Do you need to snack? Here’s 31 ideas just in case (and because you’re awesome).

Sometimes you just want some new ideas. Or it’s a day where you just feel like mooching around and making a few things in the kitchen.

Snacking. As I said earlier this week on Facebook, I’m not a fan of snacking for most people as it often means they haven’t eaten properly in the previous meal, thus their need for a snack is due to roller coasting blood sugar levels which affects their stress hormones, energy and mood.

However, sometimes you just need to snack. And if you’ve eaten what you normally KNOW is a balanced meal with plenty of vegetables, a good hit of protein and some fat, but still feel hungry – then you should probably eat. And if you’re not sure what a balanced meal looks like, then check out Jamie’s blog discussing the Heart Foundation’s take on paleo – he outlines what his meals look like. Pretty simple. (And do read the whole post – it’s GREAT).

Ignoring your hunger cues is not good in the long term – yes, even if your goal right now is to lean up, if you’re eating well and exercising appropriately, then it’s likely your muscle mass is increasing and you need to feed it! Don’t use the scales as a guide to your progress – this is gravitational pull – nothing more. In the last 6 months I’ve gained 10 kg to help restore hormonal equilibrium to my over-stressed body – and while on paper it might look like a lot, visually it’s not what you would imagine it to be, as I’ve kept up weight training and gotten a lot stronger. Of course I’ve got more body fat, but I’m a lot healthier too because I’ve got more muscle; it’s had the opportunity to grow as it hasn’t been broken down to use as fuel (which can happen when you’re over-stressed). The scales tell you nothing about the composition of your body. To under fuel (even when trying to lean up) would put your body in a catabolic state, stripping muscle and potentially bone too if you go too low in calories (protein is the major component of bone, you know).

The more you listen to your body and NOT eat to a schedule, set calorie number or macro nutrient goal, the better you will be at at figuring out what your body needs. For most people, we lose this ability at a very early age, because we are told to ‘eat everything on our plates because there are starving children in Africa.’ I feel sorry for parents actually, as almost everyone I know blames their parents for a certain lack of intuition around their eating. It’s not their fault. They were told the same thing.  The good news is, though, is that it’s not irreversible. We just have to start being more aware of what we eat (processed food which is quickly digested, low in fat or protein and not satisfying), how we eat (fast, slow), where we eat (at the table? in front of the TV?) and how much attention we are actually paying to what we eat (device use, TV etc). Here’s some quick tips about mindful eating. You can retrain yourself to listen to your body. It just takes time and effort, but it will be worth it. I’ve just ordered this book too – I’ve heard great things about it and think it will be a really valuable resource.

So back to snacks. Muesli bars, low fat fruit yoghurt and snack packs of Snax crackers are going to leave you hungrier than before you ate them. They are developed to provide the sensory pleasure to your brain that makes you want to eat more (called a Bliss point). They are also high in processed carbohydrate or sugar (especially that fruit yoghurt, these new yoghurt pouches have 4 teaspoons of sugar, around 3 of them from added sugar) which are just best avoided.

Here’s 31 other ideas in case you need some more inspo.

