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Cole's Bakery offers many keto-friendly baked goods like these cupcakes.

Anyone who pays attention to diet fads knows that sometimes fat's out, and whole grains are in. Eggs are good, then bad, then good again. Now, for those adopting the increasingly popular keto diet, fat is king bacon is totally OK but carbs and sugars are almost completely out.

Originally formulated to prevent seizures in people with epilepsy, ketogenic diets have actually been around for about a century, gathering and losing steam over the decades with different versions of the low-carb, high-fat diet (think Atkins, the Oprah-promoted Last Chance Diet and others). Once again, it's undeniable that keto is getting another heyday.

Many have found incredible success on the diet, which kicks the body into a survival state where fat is burned for energy in the near absence of carbohydrates. It's not uncommon to find people who've lost 50, 80, 150 pounds on the diet in months to a year.

Spokane-based physician Kyle Varner says he was initially suspicious of the diet, but after reading the research behind it, he says it made sense based on everything he'd learned about the human body in medical school.

After his own bariatric surgery, Varner says he'd lost about 70 pounds and was doing everything he'd been told by his doctors, including eating six small meals a day. But he still had about 50 pounds left to reachhis goal. So he switched to keto, a change that's given him those results and personal insight as he helps patients deal with obesity and metabolic syndrome.

"I'm a big keto and intermittent fasting evangelist. I think it's a very healthy diet," Varner says. "Keto is a more doable diet for the lifestyle we've come to lead as busy professionals in the United States, and a major improvement on what almost everybody is eating today."

Fats are very satiating, which can help prevent that urge to go check the fridge every few hours, he explains. The diet relies on people eating only about 35-40 grams of net carbs per day, he says, but it's important to note that fiber doesn't count.

"A lot of people don't realize you can eat a lot of things like broccoli and asparagus and mushrooms and peppers. The number one mistake is people aren't eating enough vegetables," Varner says. "It's really not necessary for most people to count them. If it's broccoli or cauliflower, I don't even count it, that's a food I'm allowed to have."

Cooking keto at home can be more expensive than other diets, and it can be a challenge to make substitutes for baked goods. Luckily, some Inland Northwest eateries are providing more keto-friendly options.

COLE'S BAKERY

Cole's Gluten Free Bakery and Cafe, located in North Spokane at 521 E. Holland Ave., has an entire menu designed for people with special dietary restrictions. The store also stocks several cases with tasty baked goods, breads and rolls for gluten-free and keto dietary needs.

Owner Jeanine Smith, who opened Cole's about six years ago, says she decided to bring on keto-friendly options after learning how helpful the diet is for children with epilepsy, as well as people with diabetes or autoimmune diseases.

"We have a whole keto section on our menu, with burgers, mozzarella sticks, chicken strips and breakfast sandwiches, and we have two full cases of keto products," Smith says.

Desserts made with a keto-friendly monk fruit sweetener include "fat bombs" in flavors like chocolate chip and lemon raspberry.

Smith's interest in gluten-free baking started with her own gluten issues and dissatisfaction with store-bought options. Many hours of baking experiments have ensued to create alternative breads.

Because baking substitutes can be difficult to craft, Cole's also offers mixes.

"What I hear a lot of is that people try to bake at home and then it just fails miserably," she says. "My advice is don't give up. If you love baking, you will find a way. But if you need a little help to get started, we've got options to help on the shelf, including bread mix, pancake mix, brownie mix and cookie mix."

FIRST AVENUE COFFEE

At First Avenue Coffee in downtown Spokane, at 1011 W. First, customers can also find a menu filled with gluten-free, paleo, vegan and keto-friendly options made at the in-store bakery.

But you won't necessarily find them labeled that way.

"For the first year, we advertised we have keto, we have vegan, we have gluten-free, and people would not try any of those items because they were afraid they were going to taste funky," explains owner Deborah Di Bernardo.

"So we took all the labels off our products and just featured them visually," she continues. "Once [people] told us they liked it, we'd say, 'Well that is vegan,' or 'that is keto,' and now just in the last few months, people actually come in asking for keto."

Keto options include donuts, grab-and-go snack packs with hard-boiled eggs and cheese, a roast beef wrap made with cheese, microgreens, mustard and salt rolled up in the meat, and a similar turkey wrap made with cranberry sauce, cream cheese and greens.

