No Backtracking

No Backtracking principles

This is a plan for life. You will carefully reintroduce certain carbohydrates into your diet — and find the balance that maintains your weight and keeps you feeling trim. This crucial phase will allow you to:

• Establish the carbohydrate levels that you can eat in order to remain slim and supply your energy requirements
• Break totally with bad habits made in the past
• Never return to yo-yo dieting
• Find a healthy attitude to food and a viable eating plan for the rest of your life.

No Backtracking rules

During this phase you need to:

• Increase your daily carb intake by no more than 10g (1/3oz) each week

• Add new foods one at a time

• Eliminate a new food if it provokes weight gain; a return of physical symptoms lost during the Fast-Track Plan; increased appetite, cravings or water retention

• Drop back to the next-lowest level of carbohydrate intake if you gain weight

• Carry on eating adequate amounts of healthy fats and lean protein at every meal to ensure a balanced diet

• Continue to take vitamin and mineral supplements regularly, drink masses of water and, of course, exercise regularly.

Make this diet the one that works

Once you have reached your target weight, you can start on the No Backtracking plan. Increase your intake of carbohydrates by 5-10 grams per day until you reach your optimum level for weight management This will probably be around 40 per cent of your total daily calorific intake, but remember that everybody differs, especially when you consider activity levels.

If you have high insulin resistance, then you may have to Keep on Tracking and be careful about how many carbohydrates you consume on a daily basis. But if you're one of the lucky ones with low insulin resistance, you may be able to eat most vegetables (including starchy vegetables), fruit, pulses andwholegrains such as oats, barley, millet, wild rice, couscous and buckwheat. You can also begin to use recipes containing carbohydrate ingredients such as breadcrumbs; you may even be able to handle an occasional potato. But don't eat all these things in one day. You still have to monitor your carbohydrate intake to stay where you are - healthy and energized. Remember the eating habits that got you here in the first place. You should have successfully gauged your ideal carbohydrate level, and be maintaining a stable weight and energy levels, within 4-12 weeks of following the No Backtracking plan.

Stick to the basic weight management tips and try to be good 80 per cent of the time. We are all allowed the odd slip up - if you want a slab of chocolate cake from time to time, make sure it is the best you find and enjoy it. If you ever see the scales creeping up, cut back, even go back to the Fast Track plan for a few days until your weight is back to normal, and then gradually raise your carbohydrate levels once again.

A template for life

Two portions of higher GI carbohydrates are included per day on the suggested eating plan. Treat this as the template you ought to follow from now on. And try some of these tricks to keep your carbohydrates at a moderate, healthy level:

• Opt for rye bread, oatcakes and rye crackers instead of wheat-based bread. Even if you are not wheat-intolerant, it is worth considering this.

• Eat fruit 20 minutes before eating anything else, not afterwards. Fruit takes less time to digest, but if eaten on top of a heavy meal, can cause bloating.

• If you are going to drink alcohol, choose dry white wine or, even better, red, which contains flavonoids with antioxidant and anti-platelet properties thought to reduce deaths from coronary artery disease. If you have managed to kick the alcohol habit, opt for grape juice, which contains flavonoids similar to those in red wine.

• Mix sweet potato with cauliflower as a mash or purée to go with roast chicken. The aim is to mix a high GI vegetable with a low one, to reduce the total carbohydrate level.

• When making a rice dish such as risotto, reverse your ratio of vegetables to rice: add a little rice to a heap of vegetables. And try grating raw vegetables such as carrots and courgettes into the dish at the last moment - it adds texture and you get the benefit of all those raw phytonutrients.

• Don't give up on those whey-protein smoothies - they are still the most effective way of getting high-value biological protein.

Fast-Track principles

This is a diet, or a way of eating, that will:

• Lower insulin levels and stabilize blood-sugar levels
• Banish food cravings
• Eliminate energy peaks and troughs, and mood swings

Enhance concentration

• Re-educate you into a way of eating that will increase your vitality and improve your overall health
• Help your body to burn fat and normalize your weight.

It is vital that you understand the principles of this diet and follow it responsibly. If you are fundamentally healthy, but insulin-resistant and experiencing any ofthe accompanying symptoms, this plan will help you redress the balance and find a level of carbohydrate intake with which your system can cope. The Fast-Track Plan offers you a kick-start and is aimed at women with a BMI of over 35 and men with a BMI of over 25.

For the period of this plan you base your diet on an approximate ratio of 50 per cent high-quality protein/20 per cent low GI carbohydrates/30 per cent healthy fats. You begin the first two weeks of the diet by restricting your carbohydrate intake to 20g (³/4oz), your protein to 150g (5oz) Biological Value and healthy fats to a minimum of 40g (1 1/2oz). On a very simplistic level this means:

• 3 cups low GI vegetables per day.
• 1 portions of protein three times per day and portion twice per day as a
  snack. (A portion of protein is the equivalent to the size of your palm.)
• Around a half to a whole teaspoon of allowable fats at every meal.