  1. A couple of hardboiled eggs (boil a dozen at the start of the week and make your way through them. They’ll last a good 5 days unpeeled).
  2. A couple of cooked chicken drumsticks (meat that is closer to the bone is far tastier and there are far more nutrients than just pure muscle meat).
  3. Half an avocado, seasoned with salt and pepper.
  4. Around 40g cheese (not Edam. Unless you really enjoy it! Full fat dairy has many important health benefits which for some reason got overlooked with the updated food guidelines. Didn’t they read my blog?
  5. Meatballs – make these and freeze in single serve packs to have an easy go-to snack. Try my sesame miso meatballs.
  6. Almost 4 ingredient chocolate chai brownie. No sugar added at all (I promise).
  7. Raspberry coconut berry bites.
  8. Lemon coconut lunchbox treat. Again, no sugar was harmed in the making of this deliciousness.
  9. A scoop of protein powder with minimal added crap (such as Clean Lean Protein, Vital Health, Balance Natural Whey powder) + ½ cup of full fat Greek yogurt topped with berries. There are many better quality protein powders now available on the market. And while protein powders aren’t my go-to for every day eating, those people who are more active and require protein to support their lifestyle, OR for people who for some reason can’t or don’t eat animal source protein, they can be a good addition to the diet. However there are many CRAP products out there, with a lot of additional fillers, preservatives, additives for flavour, thickeners etc. Check the ingredient lists.
  10. Half an avocado with 1/2 can salmon mixed in, lemon juice, salt and pepper.
  11. Steam some greens (broccoli, brussel sprouts, beans) + drizzle with 1-2 tablespoons of olive oil or butter, add salt and pepper.
  12. Vegetable chips (bit of prep) but thin sliced beetroot, carrot, parsnip, tossed in bag with 2 Tbsp olive or coconut oil + spice of choice OR salt/pepper – baked in preheated oven of 170 deg (350 deg far) for 10-12 min.
  13. Tamari almonds from Alison’s Pantry. These are dry roasted, unlike many that you find that are roasted in vegetable oils.
  14. A handful of Pure Delish cereal (look for 10g/100g or less sugar per 100g) – I love this cereal but to be honest, as a breakfast I’m not going to recommend it as a go-to. I think the brand itself is great, and perfect for tramping/camping as an easy breakfast option. But if you want to ensure you’re not going to go hungry, start your day with a bit more protein. This would fill you up but it is easy to over eat in order to feel satisfied.
  15. The only plant that would survive a nuclear holocaust chips, like these Ceres Organics ones. Hello. Delicious, but wow – expensive! Obviously super easy to make these yourself (many delicious ways to do this).
  16. Kelp leaves flash fried in coconut oil with salt (a great source of iodine, a mineral important for our thyroid function which isn’t easily available in the food supply for people who don’t enjoy seafood). This kiwi (and local to me!) product is seriously tasty.
  17. Dried meat snacks (Biltong, bier sticks) – such as Canterbury I love Epic bars in the States but while some are made with quality NZ meat, they aren’t available here. It’s hard to come by a brand which is minimally processed, so definitely read the ingredients list. Jack Links (despite the great radio adverts which I think are awesome – is NOT a great product. When you try Canterbury V Jack Links, you can taste the difference too – alongside the addition of preservatives other than spices and salt, it is a sweeter product, with 20g of sugar per 100g product, compared to between 1-3g per 100g for Canterbury.
  18. Crackers free of grains, such as Little Bird or Flackers – or make your own. Super simple and a lot cheaper too. There are a lot of variations to these, here’s mine.
  19. Apple slices layered with a tablespoon of peanut butter + 1 tsp chia seeds mixed through
  20. Meedjol date sliced lengthways, with salted pistachio nuts stuffed inside. This is small and not at all lower carb. Delicious though.
  21. Large tomato, scoop out middle, crack an egg in, grate some parmesan cheese, bake in a 180 degree oven till egg is cooked.
  22. The Vegery snack wraps: hello delicious! These would be a great lunch on the go or for a snack. Try the apple and coffee one with some peanut butter and grated carrot. Delicious.
  23. ½ cup cottage cheese + ½ small sliced banana + a handful of walnut halves.
  24. Rice paper (which has been dunked in warm water to soften, then patted dry, wrapped around sliced avocado, a slice smoke salmon, cucumber, grated carrot, snow peas.
  25. Lightly toast a handful of sunflower seeds in a pan, then pop some into a pitted avocado half, salt + pepper. Delicious change of texture.
  26. Cheese + sliced red pepper sliced wrapped in ham that has been sliced thinly off the bone.
  27. ¼ cup hummus (ideally home-made, like Jamie’s one, he is awesome) + teaspoon of pesto in bottom of jar, carrot/cucumber sticks standing up in them. Try to choose a pesto that has an olive oil base, such as this Genose one – not one that is made on a canola oil base.
  28. Apple slices cooked in coconut oil and topped with haloumi, a’la Sarah Wilson style.
  29. A leftover sausage, split into half lengthways, with some cheese grated into it and mustard, heated in microwave.
  30. A slice of my tahini chia loaf with avocado. Yum.
  31. 2 squares of 90% Lindt with a teaspoon of almond or peanut butter. Decadent. You’re worth it.

And I’ve plenty of other ideas where these come from. If you would like more individualised help, check out my services page or sign up to my online nutrition coaching system – it’s free for 28 days for you to try!

snack

PC: www. revive.ca

Does your doctor value nutrition? These 3 questions might help you find out.

