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Should I Exclude all Carbohydrates and go Gluten Free?

 “What is a healthy diet?” may sound like a simple question. But there are so many details to consider. One big question I hear people ask is “Should I cut out carbohydrates and gluten?”

In this article I have presented the arguments for and against each question so that you can decide which is the right decision for you.

I want to help you find the “way of eating” that suits you and your life.

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Lots of New Nutrition Research Leaves People Confused

In the last couple of decades loads of interesting research has been done on nutrition.

We are starting to see how diet affects our health.

We are starting to see how diet affect individuals differently.

The more researchers find out, the more questions we ask.

It can be confusing wadding through research that often doesn’t give a clear cut answer.

Experts promote different "rules”. “Trend diets" come and go. (Remember Dr Atkins?)

Previous Recommendations Are Now Questioned

Many expert say that  past governmental advice to eat a high carb, low fat diet led to the obesity crises of today. 

(There are many reasons for the obesity crisis. This is not the only reason but a large contributing factor.)

It’s a minefield of information. If you follow it all you'll find yourself cutting out grains one day then fruits another. Until you don’t know what to eat and what to avoid.

One big area of controversy are carbohydrates.

Should you go gluten free? Should you exclude all carbohydrates?

Do you have to give up pizza, pasta, croissants forever?

We Grew Up in the Great Carbohydrate Era

As you read the arguments “for and against” I’d like you to have a think about your “conditioning”.

I remember thinking a few years ago, “why would I want to give up gluten? I’m thin and it doesn’t do me any harm.”

I didn’t want to let go of a lifetime of eating gluten. My conditioning was playing a large part in not wanting to investigate further.

I had a lot to lose by thinking “gluten is bad”. I would have to give up all wheat based products, pizza, bread, pasta, cake!

Not only did I enjoy eating them (and still do in moderation) but they’re so convenient to buy and cook. And who doesn’t want an easy life? Especially if you’re cooking for kids (who in my experience are all “carbo-holics”!)

The good news is that I have found that I can have my cake and eat it. Actually I often make cake that is gluten free. (Almond flour is quick, easy and really tasty to cook with.)

My favourite gluten free cake is this easy clemetine cake.

We don’t eat entirely gluten free but I have significantly reduced the amount of gluten and carbohydrates that I eat.

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Nutrition Affects Individuals Differently

Research is revealing that what we eat affects our bodies in many complex ways. For example, the foods we eat affects our “biome” (that big mass of bacteria and other organisms that live in our gut).

The biome is fascinating and can affect our behaviour. What we eat can affect our biome.

Did you know that we have more brain cells in our gut than a cat does in its brain? I didn’t!

I confess to skipping (or sleeping through) a few lectures at medical school but back when I was training we didn’t know much about the biome. For a more in-depth read, check out Dr Michael Mosley’s “The Clever Gut”. It’s a great read.

Diet Can Affect Gene Expression

Think of genes as printers that can print different pages. Diet can affect the pages that come out.

There are so many “individual” factors when it comes to eating. We all have different genes to start off with (different printers.)

We’re beginning to see that what our mother ate when she was pregnant will have affected us.

What we ate early on as a baby is important. Children develop eating habits (for better or worse) before the age of 3. (You can change them after the age of 3.)

All of these different factors shape the body we have today.

It’s easy to see how if 2 different people eat the same foods it can affect them differently.

Forget the “Perfect Diet”, Find “Perfect for You”

We are finding out more and more that there isn’t a “perfect diet” but rather a “perfect diet for you”.

One person might be thin and healthy eating the same diet as another person who is fat and overweight.

I want you to find the diet that is a good match for you and your family.

Although diet is very important it still has to fit in with the rest of your life. (I’d argue that diet is the MOST important aspect of living a healthy life.)

I want to help you find and make changes that will suit your family and that you can sustain.

It’s not Only Diet, it’s Your Life Style

We’re beginning to see that it’s not only diet that affects our weight and health. We all know that exercise is good for us but now we can see that our entire lifestyle is important.

When we pause and think about it we already suspect that. How many hospital dramas have you seen with the "stressed business man who’s on the brink death" story line? The doctors all warn him that he has to change his lifestyle but he's so wrapped up in his business he can't let go.

