Today, in the final part of our unique series, NHS GP Dr David Unwin explains why full-fat dairy is allowed on a low-carb regimen, while chef and food writer Katie Caldesi shows you quick recipes for batch-cooking to make it all even easier!
Rich creamy sauces, butter melted on your vegetables and a healthy drizzle of olive oil on your salad.
These are some of the delicious foods that are firmly on the menu on a low-carb diet. My patients are often amazed and delighted to hear they can eat these, yet still lose weight and potentially reverse their type 2 diabetes, too.
The full-fat dairy and the good fats that a low-carb regimen permits — and which Katie Caldesi has used in her delicious recipes in the Mail this week — are a key reason that people feel so satisfied with the food on this diet, which makes it much easier to keep as a permanent part of your life.
But might these extra fats be bad news for your risk of heart disease, strokes or circulatory diseases?
Doctors agree that heart disease is a particular worry for those with type 2 diabetes, as people with poorly controlled blood-sugar levels are prone to circulatory problems and, as well as heart attacks and stroke, this means kidney and eye problems.
When I started using low carb to help my patients with type 2 diabetes improve their blood-sugar levels, I did initially worry that if my patients were eating fewer carbs (such as bread or potatoes) but more dietary cholesterol (such as eggs) and fat, would this increase their risk of heart disease?
However, as I revealed in Wednesday’s Mail, as well as blood-sugar levels, a low-carb approach can have a surprisingly positive effect on blood pressure. And far more astonishing have been the significant improvements in my patients’ average cholesterol levels.
Rich creamy sauces, butter melted on your vegetables and a healthy drizzle of olive oil on your salad. These are some of the delicious foods that are firmly on the menu on a low-carb diet. My patients are often amazed and delighted to hear they can eat these, yet still lose weight and potentially reverse their type 2 diabetes, too [Stock image]
Research I published last October in the journal BMJ Nutrition, Prevention & Health, showed that not only had 46 per cent of my type 2 diabetes patients who’d gone low carb reversed their condition after two years (with the average patient losing 18lb, or 8kg), but they also saw significant improvement in their blood pressure and cholesterol levels, too.
Their total cholesterol reading reduced by 10 per cent, their HDL (or ‘good’) cholesterol went up by 8 per cent, and their triglyceride levels (another key blood fat implicated in cardiovascular disease) improved by a whopping 35 per cent. And eight patients came off their statins.
Our findings have been borne out by an analysis published in 2018 by researchers from Liverpool John Moores University, who examined more than 1,000 people following either a low-fat diet or a low-carb diet for six months or more, and concluded that carbohydrate restriction appeared superior in improving blood cholesterol and blood fats compared with low-fat diets.
In my early days as a GP, I advised my patients to avoid all dietary sources of fat and cholesterol, explaining they were ‘clogging the circulation’. People duly gave up butter, cream, cheese and eggs, but so often the results of their blood tests did not reflect all their sacrifices. I was disappointed and mystified.
Fizzy drinks you can enjoy
We’ve known for years that sweet, fizzy drinks and cordials are linked to obesity in children and adults.
These have also now been linked to a raised risk of type 2 diabetes.
But what may surprise you is that drinks with artificial sweeteners don’t seem to be much better.
In 2016, a study in the British Journal of Sports Medicine looked at data from 38,000 cases and found just one artificially-sweetened drink a day was associated with a 25 per cent increased risk of developing type 2.
There’s evidence that longterm consumption of diet drinks is linked to insulin resistance (where cells become resistant to the hormone insulin that’s sweeping sugar from the blood into them).
But you can enjoy sparkling water made more inviting with slices of lemon or lime and a few drops of Angostura bitters.
And there is another fizzy drink you can enjoy on those celebratory occasions — Champagne.
It is surprisingly low in carbs, a glass is equivalent to less than one teaspoon of sugar. Perhaps low-carb living isn’t so bad after all. Cheers!
Many of my colleagues found the same. A 2014 study from the University of Connecticut provided valuable insight into this.
The researchers fed volunteers gradually greater amounts of fat in the form of higher-fat beef, eggs and full-fat dairy products over 18 weeks, then looked at their blood fats. Despite nearly doubling the amount of fat in the diet, the volunteers’ blood fat levels remained similar.
We now know dietary intake and blood levels of cholesterol and fat are not always closely related. A good example of this is eggs. For years, these were shunned because they are a concentrated source of cholesterol. Yet we know they can play a vital part in a healthy diet.
What we had failed to understand is that a major organ, the liver, can manufacture both fat and cholesterol from scratch. So dietary sources are only part of the picture.
Indeed, research has struggled to show evidence to support the role dietary cholesterol was feared to play in an increased risk of heart disease. As a result, in 2015 the Dietary Guidelines for Americans, written by the U.S. Department of Health and Human Services, removed the recommendation that people should restrict their dietary cholesterol to 300 mg/day (equivalent to one small egg).
So dietary cholesterol bears little relationship to blood cholesterol. If it’s not the diet, you may wonder what does cause blood cholesterol to rise?
The picture is complicated, but when doctors talk of cholesterol and risk of heart disease, we are looking at a range of different blood fats. Firstly, we look at the balance between LDL ‘bad’ cholesterol and HDL ‘good’ cholesterol (‘good’ because it’s cardio-protective). Another important blood fat is triglyceride.
So how might diet affect these three factors? This was examined in a major study published this January in the journal Nutrients. An international team, headed by a researcher from King’s College London, reviewed 38 studies (involving 6,499 adults) looking at diet, LDL and HDL cholesterol and triglyceride. The conclusion: low-carb diets were more effective at improving weight loss, HDL cholesterol and triglyceride levels. However, low-fat diets were better at lowering LDL cholesterol.