But cheddar biscuits are the most popular.

"People just go nuts over this one," Di Bernardo says. "I do an almond flour, cheddar cheese, green onion biscuit, with egg as the binder. This is how I got through my first year of changing my diet."

Di Bernardo started her own grain-free diet after being diagnosed with breast cancer and having a double mastectomy.

"I eat organic, which is why I only feature organic coffees here, and almost everything we use here is organic," she says.

Di Bernardo also confirms that keto items everywhere can be more expensive.

"Almond flour is literally 400 percent more expensive than white flour, so you know, our items are more expensive than the average donut," she says.

OTHER CHOICES

While there are still relatively few restaurants advertising that they cater to keto diets, low-carb options have made their way onto most menus in recent decades.

Doctor Varner suggests tweaks such as ordering a burger without the bun, or getting a Chinese vegetable and meat dish, with a flavorful sauce thats not sugar-based. Tacos can be made with lettuce wraps instead of tortillas, and many restaurants offer steak with vegetables on the side.

For cooking at home, cauliflower is a powerful substitute.

I love to make a taco casserole where I take the hamburger and mix it with cauliflower rice, cheese, vegetables and bacon, Varner says. Ill also make cauliflower rice paella or fried rice. Anything that has rice, you can swap out for cauliflower rice and you wont notice a big difference in flavor.

Keto adherents should ensure theyre getting necessary vitamins and minerals. Its a good idea with any major dietary change to work with your doctor. And the best success is seen in lifelong dietary changes, Varner says.

There is no diet that can be successful if it is a short term endeavor, Varner says. You have to decide every day for a long time what youre having for breakfast, lunch and dinner to see those results, and thats when you have long-term success.

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As more people try a keto diet, restaurants in the Inland Northwest begin catering to the high-fat, low-carb trend - Pacific Northwest Inlander

If you follow fighting sports, you're probably already aware of George Lockhart's work. He's the nutritionist and chef who controls weight cuts for UFC stars like Conor McGregor and Daniel Cormier, and has managed the nutritional needs of boxers, such as two-weight world champion, Badou Jack. For the past few months though, Lockhart has been working with a new client: 6ft9, self-styled "fat man", Tyson "The Gypsy King" Fury.

Tyson is like a Lamborghini and if you owned a Lamborghini you wouldnt put shit fuel in it

Using only the freshest produce, for the past seven weeks Lockhart has been making five trips a day to a local farmers market in order to fetch enough food to satisfy Fury's 4,500 calories a day need. He has, of course, also been on washing up duties after each of Fury's five daily meals.

With all that food, Lockhart predicts Fury will come into his rematch with Wilder "a lot heavier than he usually is", according to Lockhart, but he will also be "a lot leaner too".

Tyson is like a Lamborghini and if you owned a Lamborghini you wouldnt put shit fuel in it," says Lockhart. "Its about recovery. Tyson can burn 1,500 calories in 45 minutes so we are constantly replenishing. That means its not just the quantity of the workouts that has increased but the quality too.

Fury's meals are delivered with military precision, and you'd expect nothing less from a nutritionist who began his working life as a US Marine who did a tour of duty in Iraq where his four-man team helped apprehend 200 suspected insurgents. That was, of course, prior to Lockhart turning his hand to becoming a MMA fighter himself, before he eventually became nutritionist and chef to some of the world's most dangerous fighters.

Speaking to The Athletic, Lockhart revealed the type of daily diet he serves to Fury and his three brothers.

8am, breakfast: [Fury's day] starts off with fruit and Greek yogurt. He loves that. And he feels strong with that. He has that every morning. Obviously, we switch it up, but we have tons of berries so you get a lot of antioxidants.

Pre-workout shake: The pre-workout will basically, depending what time of the day it is, be beta alanine. Hell get 4,000 milligrams of beta-alanine. Well give them like 200 milligrams of caffeine and those are gonna be the basics. The base for pre-workout.

During-workout shake: Hell have BCAAs with a little bit of creatine and sugar.

Post-workout shake: Hell get dextrose in a supplement form, a type of fruit for fructose. Then well add a whey protein isolate for his post. An hour after that shake, he eats his meal.

