flavoured lollies are a source of sugar, not fruits or nutrients. Some may have 3 or 5 teaspoons of added sugar. It is now recognized that food addictions in Western countries are mainly due to sugar addiction with desensitization of our taste buds that leads to more sugar craving.

Rice crisp or snacks

Made from rice, a high GI index carbohydrate, which causes a rapid spike in blood glucose. Patients have glucose intolerance should be advised against consuming high GI index foods or food high in carbs content.

People without diabetes, with concurrent insulin release, the glucose moves into the liver and other organs and become stored as glycogen and fat. This leads to excess energy storage and visceral obesity. The sugar or carbs content is being investigated as a major cause of metabolic syndrome in Western society, the main contributing factor to the current epidemic of obesity and Type 2 diabetes mellitus.

Chocolate nut spread

Chocolates may be found in croissants or can be spread on toast. There are added sugar, vegetable oil and fats in chocolate spreads.

Fruit bars

These are mixtures of fruit, sugar, gums and artificial flavours that make up a fruit stick or strap. There is way too much sugar, too little nutrients and fiber compare to eating natural fruits.

Doughnuts

Has a high content of trans fats (which is contraindicated for people suffering from cardio-vascular disease) and is also high in icing sugar. Doughnuts are really a calorie meal with fats.

Cheese-flavoured snacks

They are high in fat, flavours, colouring and chemicals and may be addictive leading to over consumption. A lot of calories can be found in these prepared snacks that we often pack for our children to take to school.

Margarine or butter

In general keep margarine or butter to a minimum. A better source of fat is from avocados, nuts, natural vegetable oil, seeds and fish.

Processed foods

Try to avoid canned or preserved foods, such as canned fish, tinned meat, sausages, frozen food in preservatives or fruits in syrups. These foods often have salt, sugar, oils or other chemicals added, they are not desirable, boost up the calorie content and at the same time lacking in the nutrients that we require.

 

 

 

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Food or sugar addiction

For those of us living in a typical Western society, we are accustomed to foods that are high in salt, sugar or carbs, saturated animal fat and trans fat, with preference towards junk food and fast food for convenience.

Food addiction occurs at an early age and the current generation have become too reliant on processed foods. Typical examples are bread and cereals for breakfast both high in carbs and sugars, at the same time lacking in protein and vitamins.

Sugar and artificial sweeteners are part of the rewards system for the midbrain, with the release of dopamine. Hence the body becomes used to a consistently high level of sugar level and craves for more in preference to protein or other nutrient rich foods.

The consumption of simple or refined (rapidly absorbable) carbohydrates as well as added sugars (sucrose or fructose), example of which includes honey, fruit juice and syrup, have increased significantly over the last few decades. This change in carbs consumption and calorie increase (as well as overconsumption of other saturated animal fats) are associated with the obesity and diabetes epidemic in our Western society. Developing countries who have adopted the Western diet are similarly showing parallel increase in the rates of increase in obesity, Type 2 diabetes and cardio-vascular disease.

In the morbid obesity group, the solutions are not dieting and exercise alone. For the short-term result successful weight loss may be possible but in the long term often all the weight loss is regained and more before dieting.

It is known that when we restrict calorie intake, the body will attempt to maintain homeostasis and compensates by:

• Reduction in total energy expenditure.
• Compensatory increase in hunger and increase in preferences for high calorie foods. People who lose weight by dieting alone often feel tired and hungry, which then leads to a craving for high calorie foods (sugars or carbs).

Commercial wheat products are breakfast cereals, bread, cookies, cakes, crackers, doughnuts, pizza crust, hamburger and hotdog buns, tortillas), all of which should be avoided when weight loss is the intention.