That story has 2 possible outcomes. He either carries on with “stressed” and dies a dramatic death.

Or he or she has a life changing moment, lets go of the stress, recovers and lives a happy ending.

We’ve suspected it for ages, but now we’re beginning to see evidence that supports the theory.

Being more mindful helps us become more productive, happier and healthier.

Diet, exercise, “mindfulness”, lack of stress, being happy are all interconnected and contribute to our weight and health.

The Big Gluten Question.

So what is all the hype about gluten?

One one side of the fence we have people who spurn gluten. They believe that excluding it is the answer to longevity and a healthy life.

On the other side we have people who can’t get enough of it. (Or prefer to carry on as they are and ignore the uncomfortable questions.)

I’m sure you know what gluten is but I’ll recap to make sure we’re on the same page.

Gluten is a Protein Found in Wheat

Gluten is a protein that is present in wheat. It’s found in all products containing wheat. Bread, pasta, cake, biscuits, bread sticks, chapatis. Anything that resembles bread most likely has wheat in.

Gluten is also found in other grains

Gluten is added to loads of packaged products that you wouldn’t suspect contain gluten.

(Think soy sauce and some potato chips. Random stuff that you wouldn’t guess has gluten in unless you read the labels closely.)

Gluten Makes Bread Delicious

Gluten gives wheat that “sticking together” ability. It’s what makes bread delicious. If you want to make bread, you usually use “strong flour” or “bread flour” (they’re the same.)

Bread flour contains more gluten than regular flour. The gluten helps the flour to stick together even though the yeast has made it rise. If you didn't have the "yeast and gluten combo" you’d have a flat heavy pancake.

As I found out when I tried to make bread with plain flour.

Some People Are Allergic to Gluten

People who have coeliac disease have a strong hyper immune to gluten. Their body reacts to gluten making them unwell and leading to a higher risk of certain cancers.

Coeliac disease is normally diagnosed in childhood. The symptoms can be non specific and it can be difficult to diagnose. Often a child is “failing to thrive” and not growing along their centiles on the growth chart.

Coeliac Disease Can be Hard to Diagnose.

One of the first tests done is a blood test called a “coeliac screen”. It is possible to have a test that comes back negative even when the child does have coeliac disease.

Coeliac disease is formally diagnosed with a biopsy. It is treated with lifelong exclusion of all gluten (under medical supervision).

Some people are diagnosed with coeliac disease later on in life. Either they didn’t notice there was anything wrong or the symptoms appeared later than normal.

People with Coeliac Disease Must Exclude All Gluten

Everyone agrees that people with coeliac disease have to avoid all gluten for life.

Do People Without Coeliac Disease Need to Exclude Gluten?

There are lots of people without coeliac disease who claim to be “gluten intolerant".

Other people say they have have cured “irritable bowel syndrome” by avoiding gluten.

Why Should People Who Don’t Have Coeliac Disease Avoid Gluten?

This is where things start to get more confusing. You’ll find people on both sides of the fence.

Let’s start by looking at the argument against gluten.

Dr Perlmutter is one of the leading voices urging us all to exclude gluten from our diet. His book "Grain Brain" is an interesting and compelling read.

Dr Perlmutter is a practising neurologist. He puts forward the theory that gluten leads to “inflammation” that is the underlying cause of many diseases.

His focus is on brain disease, specifically Alzheimer’s. But, there are lots of other illnesses caused by inflammation.

Let’s take a pause from gluten and have a look at inflammation.

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What is Inflammation and Why is It Bad?

When your body tries to fix something, it starts a complicated process of fixing and mending. It tries to get rid of unwanted things such as bacteria.

Part of this process is "inflammation". The inflammatory process makes things red, hot and swollen.

Sometimes you can see that process going on. At medical school we would look at joints of people with arthritis. They were red, hot and swollen. That was the inflammatory process in action.

Another more common example is when you have a spot or pimple on your face. While your body is trying to fix the spot, it's red, hot and swollen.

After a while the redness and swelling go. (A pimple is a bit small to notice any heat.)

A pimple is the inflammatory process in action.

The inflammatory process can also go on within your body where you can't see it.

You might not be aware of it at all.

You might develop symptoms of not feeling great but you might not notice it for years and years.

Inflammation Helps Us Heal Our Bodies

Inflammation is fine in small doses. (This is what we call “acute inflammation” or lasting a short period of time.)