11am, lunch: Tyson likes spicy food, which blows my freaking mind because being an Englishman, its usually not the case. I cooked him up some shit because Im half Mexican that put my tongue on fire and hes cool with it. He gets a curry almost every single day for inflammation. There are a million different curries out there, so Im constantly coming up with new curries.

2pm, second lunch: He has to have at least one serving of seafood every single day. And then I try and do one red meat or chicken. So every meal he gets different meats, youll get a huge variety of foods. I try to get different meats every single meal. A chicken, a fish or last night he had sirloin steak.

Furys works out again in the afternoon and will be fuelled by more pre, during and post-workout shakes.

6pm, dinner: Fury will have something like chicken vindaloo with turmeric for its anti-inflammatory properties, but this meal will be crafted around whatever meat Fury hasn't had earlier in the day.

9pm, second dinner: Hell have his power balls, his energy balls. Its basically almond butter, oatmeal, coconut, honey, pecans and dark chocolate chips all rolled into balls. A couple of those before he goes to bed.

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Tyson Fury's Nutritionist Has Revealed the Fighter's Daily Diet Ahead of Fury Wilder 2 - Men's health UK

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This diet will help reduce your risk of heart disease and fewer people are having trouble paying their medical bills - MarketWatch

Just because diet soda doesn't contain sugar or calories, doesn't mean that it's healthy for you.

Studies are mixed, but some link diet soda with serious, life-threatening diseases. Here's what you need to know about diet soda and how it affects your health.

A 2017 study published in Stroke found that, among over 3,000 participants, an increase in artificially sweetened soda consumption was associated with an increased risk of Alzheimer's disease, dementia, and ischemic stroke.

Most recently, a 2019 study published in JAMA Internal Medicine, found that those who drink two diet sodas a day are more likely to die from circulatory diseases, as well as increased mortality overall, compared to those who had one diet soda or less a month.

Increased sugar cravings: Diet soda has been shown to increase cravings for sweets, according to various studies, including one published in 2019 in Pediatric Obesity. In turn, that increase in cravings may actually lead to consuming more calories.

Not effective for weight loss or diabetes: While it can seem like cutting back on sugar by replacing it with artificial sweeteners will be beneficial for weight loss or diabetes, evidence suggests otherwise. "Diet soda does not promote weight loss and it has no effect on glycemic response in adults with diabetes. Therefore, diet soda should not be used as a weight-loss strategy or means to control diabetes," says Rebecca Oh, RD, clinical dietitian at USC Verdugo Hills Hospital.

Altered digestive tract: "Diet soda can alter your gut microbiota, which can have negative impacts on digestion and hormone regulation," says Oh. More research is needed to understand exactly which artificial sweeteners affect gut bacteria and how. So far, preliminary studies have found that saccharin, sucralose, and stevia may alter the bacteria in your gut, though it's unclear what impact this may have on your health.

Kidney damage: "Long-term consumption of diet soda can increase production of free radicals in renal tissues, potentially causing damage to the kidneys," says Oh. Additionally, a 2017 study published in the Clinical Journal of the American Society of Nephrology showed that diet soda consumption is linked to a higher risk of kidney disease.

Not great for your teeth: Think diet soda is better for your teeth because it doesn't contain sugar? Think again. Even though it's sugar-free, diet soda is acidic thanks to ingredients like citric acid, phosphoric acid, citric acid, and tartaric acid. These ingredients can contribute to tooth enamel erosion, at almost the same rate as non-diet soda, according to Colgate.

Some ingredients in diet soda can be particularly harmful for people with certain health conditions. "Phosphorus should be avoided for people on dialysis and with late-stage kidney disease, and Phenylalanine is not safe for people with phenylketonuria, or PKU," says Oh.

Of course, consuming diet soda occasionally is safer than daily consumption for the average adult. "If you are going to drink a soda, drink a very small serving, 6 to 8 ounces max, and work on weaning your cravings," says Oh. She says this goes for diet soda or regular soda.

She also says that drinking soda, diet or regular, will not hydrate you as well as drinking good old-fashioned water add a spritz of lemon or lime juice for flavor.

"Rather than focus on the 'limit' of how much diet soda you can drink, I encourage you to focus on how best to promote your health. Water is the best way to hydrate your body, quench your thirst, and promote health," says Oh.

If you find it hard to drink plain water, she recommends unsweetened sparkling water or unsweetened tea over other beverage options. If you're struggling to cut diet soda out of your diet and are concerned about the health risks, speak to your primary care provider or a registered dietitian.