 

 

 

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Low carbohydrate meals

Low carbohydrate meals are recommended in several instances for the following indications:

• Maintenance of excess weight loss after bariatric surgery
• To improve glycemic control for those with diabetes mellitus
  • Many endocrinologist are now recommending low carb meals for the prevention of diabetes rather than just medications for blood sugar control
• To prevention of early dumping syndrome
• To prevention of late dumping or symptomatic hypoglycemia after gastric bypass
• To prevention of gas bloating side effects

 

Malabsorption type bariatric procedures

Let us use the example of Roux Y or omega loop mini gastric bypass. The first point to mention is that this is a very effective operation but patient adherence to post op dietary advice (good compliance) is needed.

Roux-en-Y gastric bypass (RYGB) is considered the gold standard in the United States as a surgical treatment for morbid obesity, with very successful weight loss result, resolution of medical co-morbidities and effective treatment of metabolic syndrome (resulting in improved glucose and lipid metabolism, blood pressure control and reduce cardio-vascular mortality).

However RYGB does have its own unique set of side effects, such as dumping syndrome and macro or micronutrient deficiencies.

Amongst the rare complications is post gastric bypass hyper insulinaemic hypoglycemia, estimated to occur in <0.5% of cases. This may be related to distal gut hormones (GLP-1) release resulting in inappropriately high levels of insulin, either from:

• disproportionately high basal insulin secretion caused by β-cell hyperactivity or hyperplasia (in the fasting state)
• a result of an excessive β-cell response to a carb-rich meal or rapid food transit to ileum (in the post prandial or after meal state)
• or possibly other mechanisms are involved that we are not aware of, where post op patients have often demonstrated a heightened insulin response and lower peak glucose levels after meals in the early post op period before any significant weight loss is achieved

The hypoglycemic symptoms include feeling dizzy, need to lie down or in extreme cases collapse and hypoglycemic coma. Traditional treatments to prevent hypoglycemic episodes include carbohydrate (carb) restriction, medical therapy (with acarbose, diazoxide or octreotide) and operative interventions that aim to delay gastric emptying or partial pancreatectomy (to reduce insulin secretion). The responses to these treatments are often difficult to predict.

The best treatment in fact may be in prevention rather than symptom control with the treatment options mentioned in the paragraph above. A low carb meal or carb restriction to 30g per meal may be sufficient to prevent excessive insulin release and hypoglycemia. The usual recommendations after bariatric surgery is small frequent meals (3 to 5 small meals a day) with adequate protein (1 to 1.5g of protein per kg ideal body weight) and sufficient vitamins and mineral supplements.

High GI index foods (simple sugars) should be avoided to prevent early dumping as well as late neuro-glycopenic symptoms. These simple carbohydrates are absorbed rapidly, induce major insulin responses and increase the risk for reactive hypoglycemia, consequently dumping syndrome.

 

 

 

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Healthy foods to eat

Weight loss does not mean that we need to keep a 40 day and night complete fast or have a Daniel fast (diet of vegetables and water only) but it can be achieved by eating healthy foods, with emphasis on eating fresh unprocessed food. Besides many dieticians will recommend that we should not be skipping meals and should be eating meal that provides essential nourishments (macro and micronutrients), without the excess calories (sugars, fats) or added chemicals.

 

Listed below are some of the foods that we should eat. This list is surprisingly easy to follow. An example of good healthy food selected from our Western diet may include:

Berries

Berries are low in calories, high in fiber, vitamin C and antioxidants.

Green tea

Green tea is high in antioxidants and may help promote fat metabolism.

Probiotic yoghurt

Probiotics are the micro-organisms (healthy bacteria) that are naturally found in the human digestive tract. Probiotics may reduce digestive symptoms (such as constipation and bloating), help restore gut flora and help rebalance the bacteria required for optimal nutrient absorption. Gut health may improve overall immune function as well.

Tomatoes

Tomatoes are rich in Vitamin C and beta carotene. Cooked tomatoes may provide lycopene another powerful antioxidant, which helps to reduce the incidence of some cancers (such as stomach and pancreatic cancer).

Red capsicum

Red capsicum rich in Vitamin C and carotenoids (an antioxidant involved with the regulation of inflammation in the body) and may lower mortality risk from heart disease, cancer and stroke.

