Count Net Carbs Instead of Total Carbs

If you are following a carbohydrate restricted diet, you may have heard of the term “net carbs”. Net carbs are the amount of carbs that your body can digest and use for energy. They are calculated by subtracting the fibre and sugar alcohols (sweeteners) from the total carbs in a food.

For example, if a food has 10 grams of total carbs, 3 grams of fibre, and 2 grams of sugar alcohols, the net carbs are:

10 – 3 – 2 = 5 grams of net carbs

Fibre and sugar alcohols are subtracted because they have little or no impact on your blood sugar levels. Fibre is a type of carb your body cannot break down, so it passes through your digestive system without being absorbed. Sugar alcohols are a type of sweetener that are partially absorbed by your body, but they have a lower glycemic index than regular sugar.

Why are net carbs important?

Net carbs are important because they reflect the amount of carbs that affect your blood sugar and insulin levels. Insulin is a hormone that helps your body use or store glucose (sugar) from the carbs you eat. When you eat too many carbs, your blood sugar and insulin levels rise, which can lead to weight gain, inflammation, and other health problems.

By limiting your net carbs, you can keep your blood sugar and insulin levels stable, which can help you lose weight, improve your metabolic health, and prevent or reverse insulin resistance.

What is insulin resistance?

Insulin resistance is a condition where your cells become less responsive to insulin, which means that your body needs more insulin to lower your blood sugar. Insulin resistance can be caused by several factors, such as genetics, aging, obesity, physical inactivity, and a high-carb diet.

Insulin resistance can lead to prediabetes, type 2 diabetes, and other chronic diseases, such as heart disease, fatty liver disease, and Alzheimer’s disease. Insulin resistance can also make it harder to lose weight, as high insulin levels signal your body to store fat instead of burning it.

How can a carb restricted diet help with insulin resistance?

A low carb diet can help with insulin resistance by reducing the amount of carbs that you eat, which lowers your blood sugar and insulin levels. This allows your cells to become more sensitive to insulin, which improves your glucose metabolism and reduces your risk of diabetes and other complications.

A low carb diet can also help you lose weight, especially around your abdomen, which is where most of the insulin-resistant fat cells are located. Losing this visceral fat can improve your hormonal balance and reduce inflammation in your body. It’s important to note that you will only lose weight on a low carb diet if you are also restricting your caloric intake. I tell my patients that we use calorie restriction to lose weight, and carb restriction to treat insulin resistance.

How many net carbs should you eat?

The optimal amount of net carbs that you should eat depends on your individual goals, preferences, and health conditions. However, here are some general guidelines based on the level of carb restriction:

– Ketogenic low carb: less than 20 grams of net carbs per day. This level of carbs is designed to put your body into a state of ketosis, where you burn fat and ketones for fuel instead of glucose. Ketosis can provide several benefits, such as appetite suppression, mental clarity, and improved blood sugar control. However, it essentially eliminates all carbs and can be challenging to meal plan and sustain. I rarely recommend it, especially when starting out.
– Moderate low carb: 20 to 50 grams of net carbs per day. This level of carbs is suitable for most people who want to lose weight and improve their health without going into ketosis. It can also be easier to follow and more flexible than a keto diet.
– Liberal low carb: 50 to 100 grams of net carbs per day. This level of carbs is still lower than the standard Western diet (typically 200-300 grams per day). I find the 100 gram ceiling is a good starting point for most people who are overweight and have insulin resistance. It allows them to ease into carb restriction. When paired with calorie restriction (and adequate protein), it can be effective and satisfying.

To wind things up, remember that net carbs (total – fibre – sugar alcohols) are what you should count when tracking carbs. It’s good to get the advice of a physician, nutritionist, or dietitian to come up with a plan to optimize your health, though, as carbs are only one part of the solution.

Be well.

The Do-Not-Eat List

I’ve often said the path to well-being is one of elimination. While normally referring to the extra things we do that keep us busy, but don’t bring us meaning, the advice extends to what we eat. After all, good health is a key catalyzer of the journey to well-being. My challenge for all of us is to eliminate most, if not all, ultra-processed foods (AKA edible products) from our diets. They are manufactured to be delicious, addictive, and shelf-stable, while damaging our metabolic function and driving weight gain, due to high caloric density.