Read more:
All the ways that diet soda is bad for you and what to drink instead - Insider - INSIDER

Its hard to go anywhere these days without hearing about the Whole30 diet. You probably know at least one person who has tried it or has considered trying it as a New Years resolution or dietary reset.

The craze for the eating plan began in 2009 when creator Melissa Hartwig began blogging about a 30-day experiment in which she eliminated items like sugar, dairy and even legumes from her diet. The idea is that you remove certain foods from your diet for a month, then add them back in and see how you react.

She then turned her experiment into a program that claims to eliminate cravings, reduce allergies, aid in digestion, help you shed weight and give you energy.

In a nutshell, the Whole30 allows you to eat vegetables, potatoes, fruits in moderation, unprocessed meats, seafood, eggs, nuts (but not peanuts since they are legumes), seeds, some oils such as olive and coconut, ghee, and unsweetened coffee with non-dairy creamer such as almond milk, explained Aimee Aristotelous, a certified nutritionist and author of Almost Keto.

Foods you cannot have while undergoing the program include dairy, grains, alcohol, legumes (one of its most confusing rules), added sugars of any kind, processed meats, and additives such as carrageenan, MSG and sulfites, Aristotelous added.

So is Whole30 as magical as people say, or is it total, unsustainable B.S.? We spoke to experts about what happens to your body and mind during the eating plan so you can decide if its truly worth it.

Your body will respond positively to a lack of processed foods.

One pro of the program is that it consists of all whole and unprocessed foods, said Staci Gulbin, a licensed dietitian in Denver. The program is full of foods that contain lots of nutrients and can contribute to good health.

Krista Scott-Dixon, a certified counselor and curriculum designer for Precision Nutrition, said eating foods on the Whole30 plan can help you increase your intake of fiber and water, along with protein and healthy fats.

Whole30 doesnt detox, but it does boost normal functions.

Gulbin noted that a controlled detox is not a thing. Your body knows how to detoxify itself on its own and does so on a daily basis, so beware of trendy diets that promise detoxification.

That said, foods included in the Whole30 plan can help your body optimally go through its normal functions. For example, the fiber-rich food on Whole30, along with the added water youre getting, can help move things through our gastrointestinal tract and bind to some substances that we dont want hanging around, helping to excrete them, Gulbin said.

Tom Werner via Getty Images

Whole30 doesnt rely on calorie counting.

Calorie counting can negatively affect your mental health, and many experts are moving away from the belief that you should track every single calorie you put into your body. (Amen.)

Whole30 doesnt rely on calorie counting or measuring your food. Youre also encouraged not to take body measurements since the plan focuses on feeling better and not dropping pounds.

Whole30 can help you learn which foods affect your digestion.

The program has you eliminate and then reintroduce foods like dairy and sugar, which could help you figure out if they cause digestion problems.

Whole 30 may help those with food sensitivities identify those foods that trigger symptoms, Gulbin said.

Just make sure to reintroduce foods back into your diet slowly. As with any reintroduction phase, add one new food every three days to allow the body time to develop any symptoms that may arise, Gulbin said.

But really, if you suspect you have any intolerances or sensitivities, its worth talking to your doctor. Someone who knows your full health history can help you more accurately determine whats going on and advise you on an elimination diet.

You may experience some weight loss on Whole30.

Again, this isnt the goal of the program, but its often a reason people do it. Experts say weight loss could be a byproduct of eating the foods outlined in Whole30.

Going on a strict diet for weight loss is not recommended based on the evidence that diets are not sustainable and that most people gain the weight back.

- Emily Van Eck, registered dietitian nutritionist

Its very likely youll lose some weight over this 30-day period from fluid loss since youll be following a lower-sodium diet that is free from processed foods as well as potential digestive symptom trigger foods, Gulbin said.

Reducing your sugar intake as the program calls for can also affect your weight, Aristotelous added.

The average person consumes 77 grams of sugar per day thats around 18 teaspoons. So if you go from the standard American diet to the Whole30 protocol, which is extremely low in sugar, then yes, odds are you will lose weight, she said.

But that weight loss is often unsustainable.

That said, the chances of maintaining your lower weight will be difficult once you finish the Whole30 program. That can spell trouble for your physical and mental health.