How much does your doctor value nutrition? This has been a rather hot topic of late, with the recent gagging of Gary Fetke in Australia, an orthopaedic surgeon who co-owns a nutrition clinic that employees dietitians to help clients. He has recently been ‘gagged’ by the Australian Health Practitioner Regulation Agency (AHPRA) and is not able to talk about the role of nutrition in preventative health, nor in the management of chronic illness on any social media platform.

That’s troubling to say the least. Nutrition and talking about nutrition is certainly a contested field, and perhaps there is some protection of the patch when it comes to nutrition advice. I’m not going to lie to you – I can get a little scratchy myself when I read prescriptive advice from people who aren’t qualified in nutrition that push the boundaries in terms of scope of practice. Mainly because of the potential fall out if they aren’t equipped with the knowledge to either resolve and issue or refer it on. But to prevent a doctor talking about nutrition is just madness.  Doctors SHOULD be talking about nutrition – especially given that some of the most common reasons people go to their general practitioner (GP) can be improved (if not resolved) by diet. Thank goodness similar shenanigans have not been taking place this side of the ditch.

To what degree GPs should have the authority to discuss nutrition with their patients is a bit of a ridiculous question if you ask me. I know many brilliant GPs that use a holistic approach to their practice, who know a LOT about nutrition, give guidelines when that is all that is required and also who refer their patients on to more in-depth nutrition help if necessary. More important is asking your GP to what degree do they value nutrition. If you feel nutrition is an important part of your overall health, I think that having a GP who feels the same is rather important, and these three questions I heard on a podcast could be a good start to give you confidence that your needs will be met by their services.

  1. What affect does nutrition have on my health?

This may seem like a weird question to be asking your GP. I mean, surely everyone knows that diet and health are intricately linked, and doctors – well, it’s their job to know this stuff, right? Given the number of clients I have who leave their doctor’s clinic rooms feeling stupid for even mentioning diet, I don’t think we can take it for granted that your GP is going to be open to the idea of diet being a reasonable therapy (or adjunct therapy) to any condition. Sure, the diet-health connection isn’t foreign to them – there is the lipid hypothesis after all. And if you’ve ever stepped on the scales and been told your body mass index (BMI) is too high, so you need to eat less and exercise more to lose a little weight and reduce your overall health risk, then clearly your GP didn’t sleep through their three nutrition lectures provided in the medical school curriculum. However I wouldn’t be surprised if you know more about diet being able to prevent or manage conditions such as auto-immune disease (including type 1 diabetes), mood disorders, inflammatory bowel disease or irritable bowel syndrome, metabolic conditions (such as type 2 diabetes), asthma and allergies and the like. Now I’m not saying your GP is an idiot – at all! But time is a resource many health professionals don’t have, and while your GP might be open to exploring alternative or adjunct nutrition therapy, they may not have had the time to research this avenue. That (in my opinion) isn’t so much of an issue. It’s not as important (in my mind) that your GP may not know as much as you; being open to you exploring it speaks volumes, though. If your GP isn’t interested, then that is a problem. Given some of the reactions that clients have reported when mentioning to their GPs they use diet as a way to manage their health condition, there are clearly GPs who choose to remain ignorant. If you are dismissed, laughed at, or told in no uncertain terms that diet will not help, alarm bells should ring in your head. My advice would be to look for another GP.

  1. What do you think about the difference between normal lab ranges and optimal ranges for nutrient status?

There’s a difference? There appears to be, or at least, some doctors argue that there is. Vitamin D is a great example of this. In New Zealand, the adequate vitamin D level starts from 50nmol/L but a published review determined that looking at endpoints on a broader scale than just bone health (including  bone mineral density (BMD), lower-extremity function, dental health, and risk of falls, fractures, and colorectal cancer) determined it best to have serum concentrations of 25(OH)D begin at 75 nmol/L (30 ng/mL), and the best are between 90 and 100 nmol/L.

Low to low normal levels of serum folate are related to increased risk of depression and increased severity of depressions and affective disorders. Our ‘normal’ starts at above 7 nmol/L and research has shown that people with chronic mood disorders have lower morbidity when their nutrient status is above 18nmol/L, and symptoms began to alleviate when supplementation brought the levels up to above 13nmol/L. Low folate is also associated with higher homocysteine levels in the blood which is an independent risk factor for atherosclerosis.