Inflammation is great when it is helping us.

But, if you have inflammation or the inflammatory process going on for a long time, that’s not so great.

Especially if you aren’t even aware that your body has triggered the inflammatory process.

Chronic Inflammation Isn’t Great

When the inflammatory process continues, it can cause problems in other parts of the body.

Dr Perlmutter states that eating gluten triggers the inflammatory process. Over a period of time this affects your brain and leads to neurological problems.

It is now widely accepted that a high carbohydrate diet is linked to Alzheimers.

(And that the best diet to reduce your risk is the "Mediterranean Style Diet".)

Dr Perlmutter goes further than Alzheimers. He gives several interesting accounts of curing people with neurological problems by excluding gluten.

But does that mean we all need to exclude gluten?

Let’s say (for arguments sake) that we agree that gluten triggers the inflammatory process in some people without coeliac disease.

Does it trigger it in all of us?

And if so, could we just reduce our intake enough so that we don’t trigger the inflammatory process?

The problem is we don’t have answers to these questions.

We also can’t see what’s going on in our bodies without doing tests.

Back to Gluten and Inflammation

So the theory goes that gluten triggers an inflammatory process in many people. (Possibly not all people but I suspect that this is where the dispute rages. And where you need to find out what affects you.)

Here’s where we get to the “cave man” bit.

Our ancestors way way back in the day, didn’t eat much gluten when they were hunter gathers.

At some stage we settled down to farm. Scholars have hypothesised it was just an excuse to make beer and enjoy the pleasures of alcohol. That was when we started to eat more gluten (in both bread and beer.)

We have been eating gluten for centuries although not in such vast quantities. And not the same kind of gluten.

In “grain brain” Dr P explains how the gluten we now eat is vastly different from a few hundred years ago. (Thanks largely to genetic modification that whizzed up the evolution process.)

He explains that our bodies take around 10 thousand years to adapt to changes in population diet.

So our bodies haven't learnt to process the new gluten yet.

Flour is Different All Over the World

In a recent trip to the USA, I met up with some nutritionists and health experts. They explained to me that the flour in the USA is so genetically modified that it contains 70% gluten.

In other parts of the world, the percentage is much lower.

In Europe we have far less genetically modified foods. (In theory none but many people are sceptical about that.)

The percentage of gluten in flour in Europe is around 30%.

So for every mouthful we eat, we’re eating less than half the amount of gluten.

Why Do we eat so much Gluten?

This is the sad disaster of the 20th century. Pretty much everyone who writes about nutrition agrees with this bit.

Back in the 50s-70s the American government told everyone to eat a high carb, low fat diet. This advice that wasn't based on good evidence.

(The reasons for why this happened are interesting and explained in various ways by different people. Some say that Eisnehower having a heart attack was the trigger.

Others name scientists and researchers who shouted their message from the roof tops. Except their message wasn't evidence based. It was more "opinion". When they got the attention of the media, the rest they say is history.)

A Low Fat Diet isn't as Good as People Thought

They claimed that a low fat diet was a healthy diet and that everyone should eat a low fat diet to avoid heart disease.

(It is becoming more apparent that eating fat isn’t the same as the fat cells that are in your body. We’ll get to that later.)

The problem is that people need to eat something so they turned to cheap and processed foods, marketed as “low fat”. Guess what made up the bulk of these foods? Carbohydrates (and most of them gluten containing carbohydrates.)

The fact that the American government also subsidised wheat farming didn’t help.

Within a decade, the American population started to get more obese not less!

The rate of diabetes also skyrocketed. (Worldwide the WHO reports an increase from 108 million in 1980 to 422 million in 2017. That's an increase of 4 times!)

America led the way for the rest of the world.

Now we Eat Loads of Gluten

Now we have a modern population eating enormous quantities of carbohydrates. Not good in itself, I’ll get to that in a bit.

Plus a new form of gluten that our bodies haven’t evolved to handle.

The worry is that the gluten triggers the inflammatory processes. And that this leads to other diseases around the body (not just confined to the gut.)

Dr Perlmutter Advocates A Ketogenic Diet

Dr Perlmutter is so convinced that this process is going on in everyone that he advocates a “ketogenic” diet. This is when you stop using carbohydrates as an energy source and use ketones instead.

