• Gerry Davies

Comfort Foods: Risk to Remedy

Transform Comfort Foods from a Risk to Remedy With Ketogenic Prebiotic Ingredients

Multiple lines of evidence support combining low carbohydrate or even ketogenic foods with substantial prebiotics as a pattern of eating for the treatment and prevention of diabetes, obesity and related non-communicable disease risks. Synergy between low carb and high fibre is to be expected because of the distinctly separate biological mechanisms involved:

1. Removal of high glycemic carbohydrate (HGCarb) and in turn postprandial hyperglycemia and hyper-insulinemia.

2. Replacing HGCarb with prebiotic fibre, which has become chronically deficient yet, essential for microbiome diversity, gut health, immune regulation, energy homeostasis, short chain fatty acid production and regulation of incretins (ghrelin, CCK, GLP1 & PYY).

The harmful consequences of a diet consisting mainly of starch and sugar are becoming well known but the wider metabolic benefits of replacing them with fibre and pre-biotics is exciting new science becoming increasingly recognized in light of the microbiome revolution.

Huge changes in macronutrient intake can be achieved just switching daily consumption of a staple such as bread or chapatis from whole wheat flour to Fiberflour:

Population studies have consistently shown higher fibre intake is associated with decreased cardio-vascular disease, diabetes and all-cause mortality. Numerous plausible mechanisms for these benefits are emerging where there is a cascade of events stemming from microbiota fermentation of non-digestible carbohydrates, increased products of hind gut fermentation such as short chain fatty acids, vitamins B and K, polyphenols and countless other metabiotic nutrients. The short chain fatty acids especially butyrate are of particular importance with numerous functions in the wider organism as well as the gut and must soon be recognized as essential nutrients for optimal health.

Production of short chain fatty acids are dose related to fiber fermentation and new evidence regarding the vital roles of butyrate suggests optimal fiber intake needs re-evaluation. A meta-analysis showed a dose response reduction in cardio-vascular disease risk with up to 70g fibre/day whereas hunter gatherer populations customarily consume in excess of 100g/day and experience far fewer metabolic disorders. Fibre deficiency could be increasingly important in view of new discoveries in immunology linking gut derived SCFA to levels of regulatory T cells (Tregs) and are very topical in view of abnormal cytokine storms in some individuals who contract flu and Coronavirus, not to mention autoimmunity in asthma, celiac, T1D, arthritis and others. The short chain fatty acid butyrate is a powerful histone deacetylase inhibitor that promotes Treg transformation, immune cells essential for limiting the damage of inflammation on normal tissue. A natural approach to reducing inflammation is essential as there is already a reluctance to employ drugs for HDAC inhibition for fear of going too far and suppressing immunity against infections and cancer. A readily available practical tool to help prevent autoimmune and inflammatory disorders is a high prebiotic fibre diet. Immune system disorder may partially explain the 10-fold higher mortality from coronavirus in those with diabetes and metabolic syndrome.

The SCFA are signaling molecules and SCFA receptors are expressed on entero-endocrine cells, immune cells and many other tissues. Through these receptors SCFA regulate immunity, glucose homeostasis, gut permeability, appetite and hunger hormones (GLP1, PYY and Ghrelin). The link between fiber-SCFA-GLP1 was shown to be responsible for alleviation of diabetes in a study using fiber supplements. In addition to regulating blood sugar metabolism GLP1 has been shown to protect pancreatic insulin producing cells from programmed cell death.

Long term compliance with dietary advice depends on controlling hunger and availability of culturally acceptable alternative foods

Calorie restriction or other time restricted eating and fasting advice are effective ways to lose weight, decrease age related diseases and even extend life expectancy but is unlikely to be adopted by most people if it is associated with intolerable hunger. High glycemic, rapidly digested carbohydrates, such as sugar, corn syrup, flour, potatoes, rice, corn flour, form over 50% of most people’s diets and attempts at calorie restriction while still consuming these types of addictive foods is associated with agonizing hunger so much so that these foods make it almost impossible to maintain a normal weight over the long term. The synergy between eliminating postprandial hyperglycemia and high prebiotic fiber intake is expected to suppress several aspects of appetite regulation outlined below.

1. Elimination of high glycemic foods in itself results in reduced hunger and food consumption.

2. High fibre food reduces gastric emptying creating a satiating “fullness effect”.

3. GLP1 & PYY satiety hormone levels increase with high fibre consumption.

4. The hunger hormone, ghrelin is reduced in response to short chain fatty acids from prebiotic fermentation.

Optimal Fiber Intake?

Despite the numerous health benefits of fibre and pre-biotics most people only manage to consume half the 30-38g recommended daily amount where we really need something in excess of 50g of fibre a day to be of maximum benefit. The OptiFit study designed to improve diabetes with dietary counseling failed to achieve recommended fibre intake with commonly available foods and eating habits without supplements. There is a problem with obtaining adequate fibre from whole grain wheat flour which is nevertheless a high glycemic/insulinemic food and 40g a day of fibre from whole-wheat flour comes with 250g (1000 kcals) of additional high glycemic starch. On the other hand it is impractical to consume large volumes of vegetables, for example 1.7 kg of broccoli to get 40g of fibre. Alternatively, replacing starch with innovative prebiotic fiber ingredients in basic baking flour in everyday comfort foods can easily achieve high fiber intake with a negligible glucose and insulin response.

Suggested Dietary Strategy for weight loss and those with type 2 diabetes.

· First one must understand the advantages of a predominantly low glycemic carbohydrate diet, high in fiber and phytonutrients with modest protein and fat while minimizing high glycemic filler foods like bread, potatoes, rice, pasta, flour and sugar.

· High fibre products should be introduced gradually to allow for adaptation to a change in bowel habit, increased stool and gas production.

· The good news to encourage compliance is that subjects can consume an unlimited amount of Fiberflour Bread, chapatis, pizza, flat bread, cookies, pastry, etc. because it is self-limiting and decreases the amount of high calorie foods they might otherwise eat instead.

· BAME & Asian ethnic groups are particularly suited as they have a high incidence of diabetes and are usually skilled chapati cooks.

· Hunger suppression will easily allow increasing periods of fasting, one meal a day, or any additional advice subject would like to follow?

· Think about hunger and ask the question: am I hungry? Do I need to eat now or am eating out of routine habit?

· If possible, keep a diary of self-assessed hunger on a 1 to 10 scale and food intake.

· After 1 month of following the program there should be significant changes in appetite & spontaneous food consumption, weight, waste line measurement, resting heart rate, blood pressure, mood and subjective wellbeing.