As I said, the picture is not straightforward. In another, even bigger review published last year (in BMJ Open Diabetes) involving more than 147,000 people from 21 countries, led by Salim Yusuf, a famous Canadian professor of cardiology, researchers concluded that higher intake of whole-fat dairy was associated with a lower incidence of hypertension and type 2 diabetes.
I am fascinated as to why this might be. My hypothesis is that full-fat dairy is more filling, so you may be less likely to eat other, more harmful foods such as biscuits, chocolate or cakes.
Another reason I recommend it is that full-fat dairy products may be less likely to have had sugar added.
And if you follow the final instalment of Katie Caldesi’s delicious low-carb recipes in today’s pullout, you’ll see how enjoyable healthy fats can be.
Always consult your GP if you have any health concerns, and particularly if you are taking prescribed medications, before embarking on any change in diet or lifestyle.
Sri Lankan chicken curry
Sri Lankan chicken curry
This recipe comes via the Caldesis’ friend Manjula Samarasinghe, who cooks it for her family. You can also swap the chicken with 400g mushrooms or green beans for a vegetarian version. The curry freezes well, so do double the quantity for batch-cooking. It can be kept in the freezer for up to three months. Serve with cauliflower rice to avoid spikes in blood sugar from eating carb-rich rice.
Carbs 2.7g, protein 25.3 g, fat 11.3 g, fibre 0.4 g, calories 219
2 tbsp coriander seeds1 tsp cumin seeds1 tsp fennel seeds1 tsp salt4 chicken breasts, chopped into pieces1 tbsp wine or cider vinegar 1 tsp turmeric1 tsp chilli powder2 tsp ground black pepper3 tbsp ghee or coconut oil1 medium onion, peeled and chopped5 cloves garlic, peeled and chopped15 g ginger, peeled and chopped10 curry leaves (optional)400 ml coconut milkSalt and black pepperCoriander, to serve
Toast the seeds in a pan over a medium heat, shaking frequently, until they are browned and smell amazing. Put the seeds in a spice grinder or use a pestle and mortar to grind to a powder and tip into a bowl. Add the salt, chicken, vinegar, turmeric, chilli and pepper and stir through to coat.
Heat the ghee in the pan over a medium heat and add the onion, garlic, ginger and curry leaves, if using. Fry for 3 minutes, or until they start to stick to the pan, then add the chicken and stir through, letting it fry until seared all over.
Pour in the coconut milk, rinse the can and add this water too. Continue to cook, stirring frequently, for 15 mins, or until the chicken is cooked. Test a piece by cutting it in half to make sure it is no longer pink inside. Adjust the seasoning to taste, then scatter coriander on top and serve.
Feta, onion & thyme scones
Feta, onion & thyme scones
These are perfect to eat on the go or to accompany a light soup or salad. They are delicious warm and spread with butter. Use whichever cheese you prefer or whatever you have in the fridge. The scones will keep in the fridge for up to 3 days or can be frozen, wrapped in foil and in a sealed container, for up to 3 months.
Carbs 4.2g, protein 7.6g, fat 18.3g, fibre 2.3g, calories 220
45g butter, melted, plus extra for greasing25g sun-dried tomatoes150g ground almonds75g spring onions, finely chopped3 eggs1½ tsp baking powder1 tsp dried thyme or oreganoPinch of saltFreshly ground black pepper75g feta
Heat the oven to 220c/200c fan/gas 7. Put 8 paper muffin cases in a muffin mould and brush them with melted butter. Pat the tomatoes dry on kitchen paper. Roughly chop and put in a mixing bowl with the rest of the melted butter plus the almonds, onions, eggs, baking powder, herbs, salt and pepper.
Mix thoroughly then crumble over the feta. Fold in gently so you still have a few cheese lumps. Spoon the mixture into the muffin cases and bake for 15 to 20 minutes, or until firm to the touch.
Check the scones are ready by piercing with a skewer; it should come out clean when done. Remove them from the oven and leave to cool before serving, or storing in a tin for later.
Moroccan lamb soup
Moroccan lamb soup
This is loosely based on a slow-cooked soup called harira, popular during Ramadan and used to break the fast; it is ideal for batch cooking and freezing. Traditionally it contains lentils and chickpeas, but these have been left out to keep the carbs down, and spinach has been added instead. It’s perfect in bowls with coriander and yoghurt, or with cauliflower rice.
Carbs 3.9 g, protein 20.7 g, fat 25.7 g, fibre 2.1 g, calories 332
4 tbsp extra-virgin olive oil1 onion, finely chopped2 celery stalks, finely chopped4 cloves garlic, peeled and lightly crushed700 g lamb minceSalt and freshly ground black pepper2 tsp ground cumin2 tsp ground coriander½ tsp chilli flakes1 cinnamon stick or ½ tsp ground cinnamon1 x 400 g tin chopped tomatoes2 tbsp tomato puree200 ml warm beef or vegetable stock100 g baby spinach
1 lemon, cut into wedgesLarge handful of coriander, roughly chopped (optional)100 g Greek yoghurt
Fry the onion, celery and garlic in the oil in a large saucepan for about 7 minutes over a low heat. Tip in the lamb, spices and seasoning, and stir through to break up the meat. Turn up the heat and cook for 5 minutes to brown the meat before adding the tomatoes, tomato puree and stock.
Bring to the boil and cook, covered, over a low to medium heat, so that it simmers for 10 minutes. Taste, then adjust the seasoning. Stir in the spinach leaves and it is ready to serve with lemon wedges, coriander and yoghurt.
Quick Tuscan beef ragu