A ketogenic diet consists of a very high fat intake, moderate protein and a very low carbohydrate intake.

If the theory is correct, you no longer trigger the damaging inflammatory process.

The problem is that if you increase your carb intake above the allowed limit, your body will switch off the ketogenic pathway and turn back to using carbohydrates as a fuel.

The Ketogenic Diet is Low In Vegetables

Everyone agrees that vegetables are good for you. They are full of fibre and phytonutrients. They help protect our bodies from diseases with their anti oxidant properties.

Vegetables are a source of carbohydrates.

Within the ketogenic diet, you can eat some vegetables. But you can’t eat starchy vegetables.

Many people really love the ketogenic diet (and manage to eat lots of leafy greens that are permitted.)

Does that Mean Everyone Should go Keto?

In contrast the Mediterranean Style Diet consists of "reduced" refined carbs. You are still getting your energy from carbohydrates so you can eat more vegetables.

Sadly Dr P doesn’t address the “reduced carb” diet. Or indeed the side effects (such as constipation) of a low vegetable diet.

(Although you can eat many non starchy vegetables within a keto diet, many people don’t.)

Presumably he thinks the benefits of excluding carbs outweigh the disadvantages of not eating vegetables.

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Should You Cut Out Gluten?

It’s safe to say that gluten affects people differently. There are many people who have resolved various symptoms by excluding gluten. (Just read Dr Perlmutter's book "Grain Brain" for individual examples.)

If you think you’re one of those people, first you should exclude coeliac disease (go see your doctor.) If it's negative, you may still be affected by gluten. It’s worth doing a proper “exclusion diet” to see if your symptoms get better.

Excluding gluten isn't a small task. You need to check all the products that you eat. Make sure that you aren't eating trace elements of gluten from random sources.

Essentially that means cutting out lots of packet foods.

Cutting out packaged foods will improve your diet.

So if you do feel better, is it because you cut out gluten or improved your diet in general?

That’s a difficult question to answer!

Let’s put gluten on hold for a moment and have a think about other carbohydrates.

 

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What is Diabetes?

Diabetes is a hugely debilitating disease where you can’t process carbohydrates. Diabetes affects all parts of your body. It is a leading cause of death and disability (such as having limbs amputated) in both the developed and undeveloped world.

There are 2 main types of diabetes. Diabetes type 1 is a genetic disease. You can’t do anything about it. It normally appears in childhood although there are cases of it occurring in adults.

Type 2 Diabetes is Related to Diet and Life Style.

When you eat carbohydrates, your blood glucose (aka blood sugar) levels go up. Our bodies like things to be within a certain range. We have systems that help control all sorts of things. Think of them as thermostats. When we get too hot, our body starts to sweat to cool us down.

When your sugar levels rise above a certain point your body gets to work to reduce them. It releases a hormone called insulin which is made by your pancreas. Insulin reduces the blood glucose level and stores glucose as fat.

The problem occurs when your glucose is frequently raised. You stop responding to the insulin. Your pancreas works harder to produce more insulin until one day it falls in a heap and gives up entirely.

Stage 1 “Diabetesis”.

Stage 1 occurs when you’re eating too many carbohydrates. Your blood sugar levels are higher than they should be. Unfortunately you have no idea so you’re not taking any measures to fix the problem.

There are hints and clues. You may be overweight. If you were to get your bloods checked, you’d find they weren’t entirely normal.

Sadly lots of people are in this stage without realising it. This is the stage that is easiest to fix by cutting down on carbohydrates.

Stage 2 “Insulin Resistance”

You may have stage 2 diabetes without realising it. But sooner or later, it will get diagnosed.

In stage 2 diabetes your pancreas is still producing insulin but your body doesn’t respond to it as well as it used to.

Are You At Risk of Diabetes?

Do the quiz to find out!

How Do You Reverse Diabetes?

The good news is that there are lots of research that shows that you can reverse this stage with diet.

Most treatments to reverse diabetes restrict your calorie intake to 800 kcals a day. As well as reducing refined carbohydrates.

That may sound like very little to eat but if you include some good fats (olive oil), it will help you to feel full up.

Many people report that they adapt very quickly.

In fact, the best news is that you don’t have to go on any “fady” diet. You can eat healthy and tasty food.