Walnuts

Walnuts are rich in long chain poly-unsaturated fats (to help protect the cells and reduce cholesterol levels) and omega 3 fatty acids (which has anti-inflammatory action).

Oily fish

Long chain poly-unsaturated fatty acids (DHA and EPA) are found deep-sea cold fish. Fresh tuna, salmon and sardines contain omega 3 fatty acids, which helps to reduce inflammation in the body and help to reduce triglycerides and blood pressure.

Broccoli

Broccolis are rich in phytonutrient, a rich source of folate, the antioxidant lutein (which may delay the progression of age-related macular degeneration) and the phytochemical sulphoraphane (which may have anti-cancer properties).

Vegetable Soup

Is preferred to animal soups. As a meal vegetable soup has less calories and plant nutrients.

Dark Chocolate

Chocolate is basically cocoa, which contains antioxidant properties, has more flavonoids and phenolic phytochemicals than tea or red wine. Obviously with chocolates, we need to exercise portion control, choose dark chocolates and the sugar free ones.

Olive oil

Olive oils (mono unsaturated fat) should be added to salads and protein meals instead of butter or animal fats. Olive oil have beneficial health effects, such as reducing inflammation (from a phytochemical called oleocanthal), lower LDL cholesterol and triglycerides, lowers blood pressure, lowers the risk for Type 2 diabetes and the risk for coronary artery disease, have anti-oxidants (vitamin E), which helps to improve immune function and it may also reduce cancer risk.

Olive oil has been part of the Mediterranean diet for thousand of years and recently become trendy in Australia, popular in Masterchef and various other cooking shows on television.

 

 

 

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The affluent English diet

From English history, we do know a bit about food consumed by the wealthy families during the Tudor period. King Henry VIII has been reported to consume many extravagant types of fatty meats and in extra ordinary amount, literally a banquet of roast boar, whale meat, peacock, swan, offals, wine and rich desserts.

The end result is obvious from various portraits of the king, from his coronation at the age of 18 years, many describing him as a handsome, fit, sporty and healthy tall young man to his death at the age of 56 years old, estimated to weigh around 178kg and having a waist circumference of 132cm.

 

No doubt King Henry VIII would be a suitable candidate for laparoscopic bariatric surgery today but beware of operating on someone who does not wish to change their lifestyle or eating habits. The surgeon may be beheaded if his or her patient can’t enjoy a buffet meal after a sleeve gastrectomy or a gastric bypass!

 

 

 

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The Mediterranean diet

 

The Mediterranean diet (which consist of a daily intake of olive oil, fruit, vegetables, whole grain cereals, low fat dairy and weekly consumption of fish, poultry and small amount of red meat) has been proposed to combat morbid obesity and metabolic syndrome.

• The anti-oxidants in berries and vegetables are essential in the prevention of cardiac disease and certain cancers.
• Nuts form part of the staple diet, have mono unsaturated fats.
• Olive oils provide the essential fats and fish or sea foods provides omega 3 fats.

Obviously for maximal health benefits apart from eating healthy foods, people living in our Western societies will also need to stop binging on alcohol or sugar drinks, stop smoking and do more aerobic exercise.

Daniel (alluded to earlier) is a young man from the Old Testament in the Bible who ate fresh vegetables, legumes and drank water, refusing to eat the Babylonian king’s specially prepared royal food for his choice young men groomed for success in his country. At the end of 10 days, Daniel looked healthier than all the other young men who had a chance to participate in the king’s delicacies.

This event obviously occurred a few thousand years ago, long before modern day food science and food facts are known and long before the world heard of an obesity epidemic. The wisdom that was displayed by a young man regarding eating healthy food still holds true today.

King Nebuchadnezzar’s diet is not detailed in the Bible except that it is considered the best meat and wine of the day. From history little is known about the type or quality of meat, the quantity or method of cooking a Babylonian cuisine.