According to the NOVA classification system, ultra-processed foods are industrial formulations with five or more ingredients, such as fats, starches, sugars, salts and hydrogenated oils extracted from other foods. You couldn’t make these products in your own kitchen. They also contain additives and preservatives that enhance their taste, flavour and shelf-life. Ultra-processed foods have been linked to increased risk of obesity, diabetes, heart disease, cancer and other chronic conditions.

Examples of ultra-processed foods to eliminate:

– Soft drinks, energy drinks, sports drinks and fruit drinks.
– Sugary breakfast cereals, granola bars, pastries, cookies, cakes and pies.
– Ice cream, frozen desserts, whipped cream and flavoured yogurt (choose plain and add your own berries, honey, protein powder, etc.).
– Potato chips, corn chips, crackers, pretzels, flavoured popcorn and other salty snacks.
– Chicken nuggets, fish sticks, hot dogs, sausages, deli meats, and other processed meats.
– Frozen meals, instant noodles, canned soups, sauces and dressings.
– Pizza, burgers, sandwiches, nuggets and fries from fast food chains.
– Candy, chocolate, chewing gum and other confectioneries.
– Artificial sweeteners, flavourings, colourings and other food additives.

Yes, that’s a big list. And these products are everywhere. They get preferred spots on the shelves on grocery stores and are heavily marketed. Resist!

Instead of these ultra-processed foods, choose whole and minimally processed foods, such as fresh fruits, vegetables, eggs, nuts, seeds, legumes, whole grains, lean meats, fish, milk and cheese. These foods are rich in nutrients, fibre, antioxidants and other beneficial compounds that support your health and well-being.

Now, go clear out the pantry!

Feel the Resistance

Resistance training is crucial for optimal function and cardiometabolic health. I ALWAYS recommend it for my patients. Twice a week is the goal. That’s it! The trouble is, there are too many resources out there and it quickly becomes overwhelming. It doesn’t have to be. Keep it simple. Below, I outline how to get into it.

If you are new to resistance exercise or want to get back into it, you might be wondering how to start. Resistance exercise is any type of exercise that involves working your muscles against some form of resistance, such as your own body weight, bands, or dumbbells. Resistance exercise can help you build strength, improve your posture, and prevent injuries.

One way to start with resistance exercise is to do two sessions per week, one focusing on your upper body and one on your lower body. This way, you can give your muscles enough time to recover and grow between sessions. You can also vary the exercises you do to target different muscle groups and avoid boredom.

For each session, you should aim for a volume and intensity that challenges your muscles but does not cause pain or excessive fatigue. A good guideline is to do 3 sets of 8 to 12 repetitions (reps) for each exercise, with a short rest between sets (1-2 minutes). You should choose a resistance level that makes the last few reps of each set feel hard but not impossible. This is called the rate of perceived exertion (RPE) and it can range from 1 (very easy) to 10 (very hard). For resistance exercise, you should aim for an RPE of 7 to 8, which means you are working at a high intensity but still have some gas left in the tank. As in, you could still do another 2-3 reps if you had to.

You can do resistance exercise with different types of equipment, depending on what you have access to and what you prefer. For example, you can use your own body weight to do exercises like push-ups, squats, lunges, planks, and bridges. You can also use bands to add resistance to these exercises or to do other exercises like bicep curls, shoulder presses, or lateral raises. Bands are cheap, portable, and versatile, and they come in different colors and thicknesses that indicate their resistance level. Finally, you can use dumbbells to do a variety of exercises that work your upper and lower body. Dumbbells are more expensive and bulky than bands, but they allow you to adjust the weight more precisely and work each side of your body independently.