Going on a strict diet for weight loss is not recommended based on the evidence that diets are not sustainable and that most people gain the weight back, said Emily Van Eck, a registered dietitian nutritionist with Intuit Nutrition & Wellness.

She added that weight cycling and dieting can be harmful to the body, your metabolism and your psyche.

Its not an easy diet to follow.

Whole30 is tough to stick to if you dont cook most of your own meals. It can also be expensive.

It takes a full kitchen purge of inflammatory foods and a full restock of Whole30-approved ones so that you have endless options at home when preparing your meals, said Stefani Kavner, a certified personal trainer and health coach in Huntington, New York.

She said that eating out on a Whole30 plan is definitely doable, but takes a lot of effort finding restaurants that are willing to modify their preparations to accommodate your diet. This might make attending parties, happy hours or dinners with friends difficult during the duration of the program.

Kavner said that you may experience issues like bloating or even mood changes when you first start Whole30. You may also get cravings for foods youve eliminated, like sugar, if youve been used to eating them for so long.

Carlina Teteris via Getty Images

It can be tough to get sufficient nutrients on Whole30.

Getting adequate protein, iron and fiber is essential in any eating plan. And since legumes, fortified cereals, and breads are prohibited on Whole30, getting sufficient nutrients can be tricky, Aristotelous said.

Aristotelous stressed the importance of consuming three to four servings of vegetables and one or two servings of fruit per day to get enough fiber, antioxidants and iron. She also cautioned against eating too much red meat which is allowed on the diet to get protein and iron.

Jim Frith, a nutrition specialist and founder of TopFitPros, said eliminating some foods that are not harmful to you personally may also do some damage. For example, if you stay away from dairy too long, you may develop a lactose intolerance, he said.

Any diet that restricts grains and beans entirely for a month is not sustainable, is likely very expensive, and likely isnt pleasurable. And food is meant to be enjoyed.

- Emily Van Eck, registered dietitian nutritionist

Bottom line: Experts arent sold on Whole30.

Whole30 is strict and at times difficult to follow; the program isnt meant to be long-term. It can also create or exacerbate an unhealthy relationship with food (especially if you have a history of an eating disorder), Scott-Dixon said.

Its a problem inherent to any dietary paradigm where people are encouraged to focus on food choices without also supporting sustainable, sane behaviors in their daily life, she said, adding that dietary programs with an eat this, not that mentality can be problematic.

For this very reason, Van Eck also doesnt recommend trying Whole30.

Changing your diet in small and sustainable ways that [dont] cut out any food groups or demonize any foods can absolutely be done, she said. But any diet that restricts grains and beans entirely for a month is not sustainable, is likely very expensive, and likely isnt pleasurable. And food is meant to be enjoyed.

If youre absolutely going to do it, make it as balanced as possible, Van Eck said.

If I were to advise someone on this diet, I would suggest eating as varied a diet within the limits as possible, she said. Do not just eat chicken and greens try different fish, different root vegetables and fruits weekly. Get lots of leafy greens, berries, mushrooms and cruciferous vegetables like Brussels sprouts and cauliflower. Add nuts and seeds, avocados and nice olive oil. Make curries and stews with pasture-raised chicken and sustainably caught fish.

Read more:
This Is Your Body On The Whole30 Diet - HuffPost

From Women's Health

My name is Sandra Ross (@ketokonduct), and I am 37 years old. I live in South Jordan, Utah, and work as a personal trainer. After reaching over 300 pounds and yo-yo dieting without success, I went keto, started weight lifting, and was able to lose 130 pounds.

My struggles with my weight began when I was 9 years old. I started gaining weight, and my dad put me on my first true diet, Slim Fast. Being so young, I developed a bad relationship with food. Food was viewed as bad," and all the diets just perpetuated my issues with food and weight. This pattern continued through my life into my late 20s as I yo-yo dieted to try to find a balance. When I was tipping the scales at over 300 pounds, social anxiety started to play a huge role in my poor relationship with food. I felt uncomfortable eating in public because I worried people would judge me for whatever I put in my mouth. So, I became a recluse and didnt want to leave my house. I lost friendships because I didnt want to engage with my friends. Home was safe and where I could eat what I wanted and do what I wanted without judgement.