PLEASE NOTE. That if you're already on medication, you need to do chat to your doctor before you start a calorie restriction diet. You'll need to change your medications as you reduce your calorie intake. 

Stage 3 “Insulin Dependent”

In Stage 3 your pancreas stops producing insulin. Traditionally people injected insulin to try to control their sugar levels. (Before you could inject insulin, people often died of Diabetes.)

Now more and more people are managing their sugar levels with diet. 

A low carbohydrate diet stops the peaks in blood glucose so you don't need to use as much insulin.

Research on Reversing Type 2 Diabetes

Professor Roy Taylor of Newcastle University is one of the pioneers of reversing type 2 diabetes.

In one study he showed that 11 out of 11 type 2 diabetics reversed their illness in under 8 weeks.

Other studies show that diabetics need to lose one-sixth of their pre-diagnosis body weight to reverse the illness. This removes enough fat from their pancreas to allow it to get back on track and produce insulin again.

Most of the papers that have shown they can reverse type 2 diabetes have restricted total calorie intake to 800 calories a day.

Reversing type 2 diabetes with a healthy way of living is remarkable! Think of the implications for people who have type 2 Diabetes. And think of the implications for health services!

The best results were seen with people who had been recently diagnosed (and therefore, hadn’t had the illness so long).

If You Want to Do A Calorie Restricted Diet

Calorie restricted diets are for people who want to loose a significant amount of weight or reverse diabetes. You need to read up about it first. I recommend "The 8 Week Blood Sugar Diet" by Dr Michael Mosley which will fill you in on ALL the research. 

He also explains exactly how to eat 800 calories a day in a safe way.

It's also important that you talk to your doctor before you start.

What about People Who Don’t Have Diabetes? Do They Need to Cut Out Carbohydrates?

This is an interesting question. Carbohydrates seem to affect some people more than others.

Many people report symptoms of "not feeling great" if they eat too many carbohydrates.

In “Eat Fat Get Thin” Dr Mark Hyman talks about a “FLC Syndrome” (ahem…”Feel like crap syndrome”.) He lists an entire plethora of symptoms ranging from itchy ears to acne to hay fever that he says are caused by eating too many carbohydrates.

Carb Cravings and Carb Intolerance

Some people have “carbohydrate intolerance”. They can't digest carbohydrates in the same way as others.

People with "carbohydrate intolerance" will feel the symptoms of "too many carbs" way before others.

They may have strange symptoms but having carbohydrate intolerance may mean that you put on more weight than other people eating a similar diet.

It might be that you have developed carbohydrate intolerance by eating lots of carbohydrates. Or that you are just made that way.

Either way, reducing or even excluding carbohydrates should make you feel better.

If you have carb cravings, it’s a sign that you need to cut back on your carbs.

The Mediterranean Style Diet in Research

What exactly is the “Mediterranean Style Diet” (MSD) and why is there so much hype around it?

The Spanish government funded a large study (the “PREDIMED” study) in 2012 that looked at the way people eat in Spain.

(Note: the PREDIMED study was first published in 2012 and then retracted due to errors in statistical analysis. These were then corrected and it was republished in 2013.)

The study looked at 7400 overweight people. Researchers randomly allocated them to either a low fat diet or a Mediterranean diet.

People in the low fat camp could eat lean meat, low-fat diary, minimal use of oil. Those in the Med group had far more freedom, oily nuts, oily fish, lots of olive oil, eggs, dark chocolate, red wine.

They followed them up over a long period of time and the results were quite clear.

Benefits of a Mediterranean Style Diet

The people eating the Mediterranean Style diet put on less weight, particularly around the middle. (Belly fat is particularly dangerous.) They were 30% less likely to develop heart disease and half as likely to develop type 2 diabetes.

A particularly important element of the diet seems to be olive oil. (Hooray! Because I love olive oil!)

In fact, women in the study who were asked to add an extra couple of teaspoons of extra-virgin olive oil a day cut their risk of developing breast cancer by nearly 68% (compared to the others eating the low fat diet.)

What is the Mediterranean Style Diet?

When you think of Italian or Spanish food, you might think of pizza, pasta and paella. Carbs, carbs and more carbs.

But that is not the basis of a Mediterranean Style Diet.