To give you an idea of what a resistance exercise session might look like, here is an example of an upper body workout that you can do with bands or dumbbells:

  • Warm up for 5 minutes with some light cardio (e.g., jogging, skipping, cycling) and dynamic stretches (e.g., arm circles, shoulder rolls, neck rotations).
  • Do 3 sets of 8 to 12 reps of each of the following exercises, resting for 60 seconds between sets:
  • Chest press: Lie on your back on a bench or on the floor with a band or a dumbbell in each hand. Bring your arms up over your chest with your palms facing away from you and your elbows slightly bent. Slowly lower your arms until they are parallel to the floor, then press them back up to the starting position. (A bodyweight variation would be push-ups from your knees, or against an elevated surface like a table or wall.)
  • Row: Stand with your feet shoulder-width apart and hold a band or a dumbbell in each hand. Bend your knees slightly and hinge forward from your hips, keeping your back straight and your core engaged. Let your arms hang down in front of you with your palms facing each other. Pull your elbows back until they are in line with your torso, squeezing your shoulder blades together. Slowly return to the starting position.
  • Lateral raise: Stand with your feet shoulder-width apart and hold a band or a dumbbell in each hand. Keep your arms straight and your palms facing down. Raise your arms out to the sides until they are parallel to the floor, then lower them back down.
  • Tricep extension: Stand with your feet shoulder-width apart and hold one end of a band or a dumbbell in each hand. Raise your arms over your head with your palms facing each other and your elbows close to your ears. Bend your elbows and lower the band or the dumbbell behind your head until your arms are at a 90-degree angle. Straighten your arms and return to the starting position.
  • Cool down for 5 minutes with some light cardio (e.g., walking, jogging) and static stretches (e.g., chest stretch, shoulder stretch, tricep stretch).

Remember to start slowly and gradually increase the resistance level as you get stronger. Listen to your body and stop if you feel any pain or discomfort. Consult a doctor before starting any new exercise program if you have any medical conditions or injuries. And most importantly, have fun and enjoy the benefits of resistance exercise!

If you don’t know how to do any exercise, simply search for a video online. There are a ton of examples out there. If you really aren’t sure where to begin, or if you have previous injuries or functional limitations, two or three personal training sessions may be the ticket.


Personal training or in-person training (London area): Hybrid Fitness | » Personal Training at Hybrid

Info on health and exercise for specific conditions: Home – My Active Ingredient

Release your inner athlete.

From an evolutionary perspective, humans are designed to be physically active. Our ancestors were hunters and gatherers, constantly on the move in search of food and shelter. This lifestyle required a high level of physical activity, and our bodies evolved accordingly.

Our bodies are a testament to our active past. The structure of our muscles, the function of our heart and lungs, and even the shape of our bones reflect a design optimized for movement. For instance, our bipedal locomotion allows us to cover long distances efficiently, while our opposable thumbs give us the dexterity needed for complex tasks.

In today’s world, our sedentary lifestyles are at odds with our evolutionary heritage, causing health problems, including obesity, heart disease, and mental health disorders.

Regular exercise is crucial for maintaining our health and function. It strengthens our muscles and bones, improves cardiovascular health, boosts mood and mental health, and extends lifespan. Exercise also helps regulate our body’s internal systems – from metabolism to sleep patterns – keeping us in balance.

Remember, there is an athlete in all of us. It doesn’t matter if you can’t run a marathon or bench press 200 pounds. What matters is that you engage in regular physical activity that challenges your body and keeps you fit.

You don’t have to train like an Olympian to reap the benefits of exercise. Even simple activities like walking, cycling, or doing household chores can make a big difference. The key is consistency. Make physical activity a part of your daily routine.

Embracing our evolutionary heritage by staying physically active is not just about looking good or being able to perform impressive feats of strength or endurance. It’s about maintaining the health and function that our bodies were designed for. So let’s celebrate the athlete in all of us by moving more each day!

Be well.

What you need to know before starting Ozempic and Wegovy: Ep. 42 CMBH Podcast

In this episode, Tommy and Andrew have another discussion about the rise in popularity of the GLP1 receptor agonist class of drugs for diabetes and weight loss (Ozempic, Wegovy, Saxenda, Mounjaro) including potential benefits, significant harms, and unknown long-term side effects. This is a must-listen for anyone thinking about starting one of these treatments.

Please help us spread the word. Listen, like, share.

Quinoa Chicken Salad Recipe

Batch cooking healthy lunch makes for an easier week. I often make this recipe in bulk to eat throughout the week. Enjoy!