Within 48 hours your body will start to burn its own fat as fuel, as your body switches into benign dietary ketosis.

Ketosis

Being in ketosis means that your body burns fat because it isn't taking in sufficient glucose to meet your energy needs. Under everyday conditions the carbohydrates that you eat are converted to glucose, which is the body's primary source of energy. Whenever your carbohydrate intake is limited to a certain range, for a long enough period of time, your body will draw on its fat stores — turning this into a source of fuel called ketones. When you burn a larger amount of fat than is immediately needed for energy, the excess ketones are discarded in the urine.

Dietary ketosis has received a bad press because it is often confused with ketoacidosis, a life-threatening condition most often associated with insulin- deficient, type 1 diabetes.

Benign dietary ketosis, however, is a natural adjustment to the body's reduced intake of carbohydrates, as the body shifts its primary source of energy from carbohydrates to stored fat. The presence of insulin keeps ketone production in check so that a mild beneficial ketosis is achieved. Blood-sugar levels are stabilized within a normal range and there is no breakdown of healthy muscle tissue, as long as sufficient protein is included in the diet.

Measuring ketosis

On a rapid weight-loss diet you will usually start to burn fat instead of sugar within the first 48 hours. To measure the ketone levels in your urine, buy urinary test strips, called lypolisis strips, from any pharmacy, which will show you if your carbohydrate/insulin balance is at optimum levels for fat burning. You should do this twice a day: before breakfast and before your evening meal. Your levels need to be between trace and small (0.5-1.5 mmol-l).

Caution: if your levels rise to above moderate (4 mmol-l), you are not eating enough and should increase your low GI carbohydrates until the ketones are reduced to between trace and small (0.5-1.5 mmol-l). Always drink plenty of water: at least eight large glasses per day.

Must Know: Facts about fat in Your Diet

Although the effect of the total amount of fat in the diet on blood cholesterol levels has been well documented, the most important effectrelates to the type of fat.

Saturated fats have a profound hypercholesterolemic effect (in other words, they increase blood cholesterol levels significantly) and simultaneously increase concentrations of LDL or 'bad' cholesterol. Sources: Saturated fatty acids are found in both animal and plant products, but animal products (such as butter, cheese, full-cream milk, cream, ice-cream, beef, pork and lamb) are the major source of saturated fat in the average South African diet. Similarly, hard or brick margarine (the product packaged in a wrapper) is high in saturated fat; soft of 'tub' margarine is the healthier alternative, since it is low in this type of fat and higher in polyunsaturated fats. Using a polyunsaturated fat will also help to improve your P:S ratio (see below). Coconut oil, cocoa butter, palm oil and palm kernel oil are common 'saturated' vegetable fats which are generally found in many commercially baked goods such as biscuits, also in non-dairy creamers, cake mixes and chocolates. Read labels carefully if youwant to avoid these products.

Mono-unsaturated fats were previously thought to be 'neutral' intheir action on blood cholesterol levels, but recent studies suggest that these fatty acids may play a useful role in the dietary prevention of CHD, since they appear to have most of the benefits of polyunsaturated fatty acids.

Sources: Olive oil, avocado pears and nuts are rich sources of monounsaturated fat.

Polyunsaturated fats lower blood cholesterol levels as well as the concentraton of LDL cholesterol.

Sources: Sunflower oil, tub margarine.

There are two classes of polyunsaturated fatty acids, namely omega-3 and omega-6, which have a variety of functions in the body. Omega-3 fatty acids are found in some vegetable oils and, in particular, in fatty fish. Eicosapentanoic acid (EPA) - a fatty acid which falls into thissub-class - is derived from fish and is highly concentrated in fish oils. Research suggests that this fatty acid may play a beneficial role in a diversity of biological processes including arthritis, eczema and even cancer. However, the role of omega-3 fatty acids - and specifically EPA - in the treatment of hypertension and raised serum cholesterollevels remains controversial.

It seems from studies done so far that fish and fish oil supplements may lower triglyceride levels, reduce clot formation, decrease blood viscosity (or thickness) and lower blood pressure levels. However, the optimal doses of these fatty acids have not been established and until answers to these questions are known, the widespreadsupplementation of omega-3 fatty acids is not recommended. It is a better idea to substitute fish, especially fatty fish (such as salmon, galjoen, snoek, pilchards and tuna) as a source of protein in two or three meals a week, thus consuming a whole spectrum of nutrients and not just a single fatty acid fraction.