The way people eat in the Mediterranean is lots of variety.

As my friend says, "a little bit of everything and not a lot of anything."

In a nutshell, the Med diet uses oily nuts, seeds, lentils, fish, diary and lots of olive oil. Plus the occasional glass of wine. (The debate about wine and alcohol rages on!)

Reduced, Unrefined Carbohydrates

The Mediterranean diet incorporates “reduced carbs”. Think “less refined”, (pasta, bread, rice). Think more bulgar wheat, quinoa, lentils and starchy vegetables.

Good Fats

Fat is a topic that is big enough for an entire book (see “Eat Fat, Get Thin”).

There is a big difference between refined and processed fats and oils and “good fats”.

Many people advocate coconut oil as a good fat (this is a controversial area with many people calling it “poison”. Check out Sally from Real Mom Nutrition and her overview of coconut oil.)

The Med diet uses olive oil as the main oil to cook with.

Olive oil has many health benefits and contrary to popular belief is fine to cook with up to high temperatures.

Here in Spain, you’ll find a bottle of olive oil on every table in every restaurant and home. People use it to dribble over their food (in varying quantities but generally people aren’t shy of it!)

Good Proteins

The Med diet incorporates healthy sources of protein (rather than processed meats) including lots of fresh fish, eggs and lentils.

Lots of Variety and Fresh Produce

They say that variety is the spice of life. It definitely helps to get our nutrients from a plethora of different places.

People in Spain eat locally produced foods sold at the local market.

Produce varies according to the season.

In the spring we all flock to the woods to hunt wild asparagus and in February it’s “sea urchin” season (a local delicacy.)

Rather than sticking to the same 10 fruits and vegetables, you want to aim for at least 20 different varieties each week.

 

My friend, "Lady Teresa Bracknell" says:

"Eat a little bit of everything and not a lot of anything!"

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Carbohydrates and Gluten in Summary

  • There is LOTS of new research on nutrition.
  • Sometime the research (and the experts) don't agree with each other.
  • A low fat high carb diet is no longer "the miracle" cure.
  • Nutrition affects individuals differently (skinny friend who eats everything, I'm looking at you!)
  • You need to find the "perfect diet for you".
  • Lifestyle plays a large role in your health and your weight.
  • Carbohydrates are sugars that we eat.
  • Gluten is found in pasta, bread and added to many products.
  • People with coeliac disease have to exclude gluten for life.
  • If you're worried about coeliac disease, discuss it with your doctor.
  • Some (perhaps all) people without coeliac disease are also affected by gluten.
  • The theory is that gluten triggers chronic inflammation with causes other illnesses.
  • Some experts advocate excluding all gluten and most carbohydrates (with a ketogenic diet).
  • Type 2 Diabetes (DM) is a debilitating disease and a leading cause of death.
  • DM can be avoided by reducing your carbohydrate intake and other lifestyle changes.
  • Many people have the start of the disease process without know it.
  • Studies have shown that you can reverse type 2 DM by restricting your calorie intake and reducing your weight over 2-3 months.
  • Carb cravings can be an indication that you eat too many carbs. (They often go when you cut out refined carbs for a couple of weeks.)
  • Research shows that the "Mediterranean Style Diet" (MSD) helps people lose weight and has significant health benefits.
  • MSD can be applied to any cuisine and consists of lower carbs, good protein, good fats in the form of olive oil.

 

Do You Need to Reduce Your Carbohydrate Intake?

What do you need to do to make your diet a healthier diet? Do you need to exclude all carbohydrates and gluten?

A tough question to ask! Particularly as nutrition is so personal.

If you’re suffering from any symptoms that you think may be caused by your diet, it’s worth thinking about an exclusion diet. (There are many books and on line resources to tell you exactly what to exclude. If you'd like private coaching, you can contact me via my "work with me" page.)

If you’re generally in good health but want to maximise your health by taking control of your diet, I suggest starting with the “Mediterranean Style Diet”.

If you’re keen to try out the ketogenic diet, it’s another good choice. (But I recommend doing a bit of research first as you have to keep yourself in ketogenesis, otherwise it won’t work.)

In a word “Yes” you probably do need to reduce your refined carbohydrate intake.

Changing your diet can seem like a daunting task but it can also be fun and exciting!

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