  • 1 cup quinoa
  • 1 chicken breast
  • 1 red bell pepper, diced
  • ½ cup shelled edamame
  • 2 tablespoons chopped fresh cilantro leaves
  • ¼ cup balsamic vinegar
  • Zest of 2 limes


  1. In a large saucepan of 2 cups water, cook quinoa according to package instructions; set aside.
  2. In a small bowl, whisk together balsamic vinegar and lime zest; set aside.
  3. In a large bowl, combine quinoa, bell pepper, edamame, and cilantro.
  4. Pour the balsamic vinegar mixture on top of the salad and gently toss to combine.

Enjoy your meal! 😊

Exercise and Identity

Our personal identities are the lenses through which we view ourselves and interact with the world. They shape our beliefs, behaviours, and decisions in countless ways, including how we approach our health. Personal identity formation can bolster or hinder our health behaviours. The good news is you can choose to define yourself as someone who enjoys regular exercise.

Personal identity encompasses the beliefs and perceptions we hold about ourselves, reflecting who we are and who we want to be. It influences our health choices, such as diet, exercise, and stress management. Imagine you’ve decided to improve your fitness. You start by incorporating exercise into your daily routine and gradually increase your physical activity. Over time, you begin to see yourself as someone who enjoys exercise. This shift in identity can significantly bolster your health behaviors in several ways:

  1. Consistency: Identifying as an “exercise enthusiast” makes you more likely to stick to your fitness routine. Your self-image aligns with your actions, reinforcing the behavior.
  2. Motivation: A strong personal identity as someone who exercises can serve as a powerful source of motivation. You’ll be more driven to maintain your newfound identity by staying active.
  3. Resilience: When faced with setbacks or challenges, a well-defined exercise identity can help you bounce back. You’re less likely to abandon your fitness goals because they’re an integral part of who you are.

On the flip side, personal identity formation can hinder health behaviors when it’s aligned with unhealthy habits. For instance, if you’ve long seen yourself as a “non-exerciser,” it can be challenging to break free from this identity. Some obstacles you might encounter include:

  1. Self-limiting beliefs: An identity rooted in non-exercising may come with negative beliefs about fitness, making it harder to adopt healthier behaviors.
  2. Lack of motivation: When your self-image is tied to inactivity, you may struggle to find the motivation to start and sustain an exercise routine.
  3. Resistance to change: Changing your identity can be uncomfortable, leading to resistance against adopting healthier habits.

If you find that your current identity is hindering your health goals, it’s not too late to redefine it. Here’s how to get started:

  1. Set clear goals: Identify the specific health behaviors you want to change, such as regular exercise.
  2. Gradual changes: Begin by making small, sustainable changes to your behavior. Over time, these can lead to a shift in identity.
  3. Positive affirmations: Use positive self-talk and affirmations to reinforce your new identity. Tell yourself daily that you are becoming the person you want to be.
  4. Seek support: Surround yourself with a supportive community or seek professional help, like a fitness trainer or therapist, to assist in your transformation.

Personal identity formation plays a pivotal role in our health behaviors. Whether you see yourself as an “exercise enthusiast” or a “non-exerciser” can greatly impact your fitness journey. By consciously shaping your identity and aligning it with your health goals, you can harness its power to become the best, healthiest version of yourself. Remember, change is possible, and it all begins with how you define who you are.

Be well.

Eat Less Salt.

Salt has been a staple in our diets for centuries, enhancing flavour and preserving food. While sodium is essential for human physiology, too much is harmful. Excessive sodium intake is associated with a range of health problems:

  1. High Blood Pressure: One of the most well-documented dangers of excessive sodium intake is its contribution to high blood pressure (hypertension). Sodium attracts water, and when you consume too much salt, your body retains excess water, increasing blood volume and pressure on your arterial walls.
  2. Cardiovascular Disease: Increased blood pressure places additional strain on your heart, making it work harder to pump blood throughout the body. This strain can lead to heart diseases like heart attack, heart failure, and arrhythmias.
  3. Kidney Problems: Your kidneys play a crucial role in maintaining a healthy sodium balance in the body. Consuming excessive sodium can strain your kidneys, potentially leading to kidney stones, reduced kidney function, and chronic kidney disease.
  4. Osteoporosis: Surprisingly, excessive sodium intake can lead to calcium loss in the urine, potentially contributing to the development of osteoporosis – a condition characterized by weakened and brittle bones.