The P:S ratio

The ratio of polyunsaturated to saturated fatty acids in a diet is known as the P:S ratio. The typical South African diet has a P:S ratio of 0.5:1.0 (in other words, twice as much saturated as polyunsaturated fat). However, the eating plan recommended for the prevention of CHD suggests a ratio of at least 1:1 (or an equal quantity of both), which for most of us means restricting our saturated fat intake and replacing it, where practical, with polyunsaturated fat such as fish or sunflower oil. Most of the comparisons between the effects of saturated and polyunsaturated fat have indicated that gram for gram, the blood cholesterol-raising effect of saturated fat is up to two times greater than the cholesterol-lowering effect of polyunsaturated fat.

Many studies have shown that so-called 'intervention trials' aimed at lowering raised blood cholesterol levels, reduce the CHD risk and slow the progress of arterial damage. These studies provide strong support for recommendations for a considerable overall decrease in dietary fat by the general public, from the present 35-38°/o to 30% of total kilojoule intake, and a decrease in saturated fat to 10% of total kilojoule intake.

How fibre affects the body continue...

Appendicitis

Appendicitis is inflammation of the appendix, the small blind-ended tube at the beginning of the large bowel. Although the underlying causes of appendicitis are not clearly understood, there is evidence that regular intake of fibre may prevent the development of the disease.

Hiatus hernia, varicose veins and piles

Many doctors believe that abdominal straining due to constipation encourages the development of conditions such as hiatus hernia (where the top of the stomach is pushed upwards, out of the abdomen and into the thoracic cavity), varicose veins and haemorrhoids (piles). It is often necessary to have surgical treatment for these conditions. Treating constipation with high fibre diets and, as a result, avoiding straining, may prevent these problems and may even reduce the need for more drastic treatment in some cases.

Coronary heart disease (CHD)

Coronary heart disease is the most common cause of death in affluent Western countries (see page 151). A large number of factors influence the development of the disease, of which raised blood cholesterol levels, high blood pressure and hypercoagulability (the tendency of the blood to clot too easily) are probably the most important.

Researchers believe that high-fibre, low fat diets protect against CHD by lowering blood cholesterol and probably also by decreasing blood pressure and the clotting ability of blood. It is especially the water soluble or gel-forming dietary fibres - found in oats, legumes and some fruit and vegetables - which help to lower cholesterol levels. While it should be borne in mind that diet is but one of the many factors which influence the development of CHD, it is also one of the controllable ones.

Diabetes mellitus

There are two forms of diabetes mellitus, a disease characterised by the excretion of glucose (sugar) in the urine (see What is diabetes? on page 175). Both forms are today treated with a high carbohydrate, high fibre, low fat diet. Fibre in the diet normalizes the body's response to dietary carbohydrate (glucose tolerance). A regular high intake of dietary fibre also improves insulin function by increasing the sensitivity of muscle and fat cells to the hormone.

Gallstones

The body manufactures these crystalline substances when the amount of cholesterol in the bile is so high that the bile salts cannot keep it in solution. The stones may block bile ducts between the liver and gall bladder or between the gall bladder and small intestine, resulting in severe pain and even jaundice. As in the case of other diseases of affluence, a number of factors may contribute to the development of gallstones. It has however been shown that high fibre intakes stimulate the production of those bile salts which keep cholesterol in solution, thus decreasing the risk of gallstone formation. Populations who follow high fibre diets have a significantly lower risk of the disease than those on the average refined Western diet.

To what degree is fibre involved?

Although research has proved that dietary fibre has a positive effect on body functions in general, the degree to which it is involved in the risk and development of the above diseases is still unclear. Studies are hampered by the fact that a variety of causes play some role and also because high-fibre diets differ in more than one respect from low-fibre ones. For example, they usually have a lower fat content - especially saturated fatty acids from food of animal origin - and are higher in vitamins and minerals. These factors could add to the beneficial effects seen in people who eat a high-fibre diet.

What is diabetes?

Diabetes is a disorder in which the pancreas cannot produce enough insulin, a hormone which prevents blood sugar levels from rising too high, or in which the insulin that has been produced does not function properly. It does this by helping body cells to take up glucose - either to metabolise to energy or to store as glycogen or fat.

If an individual manufactures too little insulin, there are two possible forms of treatment: The young, more severely affected diabetic can only survive if given daily injections of insulin for the rest of his or her life. However, if diabetes develops at a later age, treatment with pills is usually effective. These pills are not insulin; they are essentially compounds which give the pancreas the necessary stimulus to produce more insulin to cope with the carbohydrate (sugars and starches) which the individual eats. Because sugar causes a dramatic rise in blood sugar levels, diabetics should obviously avoid it in their diets; indeed, they should avoid all unnecessary food in general if they are overweight, as not only is the insulin requirement related to food intake, but excess weight has an aggravating effect on the condition. Obese diabetics who develop the disease in later life can often be treated by diet alone.

A low fat, high fibre intake - which 'dilutes' the contents of the digestive tract - slows down the passage of glucose into the blood stream and hence the elevation of the blood sugar is less dramatic.