In contrast the traditional Jewish Mediterranean diet is well described for thousands of generations to follow from the beginning of time or modern human history thanks to the Bible. Fundamentally they consist of plants (fruits and vegetables) that bear seeds. For example apple, avocado, grapefruit, cherries, cranberry, pomegrates, olives, tomatoes, beans, lentils, strawberry, raspberry, squash, corn, rye, beetroot, rhubarb and radishes, which are eaten daily when in season. Protein includes beef, sheep, goat, deer, fish and chicken, which are usually eaten once a week. These foods are eaten fresh without preservatives.

The Modern Mediterranean diet describes the eating habits of people from Middle East, Italy, Greece, Spain and France. An example of a typical Mediterranean diet is:

• Natural unprocessed fruits, vegetables, whole grains, nuts
• Olive oil (as source of dietary fat)
• Fresh fish (once a week)
• Lean or red meat (once a month)
• Red wine (1 or 2 glass a day)

The many reported health benefits of a Mediterranean diet include:

• Reduced risk for coronary artery disease and stroke
• Lower blood cholesterol
• Lower blood pressure (by avoiding too much salt in the diet)
• Help to reduce body weight and maintain weight loss
• Reduced risk of Type 2 diabetes mellitus
• Reduced risk of some cancers
• Reduced risk of osteoporosis
• Reduced risk of Alzheimer’s disease
• The diet may be beneficial for people suffering from constipation, irritable bowel syndrome, gastro-oesophageal reflux and osteoarthritis.

Obviously the Jewish people do not eat pork and shellfish. Without understanding much about Jewish laws or tradition, most of us are aware that there are too much saturated animal fats in pork and many crustaceans are scavengers of waste in our waterways, leading to accumulation of minerals and environmental toxins. Maybe there is more wisdom yet to be discovered from the Bible?

 

 

 

 

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The Paleo diet

Similar to the Biblical idea of eating simple unadulterated foods, comes the idea of a Paleo diet. There may be merit for this diet especially for some people who have food allergies (diseases such as gluten insensitivity or inflammatory bowel conditions) and food addictions (people suffering from morbid obesity and glucose intolerance).

In the mid 1970s and 80s interest was generated for mankind to return to a more basic and primitive type of diet that was consumed by caveman, obviously a long time ago where many Western society metabolic disease of today (such as Type 2 diabetes, central/visceral obesity, hypertension, hyperlipidaemia and coronary artery disease) does not exist or is known to exist. Several books have been published and authors, some are well-educated scientist, referred to this period of time as the Paleolithic era, the hunter-gatherer era, where the food choices are believed to be better (in terms of nutrients) than it is today.

During the course of human history several pivotal events occurred, which significantly altered the way we live. There was the agricultural revolution (when crops/cereals were grown and animals was breed for food), then come the industrial revolution (where machines were used to till the soil, sow the seeds, apply chemical fertilizers, harvest the grains, long distance transport to consumers), followed by processed foods, modernization of our society (modern food science for factory farms, genetically modified foods, frozen foods and better storage facilities for seasonal foods to be available all year round) and more recently the decadent age (abundant source of convenience food, fatty meals, processed foods high in preservatives, sugar, carbs, artificial chemicals, etc.).

With time and progress our multi-cultural society has gone through much changes, especially in the last few decades. We are now accustomed to fusion meals (Western meals with influence from Asia and South America), giving food their unique flavours, which are often laden with salt, sugar, spices, fats and oils, making them so tasty and addictive.

Many developing countries are now also full of American or European franchisees (burgers, chicken, pizza, pancakes, doughnuts, etc.), many of them specifically cater for the local taste buds and restaurants also make sure the great taste keeps patrons returning for more.

Food processing industry often fortifies highly processed foods (breakfast cereals, soft drinks, branded yogurts, granola, mayonnaise, orange juice) with various nutrients and then re-characterizes them as “nutritious” or “heart healthy” but they are not necessarily nutrient rich.

With the modernization of our society, introduction of refined grains, sugars, vegetable oils, canned foods, processed and junk food, the consumption of nutrient depleted foods became the norm.