Foods High in Sodium

  1. Processed Foods: Processed and packaged foods are often loaded with sodium to enhance taste, preserve shelf life, and improve texture. Common offenders include canned soups, frozen dinners, chips, and processed meats like bacon and ham.
  2. Condiments: Items like soy sauce, ketchup, salad dressings, and even pickles can be surprisingly high in sodium.
  3. Restaurant Food: The convenience of fast food often comes at the cost of high sodium content. Burgers, fries, and many other items can be significant sources of sodium.
  4. Bread and Baked Goods: Even seemingly innocuous items like bread and certain baked goods can contain surprisingly high levels of sodium.
  5. Cheese: Cheese, especially processed and aged varieties, can be quite high in sodium.

Maintaining a Low-Sodium Diet

The best way to limit sodium intake is by following a whole-food dietary pattern. The goal for healthy people is to consume less than 2300mg daily, while those with high blood pressure, kidney disease, or heart disease should target less than 1500mg; that’s half a teaspoon!

  1. Read Labels: When grocery shopping, carefully read food labels to identify sodium content. Choose products labeled as “low sodium” or “no added salt.” As a general rule, if you must buy packaged or prepared foods, choose ones where the sodium per serving is less than the calories per serving.
  2. Cook at Home: Preparing meals at home gives you control over the ingredients you use. Opt for fresh ingredients and herbs and spices to flavor your dishes instead of salt.
  3. Limit Eating Out: Reduce the frequency of dining at restaurants, especially fast-food establishments, as these often contain hidden sources of sodium.
  4. Use Herbs and Spices: Experiment with herbs, spices, and citrus flavors to enhance the taste of your food without adding salt.
  5. Rinse Canned Foods: If you use canned vegetables or beans, rinse them thoroughly under running water to reduce their sodium content.
  6. Choose Fresh Produce: Whole fruits and vegetables are naturally low in sodium and provide essential nutrients.
  7. Drink Water: Staying well-hydrated can help flush excess sodium from your system.

Be well.

And We’re Back!: Ep. 40 CMBH Podcast

After our summer hiatus, we got back into the recording studio to discuss an assortment of topics related to Cardiometabolic Health. In this episode, we cover:

  1. Testosterone replacement therapy cardiovascular safety
  2. Updates on evidence and use of Ozempic/semaglutide
  3. Recent data on vegan/vegetarian diets effects on cholesterol, blood sugar, and blood pressure

Check it out! Subscribe! Share! Heck, even leave a review.

Front-load the day with protein: Quick Oatmeal Recipe

You all know how much I love protein, especially in the morning. I encourage everyone to get at least 30-40g per sitting, 3-4x per day. This optimizes both absorption and total daily amounts. Enjoy!

High-Protein Oatmeal


  • 1/2 cup rolled oats
  • 1 cup unsweetened almond milk (or any milk of your choice)
  • 1 scoop of your preferred protein powder (choose one with at least 20 grams of protein per scoop)
  • 2 tablespoons chia seeds (for fiber)
  • 1/4 cup Greek yogurt (for protein)
  • 1/4 cup berries (e.g., blueberries or strawberries)
  • 1 tablespoon honey or maple syrup (optional, for sweetness)
  • A pinch of cinnamon (optional, for flavor)


  1. In a microwave-safe bowl, combine the rolled oats and almond milk.
  2. Microwave on high for 2-3 minutes or until the oats are cooked to your desired consistency.
  3. Stir in the protein powder and chia seeds.
  4. Top the oatmeal with Greek yogurt, berries, and a drizzle of honey or maple syrup if desired.
  5. Sprinkle with cinnamon for extra flavor.
  6. Enjoy your high-protein, high-fiber breakfast!

This recipe should provide approximately 40 grams of protein and 10 grams of fiber, depending on the specific protein powder and milk you use.

Be well.

Mindset for Optimal Health

Becoming the healthiest version of oneself starts with taking personal responsibility for our actions and choices. However, it’s equally essential to avoid taking ourselves too seriously in the process.

