Dietary options for Scenario 4

This page summarizes the dietary options for Box 4 from the Diet Selection Sub-Protocol.

Last updated: May 7, 2024

Conflicts to declare: None.

Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here.

In this scenario, you have observed that you are:

(a) Eating a maintenance level of calories such that your weight is stable, (b) You are not metabolically healthy. (c) After an assessment, your clinician may assess that weight loss is required for the purpose of optimizing your metabolic health. (d) This also assumes that you have no diet-restricting medical conditions (e.g. kidney disease that would restrict volume of protein intake).

First, reduce your total caloric intake (while ensuring adequate protein intake) to prevent continued additional weight gain. Discuss whether or not you require a caloric deficit with your healthcare provider.

• You can approximate daily caloric requirements for keeping a stable body-weight with simple calculators, but this should always be referenced to body weight/body composition changes over time.

• Talk to your licensed healthcare provider about whether or not you need to aim for a caloric deficit for the purposes of weight loss. This decision may be informed by body measurements such as waist circumference or imaging such as a DEXA scan.

• Note that in some circumstances, it is possible to lose fat and gain muscle at the same time - this is referred to as body recomposition.

• Some (but not all) patients who are metabolically unhealthy will require a caloric deficit (to eat fewer calories than the maintenance rate) in order to achieve metabolic health and optimization (e.g. individuals with a "skinnyfat" body composition may not need weight loss in the way that someone with obesity may require).

• Remember that individuals undergoing a weight loss program need to do resistance training to prevent them from losing too much muscle.

Second, consider adding the following general heuristics to your diet:

Note: These heuristics may not apply for carbohydrate-restricted diets, and are taken from the 2021 CCS guidelines:

1. Aim for ≥30g nuts/day (can reduce LDL-C by 5-7%).

2. Aim for extra-virgin olive oil as your oil of choice (≥60 mL/day).

3. Aim for regular intake of fruits and vegetables (≥5 servings/day).

P.S. - be careful with fruit or sugar-containing smoothies, since fruit juice and/or the process of blending away the fruit-fibre-matrix can deliver a sudden spike in blood glucose upon consumption.

4. Aim for regular intake of legumes (≥4 servings/week).

5. Aim for >30 grams of fibre a day (whether through food or through fibre supplements like MetaMucil pills)

Sub-recommendation: Consider a targeted aiming for fibre from specific sources: high viscous soluble fibre from oats, barley, psyllium, pectin, or konjac mannan (≥10 g/day) (e.g. MetaMucil powder/pills) (can reduce LDL-C by 5-10%).

6. Eating ≥ 3 servings of whole grains a day (assuming no carbohydrate-restricted diet).

A simple 2-page guide that includes most of these heuristics is also available here.

Third, pick an specific dietary protocol from one of the following options:

1. Mediterranean diet.

• This is the standard omnivorous diet recommended for most patients in the 2021 Canadian Cardiovascular Society Guidelines for dyslipidemia.

• This diet is easier for most people to adhere to relative to a carbohydrate-restricted diet or a plant-based diet since it includes animal foods.

  • Note: A low glycemic-index variation of the Mediterranean diet can also be implemented.

2. Plant-based vegan diet.

• This is a viable alternative for individuals who do not wish to consume animal food products.

• This diet can lower LDL and ApoB.

• There is some limited evidence suggesting that, unique among dietary interventions, it may lower Lp(a)).

• Pay special attention to micronutrient supplementation (e.g. Vitamin B12, creatine) if you are not consuming any animal products.

• Be mindful of your protein intake quality in particular - plant protein is less bioavailable than animal protein. Click here for information on how to adjust your protein intake calculation for vegans.

• Some individuals may wish to eat a primarily plant-based diet and include some limited elements of animal protein (e.g. dairy, fish, eggs), although some research suggests that healthy omnivorous diets may not be as effective as vegan diets in lowering LDL. (on the positive side, they can provide easier access to higher protein quality and may be easier to adhere to).

1. Low-glycemic index diet.

• This is a diet that is designed to avoid sudden spikes in blood glucose, but unlike a ketogenic diet, it still allows for larger quantities of carbohydrates to be consumed, and may be easier to adhere to.

• Note that low-glycemic foods can be selected within the parameters of a mediterranean diet, and some researchers have found benefit from this combination of approaches.

Fourth, implement the dietary protocol you picked in step 3, while incorporating the general heuristics from step two.

• We are currently working on an individualized meal-delivery service to assist our members in implementation.

Disclaimer: The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others.