Hence the idea for a new food fad called the Paleo diet. It is deduced that the typical hunter-gatherer ate wild plants, root vegetables, fruits, nuts, fish and wild animals. Without farming there are a lack of legumes, grains, milk or animal fats.

For the purist, the Paloe diet is really food available before the Neolithic agricultural age or time before the domestication of animals. Many of the food items we take for granted today will not be available, such as:

• Milk and dairy products
• Grains (wheat, rye, barley) (hence Paleo meals are gluten free)
• Legumes (beans, peanuts)
• Processed vegetable oils
• Refined sugar (soft drinks, desserts)
• Salt
• Coffee and alcohol

In Australia, obviously it is not realistic not to consume the above. Thus the modern version of the Paleo diet today tend to include:

• Protein: Lean meat (preferably grass fed) and seafoods
• Fats: Mono unsaturated and poly unsaturated fats and omega 3 fats
  • Avoid trans fat and omega 6 fats
• Vegetables: Steamed vegetables
  • Avoid starchy vegetables (potatoes, wheat, corn)
• Fiber: From non starchy vegetables and fruits

Even going back just a few generations ago, for many of our grandparents foods are obtained from the fruit orchard, vegetable patch or directly from a farmer’s market. They will be shocked if they have to but last season’s frozen fruits or bad quality preserved TV meals cooked in a microwave.

The Paleo diet is essentially putting the emphasis back on fresh fruits, vegetables, seafood and lean meats, unprocessed and foods that contain no chemicals or preservatives, in an attempt to combat the rising epidemic of medical problems associated with morbid obesity.

 

 

 

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Good eating habits

Lastly apart from controlled food portions and healthy food choices, we also have to be responsible eaters.

I finish off this blog by mentioning the importance of having a consistent meal and good eating habit. Inadequate consumption of healthy food is sometimes not the result of poor compliance to dietary advice (eating the healthy foods that are listed above) but because of poor eating habits that we don’t give up.

Many dieticians would suggest:

Avoid irregular meal schedules or constantly trying a new diet fad

• It is better to be guided by your hunger signals, focus on eating healthy quality meals and good nutrition rather than worry about the quantity.
• Skipping meals or dieting, prohibition and guilt may lead to binge eating of convenience foods.

Avoid eating late at night, after 7pm or before going to bed.

Avoid snacking during cooking or snacking late at night.

Avoid emotional eating behaviours.

• Negative experiences (such as stress, fear, anger) around eating often leads to unrestrained eating of comfort food (a reward system for the brain).

Avoid binge (speed) eating.

• Take 30 minutes to eat a meal and wait 30 minutes after finishing a meal before you decide if you are still hungry or need a second helping. Gastric emptying times are usually between 20 to 45 minutes, the time it takes for food to enter the small bowel before the release of distal gut hormones for satiation (feeling full).
• Avoid meals with too much carbs or sugars and not enough protein. The intensely flavoured sweet and savoury foods make us want to keep eating compared to protein meals that provide better satiation (feeling full faster).

Avoid the very tasty or flavoured meals

• With modernization and our convenience food culture, our taste buds have obviously become accustomed to the saltier, spicier, sweeter flavours, which are all part of food addiction and the reward system in our brains. (We are too familiar with this temptation, for instance flavoured potato or corn chips taste even better when eaten with dips in front of the TV).
• We dismiss natural flavours of fresh foods (like the Mediterranean or Paleo diet) and instead opt for restaurant or convenient take away type prepared foods.

 

 

 

Conclusion

Every one of us who live in a modern day Western society are faced with either good/healthy or bad/unhealthy food choices on a daily basis.

We may not have a choice about deciding how food cultivation or preparation has changed over time but being aware of the differences between some of the food fads around helps to identify what are the crucial points about nutrients and good healthy eating.

Obviously there are many other food cultures and traditions that have their advantages and disadvantages. This blog only use the example of a Mediterranean diet and Paleo diet to make a point, not necessarily advocating one over the other.