Taking personal responsibility is the cornerstone of optimizing health. It means acknowledging our strengths, weaknesses, actions, and choices without blaming external factors. When we own up to our decisions, we empower ourselves to create meaningful change. This responsibility extends to our goals, relationships, and overall well-being.

A growth mindset is essential. It involves recognizing that failures and setbacks are not endpoints but opportunities for growth. By reframing challenges as chances to learn, we adopt an optimistic and resilient outlook.

However, taking ourselves too seriously leads to unnecessary stress and pressure. Perfectionism and unrealistic expectations hinder progress. Instead, embracing a sense of humility and acknowledging that we are all a work in progress alleviates the burden of constantly striving for flawlessness.

Balancing personal responsibility and a lighthearted approach might seem challenging, but it’s entirely possible. Setting realistic goals, celebrating small victories, and learning to let go of what we can’t control are essential steps. Remember, optimizing health isn’t a race—it’s a continuous process that unfolds over time.

Be well.

Dieting vs. Dietary Patterns. What’s the Difference?

In the pursuit of a healthier lifestyle, people often find themselves caught between two approaches: traditional dieting or adopting a new dietary pattern. While both aim to improve one’s health, they differ in their underlying principles, sustainability, and long-term impact.

Dieting refers to a short-term, restrictive approach to eating with the primary goal of achieving weight loss. It often involves counting calories, eliminating specific food groups, or following fad diets that promise quick results. Dieting can lead to a cycle of restriction and overindulgence, often causing frustration, guilt, and an unhealthy relationship with food. While dieting might offer immediate results, it tends to be unsustainable in the long run and can contribute to yo-yo dieting.

Dietary Patterns, on the other hand, focus on establishing a long-term, balanced way of eating that promotes overall health and well-being. Rather than fixating on quick fixes, dietary patterns emphasize the quality and variety of foods consumed. Examples of well-known dietary patterns include the Mediterranean diet, DASH (Dietary Approaches to Stop Hypertension), and plant-based diets. These patterns prioritize whole foods, including fruits, vegetables, lean proteins, whole grains, and healthy fats, while allowing flexibility and moderation.

Key Differences:

  1. Duration and Sustainability: Dieting is often short-lived, with a focus on achieving specific weight goals. Once these goals are reached, individuals may revert to their previous eating habits, leading to weight regain. In contrast, dietary patterns promote sustainable changes that can be maintained for the long term, contributing to overall health and preventing fluctuations.
  2. Focus on Nutrient Intake: Dieting tends to concentrate on calorie reduction and can sometimes neglect important nutrients that the body needs. Dietary patterns prioritize consuming a variety of nutrient-dense foods that provide essential vitamins, minerals, and antioxidants, promoting better health and preventing deficiencies.
  3. Mindset and Relationship with Food: Dieting can foster an all-or-nothing mindset and create a negative relationship with food. Individuals might feel guilty for indulging or straying from their prescribed diet. Dietary patterns encourage a healthier relationship with food, allowing for occasional treats without the associated guilt.
  4. Health Benefits: While dieting might lead to initial weight loss, it may not necessarily translate to improved overall health. Dietary patterns, such as the Mediterranean diet, have been linked to a reduced risk of chronic diseases like heart disease, diabetes, and certain cancers due to their balanced and nutrient-rich nature.
  5. Adaptability: Dietary patterns can be adapted to personal preferences, cultural backgrounds, and health conditions. This flexibility makes them more sustainable over time, as they can be tailored to suit individual needs.

In the quest for a healthier lifestyle, it’s essential to recognize the fundamental differences between dieting and adopting dietary patterns. By choosing to focus on dietary patterns, individuals create a healthier relationship with food and experience lasting benefits for their physical and mental health.

Be well.

The most important nutrient people don’t think about

Often overlooked, dietary fibre plays a crucial role in nutrition. Fibre is a carbohydrate the body cannot fully digest or absorb. Unlike other nutrients, it goes through the digestive system intact, helping various bodily processes. There are two types of fibre: soluble and insoluble. Soluble fiber dissolves in water and helps lower cholesterol and regulate blood sugar levels. Insoluble fiber adds bulk to the stool, promoting regular bowel movements and preventing constipation.