The doctor told me if I continued to gain like I was, I would not live past my mid 30s. My labs were not ideal and I knew it was bad, but I didnt really understand the details enough to make changes. On the way home from the doctor I stopped at Carls Jr. At that moment I realized I needed to make a change, but didnt know how to start. So I started yo-yo dieting. I went to another doctor who prescribed the weight loss drug phentermine. I took it until and I maxed out the amount you can take, and it was no longer effective. So I switched to another weight loss drug called phendimetrazine and maxed out of that as well. I felt hopeless and out of options.

I didn't feel like I was being restricted or like I was on a diet. I learned that eating low-carb and higher-fat could help me lose weight and sustain that weight loss. That finally helped me curb my cravings and kept me full for much longer periods of time than when I was eating *a lot* of carbs. I finally felt what it was like to not constantly think about food. Up to that point, I was completely obsessed with food.

Breakfast: Coffee with collagen and half and half at 7 a.m. Eggs with cheese, bacon/sausage at 9 a.m.

Lunch: I will have a salad with protein (chicken or tuna) typically at 3 p.m.

Snack: Pork rinds and egg salad or cheese.

Dinner: Spaghetti with healthy noodles or steak and some sort of veggie like loaded broccoli.

Dessert: Keto cookie or berries with cream.

Typical my week of exercise includes 5 days of weight training. I got into it because I learned that if you have more lean mass you can eat more calories, and I was *all* about that!

Change 1: Incorporating fats helped curb my appetite. Fat also helps convert your body from being a carb-burner to burning fat as fuel (aka ketosis), and this helped me feel less hungry. Lowering my carbohydrate intake also freed me from being a carb addict.

Change 2: Eating fewer carbs helped ease my joint pain. Converting to burning fat as fuel helps to decrease inflammation, which helps reduce water weight and joint pain. This helped me to be able to weight train and be more physically active.

Change 3: Weight training has helped my social anxiety *so much.* In the beginning, I was at my most vulnerable and most uncomfortable. I had to put myself out there and outside of my comfort zone to make myself better and stronger and healthier. In time, I have become much more confident. The strength and the mental acuity that I have developed with weight training has also helped me overcome my anxiety.

My weight loss journey wasnt streamlined or perfect. It takes a lot of lessons and mental changes, which take time. I had to look at food differently and correct my relationship with it. For years, food comforted me. Food can be enjoyed, but it is fuel, and Ive learned to comfort myself in other ways. To make lasting changes, it's so important to be kind to yourself and give yourself time to adjust.

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'After Being Put On My First Diet At 9, I Finally Have A Healthy Relationship With Food And Lost 130 Pounds With Keto' - Yahoo Lifestyle

The no white diet that apparently helps shed body weight has been the latest sensation in the wellness and nutrition industry. As the name suggests, this unique diet says a big no to starch, sugar and flour that are white in colour. These include foods that have high glycemic index, high starch and carbohydrate rates and also processed foods. It is no big secret that such foods are unhealthy and do not suit those who are trying to shed weight.

The 'no white' diet helps reduce a few kilos very easily. This could improve your eating habits and help regulate the blood sugar levels as well.

Why should you avoid white food?

White coloured and processed foods do not contain any fibres or essential nutrients. However, it is loaded with bad carbohydrates that are not great for our health. As these foods are not filling and can make you feel hungry soon, there are chances that you eat more calories than what is actually required. Diabetes patients should strictly stay away from such unhealthy food. Biscuits, cheese, sweets and aerated drinks are some of the processed foods that should be avoided.

What could replace the white food?

You could eat healthy brown oats, multi grain bread, wheat pasta instead of white pasta and whole grains instead of rice, and stevia, honey, maple syrup and brown sugar instead of processed sugar. However, it is not right to evaluate the nutritional benefits of the food based only on its colour. Though milk, tofu and paneer are white in colour they are rich in nutrients. They are healthy foods and help in reducing the body weight.

Say yes to these foods

Cottage cheese, yoghurt, coconut, cauliflower and white chicken are some of foods that are nutritious and should be included your weight loss diet.

Before choosing what you eat, it is important to know whether they are good for your health or not. Refined flour and sugar should be avoided. However, not all white foods are unhealthy. A well balanced and nutritious diet and proper workouts are the easiest ways to shed that extra flab.

Read more here:
No white diet, the easiest way to shed weight - Onmanorama