The Benefits of Dietary Fiber:

  1. Improved Digestive Health: preventing constipation reduces the risk of developing gastrointestinal disorders such as diverticulosis and hemorrhoids. It may seem trivial, but we see this in hospital all the time.
  2. Weight Management: High-fibre foods are more filling and prevent overeating.
  3. Heart Health: Soluble fibre, found in foods like oats, beans, and fruits, can lower cholesterol levels, reducing the risk of heart disease.
  4. Blood Sugar Control: Fibre slows down the absorption of sugar, preventing rapid spikes in blood glucose levels.
  5. Reduced Risk of Chronic Diseases: Studies have shown that a high-fibre diet is associated with a lower risk of developing various chronic conditions, including type 2 diabetes, certain cancers, and cardiovascular diseases.

Ways to Incorporate More Dietary Fibre:

  1. Whole Grains: Opt for whole grain versions of bread, pasta, and rice, instead of refined grains. Better yet, just eat the grains themselves.
  2. Load Up on Fruits and Vegetables: Aim to include a variety of fruits and vegetables in your daily meals. Leave the skin on whenever possible, as it often contains fibre. Berries, apples, broccoli, and carrots are excellent choices.
  3. Legumes and Pulses: Incorporate legumes such as lentils, chickpeas, and beans into your diet. They also have protein, making them a healthy addition to your meals.
  4. Nuts and Seeds: Include a handful of almonds, walnuts, chia seeds, or flaxseeds. They provide a good dose of fibre along with healthy fats and other essential nutrients. Proviso: if you’re trying to lose weight, don’t over do it here as caloric density is high.

Theme here, as with all nutrition, is to lean into a whole-food dietary pattern. For those who track, and you should do so once in awhile, target 30-40g of fibre daily.

Be well.

What you need to know about blood pressure: CMB Podcast Ep. 39

Everyone has had their blood pressure checked. But was it done properly? Chances are, it wasn’t. That matters a lot. High blood pressure often goes undetected for many years. Treatment delays lead to missed opportunities for reducing cardiovascular risk. Importantly, there are evidence-based ways to lower your BP without medication. We cover all of this, and more, in our latest CMB Podcast Episode. Now on YouTube!

Help us spread good information. Simply forward this e-mail to someone else!

Continuous Glucose Monitoring: CMB Podcast Ep. 38

I spend a lot of time discussing how diet affects blood sugars. When I have a patient with insulin resistance, or diabetes, this conversation is a top priority. With the goal of preventing or reversing diabetes, we want to keep blood sugar under control, along with big spikes in insulin. The trouble is, individual responses to specific foods are variable. So, how can you learn what foods cause the biggest blood glucose increases? Continuous glucose monitoring (CGM) is an accessible technology that can help. CGM uses a sensor applied to the back of your arm for two weeks, continuously sampling and measuring your blood glucose. Using a smartphone, you can check your levels as many times a day as you like.

In Canada, insurance covers CGM for patients with a diagnosis of diabetes being treated with insulin. However, there is likely a much broader benefit for those who’d like to prevent diabetes in the first place, especially if you are known to be at risk.

In this episode, we discuss my recent experience using CGM on myself and how I think this could be a practical tool for others.

What is Lifestyle Medicine?: CMB Podcast

The foundation of prevention and treatment of chronic disease is optimal lifestyle. Every set of evidence-based guidelines, whether for heart, lung, kidney, or neurological disease, starts by recommending dietary and exercise management. Practically, though, these components of treatment are paid lip service, opting instead for “medical” management.

Fortunately, there is an emerging specialty area called Lifestyle Medicine. Better known in the USA, we are starting to see it come north of the border. Lifestyle Medicine focuses on optimizing six pillars:

  • Nutrition
  • Physical activity
  • Sleep
  • Stress reduction
  • Social connection
  • Substance use reduction

Each pillar is important to address and based on good scientific evidence. Yet, there are challenges to implementation from the individual to systems levels, especially in our Canadian health care system. We explore these challenges and more during our conversation in today’s episode of the Cardiometabolic Health Podcast. Enjoy!

New Hope for Menopausal Hormone Therapy

I normally cringe when I see media coverage on menopausal hormone therapy. The use of hormones to treat perimenopausal symptoms, including hot flashes and night sweats, has been drastically underused, following misinterpretation and media hyperbole about findings form the Women’s Health Initiative study published in the ’90s.

I won’t go into it here, but suffice to say the risk of hormone therapy, especially breast cancer, has been overblown, resulting in a generation of women untreated and suffering unnecessarily. The nuances of the findings, and subsequent longer term data, are far more complicated than media care to report. And, unfortunately, misinformation persists among medical professionals.

This is why I was elated to read a fresh review article in the CMAJ and accompanying media coverage. The authors do an admirable job explaining the original concerns, while conveying the importance of using hormone therapy in a thoughtful and practical way. Particularly important is the comparison of risk of treating versus the risk of not treating.

In my practice, I see many women in their 40s and 50s with reduced quality of life, sleep deprivation, mood disturbances, and stress related to perimenopausal symptoms. Left untreated, symptoms lead to worse cardiometabolic health and increased risk for cardiovascular disease.

I encourage women and their medical professionals to familiarize themselves with this fresh look at menopausal hormone therapy and to open the conversation about its potential benefits.

How to Manage Hunger During Weight Loss

No matter your weight loss strategy, you will have to contend with hunger. Understanding hunger and having a strategy will help. First, hunger is a neurohormonal signal mediated by your brain’s response to what is happening in your digestive tract and metabolism. It’s no different than your brain’s signals for thirst or feeling hot. Like all uncomfortable sensations, the purpose is to change behaviour. If you’re hungry, eat. If you’re thirsty, drink. If you’re hot, remove layers of clothing. It’s no more complicated. The first, and often biggest challenge, is being aware of how your behaviour is controlled by these forces.

Once you are aware, you start to catch yourself in the act; mindlessly staring into the fridge or pantry. The second challenge, then, is changing your behaviour to promote your health-promoting goals. Before this, however, a couple of important things to know:

  1. Hunger is not starvation. Hunger is a feeling that is in no way harmful (if you can control it). Starvation is a state of prolonged malnutrition from dietary deficiency.
  2. Hunger is habitual. Our brains are incredible at associating activities and times. If you typically eat lunch at noon, you will feel hungry at noon, even though you have plenty of metabolic fuel on board to keep you going for days. If you eat at your desk, you’ll feel hungry once you sit down, even though you just ate an hour ago.
  3. Your blood sugar is not low. Again, hunger is not dangerous. Most people’s bodies and brains are used to getting a steady supply of food. Once you turn off the tap for a while, the system rebukes you with hunger. Though uncomfortable, there is no physiological reason why your blood sugar levels would drop too low. The obvious exception here is someone who has diabetes and is on medication that lowers blood glucose (eg. insulin, gliclazide).

Now that you know to anticipate and be aware of hunger, what can you do about it? Time for another list!

  1. Stay hydrated. Drink plenty of water throughout the day. If you feel hungry and it’s not time to eat, water, coffee or tea will lessen the feeling.
  2. Eat enough protein. Protein is satiating. Get 40-50 grams at your first meal of the day. There is good scientific evidence this leads to fewer calories consumed the rest of the day. Hit your total daily target and eat the protein first at each meal.
  3. Eat enough fibre. Fibre is satiating. Fresh fruit & vegetables, berries, avocados, legumes, and whole grains are good sources.
  4. Do NOT eat sugar, refined carbohydrates, or high glycemic index products. They are known to increase hunger shortly after consumption.
  5. Exercise. Being active reduces the feeling of hunger. Get up and go for a walk.
  6. Stay busy. Being engaged in activities takes your mind off of hunger.
  7. Wait. Hunger won’t last. Once your brain realizes it isn’t going to a quick hit of glucose, your metabolism will carry on via alternative pathways to keep your system running on stored nutrients. The hunger passes. It’s OK.
  8. Eat only at the table, ideally with your family or friends. Socializing slows us down and makes us feel better, regardless of what we’re eating.
  9. Be mindful of when hunger is gone and take your time. Don’t continue to eat simply because there is food on the plate. Eat slowly and deliberately. You should never feel overly full or ‘stuffed’.

When it comes to hunger and weight loss knowledge and planning are powerful tools. And yes, a little will power is also required. This is how you train your body and brain to optimize health.