While B12 levels in the blood are actually a poor indicator of B12 activity (as only 5-20% of the is bound to transports and able to be metabolically active), research has found a relationship between levels of B12 of 258pmol/L and lower in the bloodstream and depression. The ‘normal’ range starts at 170pmol/L, with borderline low from 110-169pmol/L. I know GPs who look for levels of 400pmol/L as being optimal for cognitive functioning and health. A sports doctor I am aware of uses higher cut-offs when it comes to haemoglobin and ferritin (both markers of iron deficiency) for athletes and will supplement to determine if a boost in iron intake helps address fatigue-related complaints or not, even if the athlete is within ‘normal’ range (see here).

Thyroid stimulating hormone, a commonly measured marker of thyroid function has a reference range between 0.5-4.0mIU/L. However, TSH is considered to be a poor indicator of thyroid function and the ‘normal range’ included people that had underactive thyroid or thyroid disease. The recommendation from the American Association of Clinical Endocrinologists association was to lower the range to 3, with a view of it lowering further to 2.5mIU/L because data from the National Academy of Clinical Biochemistry found more than 95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L. Though this was recommended in 2003, it was contested by other governing bodies, potentially as it meant that the number of people in the US with subclinical thyroid function increased from 3 to 20% of the population, thus (as concluded in this paper) many more would require thyroxine medication as treatment.

These are just a few examples where you may fall into the ‘normal’ range, but may not be optimal according to the opinion of some doctors. At the very least, it may explain why you may be experiencing physical symptoms but these aren’t recognised by your lab test results.

  1. What will you do if my test results don’t marry up with what I’m telling you my symptoms are?

Important question, don’t you think? Let’s hope that your GP doesn’t respond with ‘perhaps you need to see a psychologist’ – as one of my clients reported. To be honest, I actually think there is a degree of psychosomatic issues that occur when someone is struggling with a health problem – most of us are familiar with the gut-brain axis and relationship between stress and digestive problems. This is partly driven by the return of seemingly ‘normal’ test results that don’t explain their ongoing concerns. However, to dismiss your symptoms as being unimportant because the results don’t reflect what you are reporting should (to me) set off alarm bells.

I think one problem could lie in the funding for lab tests. My GP is brilliant and will order me any test I want, but at my cost. I don’t blame her for this as there is pushback with GPs ordering tests. However I know that not all GPs are like this, and not all people can afford testing to get to the bottom of the issues. I think if more GPs appreciated the role nutrition can play in preventing, managing or reversing many of the chronic conditions people are dealing with today, then, then there would be more referrals to nutritionists or dietitians on the basis of reported symptoms or test results that may fit into the ‘normal’ range, but aren’t what is considered optimal.  From here, nutritionists, naturopaths and dietitians can order tests that delve further into hormonal issues, gut problems and even cholesterol levels if required. But this might not be necessary as they may pick up from your initial test results that certain nutritional strategies can help you optimise your nutrient levels without the need for further testing.

At the end of the day, you should feel confident that your GP values nutrition as much as you do.These questions may help you determine that and, if you suspect they do not, perhaps it’s time to find another GP.

Nutritionist

Obligatory doctor and fruit shot. I couldn’t find one with a steak.(PC: http://www.healthtrap.com)

 

Kumara toast spread with fennel pesto and topped with tasty cheese.

Nutrigrain does not build Iron Men (or Women) + an Up and Go isn’t breakfast

(But I’m picking you know that).

By default, I’ve been in the sports nutrition world more than usual over the last couple of weeks. The Eat Well Live Well topic at New World (where I’m on hand to give nutrition advice and share good choices for foods), a sports nutrition talk during the week to a bunch of athletes and my first experience of Saturday morning kids winter sport this weekend. Well, first adult experience, as being your typical kiwi girl I was an enthusiastic netball player when I was in my early teens, and remember 9am starts at Kettle Park, playing on an ice-white netball court that had been frosted over the night before.

These experiences have reminded me that the ‘real food’ nutrition choices are not mainstream yet. And have a way to go before they will be. It’s still common for athletes to smash food straight after training (to make the most of the ’30 min window of opportunity’, to base their meals around processed carbohydrates (cereals, breads, pasta, rice) and to follow an eating style that didn’t allow for adequate delivery of fat and protein across the course of the day, so they are left irritable, tired, and hungry. The problem isn’t carbohydrates per se. It’s that processed carbohydrate has pervaded the diet to the extent that we now view it as an essential part of every meal at the expense of fat and protein which provide essential fatty acids and amino acids for healthy growth, development and recovery. This is especially true for children. It can get confusing though when cereal companies spend the big bucks persuading the consumer that products such as Nutrigrain or Special K are a nutritious, substantial start to the day. Such examples include:

  1. They fortify their cereals with micronutrients and can then sell them as a substantial source of vitamins and minerals, whereas we don’t know how effectively these are absorbed in the body. Nature is really smart at packaging nutrients in the correct ratios for maximum absorption when we eat, say, an apple. There’s so much about nutrition we don’t know, I doubt that Kellogg’s has cracked that nut yet.
  2. They pump their products with additional gluten and soy and can then promote them as being ‘high protein’ and ‘plant based’. A lot of people are sensitive to gluten and processed soy is far removed from the soy which is attributed to the many health benefits of a traditional Asian diet. And ‘plant based’ is bandied around so much these days, as if to insinuate it is nutritionally superior to a diet that contains animal protein. The opposite is true, given that many minerals and vitamins aren’t able to be as readily absorbed because of the phytic acid and other anti-nutrients which bind them.
  3. They put dried fruit and ‘ancient grains’ in their products, call them ‘Nourish’ and then sell it as real food. All this does is load them up with additional sugar.
  4. They pay sports stars and other influential people good money to front their ad campaigns. Even if you can do 12 Weet-bix in one hit, I’m picking that you’re not going to be able to do much else for the rest of the day if you make a habit of it.
  5. They compare a product to something else that we perceive as being  healthy or nutritious – for example, Up and Go being marketed as having as much ‘fibre, energy and protein as 2 Weet-bix and milk’. For the record, 2 Weet-bix and milk doesn’t have much fibre, protein or energy – but you wouldn’t know that from this claim which is what Sanitarium is counting on. There is 4.3g of fibre in a 250ml serve of Up and Go, and 19.3g of sugar. And a bunch of other additives, preservatives and vegetable oils to go with it.

    upandgo

    How many ways can you say sugar? There’s 5 right here.

The cereals I’ve mentioned above are as good (or bad) as junk food. But, do any of my points really matter if your kid is super active? They can’t just eat more of it, right? Hmm.  I’ve recently been reminded that there is a real culture in sports that suggest people who are active can ‘get away’ with eating high sugar junk food, and kids especially can eat sugar (I’ve heard some suggest they NEED sugar) as they can ‘burn it off.’ Nothing is further from the truth. Despite what the sports nutrition resources tell you, or what you might learn in a nutrition talk at the sports club, or see advertised on television, they don’t need additional sugar to make up for energy burnt during their practices or games. Sports drinks, white bread jam sandwiches, 2-3 jet planes aren’t necessary straight after exercise and are best left out of a young athletes menu. The ‘window’ of  opportunity of replenishing carbohydrate stores has been a convenient theory for sports nutrition products to justify their use, but we have since discovered the body can adequately restore carbohydrate up to 48 hours after a match or training. Unless, of course, there is a multi-day or multiple events on one day that requires a quick refuel, but even then there are options that allow for quick refuelling that are real food options.

A calorie is not a calorie, and active kids need more attention paid to their diet because of the heavier demands placed on their growing bodies. This expands their micronutrient and energy requirements. However, because we use body size as the main marker (or for some, the only marker) of health, we look at kids who are active and thin as ‘healthy’ without giving consideration to other equally (if not more) important indicators. I’ve worked with a number of adults who are prediabetic, yet have been fit and active their whole life, and a blood sugar screening reveals their metabolic state is probably worse than if they didn’t do any activity at all. A contributing factor to this is the carbohydrate-dominant diet that has fuelled them through the preceding years, and not just the additional treats they may have eaten because they could ‘eat what they liked.’ To the body, a high carbohydrate load is a high sugar load, regardless of where those carbs come from, because it’s broken down to the same single glucose unit.

So to save your active kids from the same fate, we need to set them up right from the get go.

Now I got a bad rap last year when I suggested that the new Weet-bix campaign that provided a ‘better brekkie’ was anything but. Weet-bix have long been the staple kiwi breakfast and growing up in winter, I had mine with hot water, warm milk, raw sugar, (because it was healthier*) and the aroma of a Gregg’s instant coffee with a freshly lit cigarette (it was the 80s, after all). Even now that combo conjures up that warm snuggly feeling of familiarity in me. The problem is that Weet-bix, or any cereal, isn’t typically a great vehicle for a nutrient dense, energy filling breakfast. Even with the campaign to make them a ‘better brekkie’. Most of the recipes on Sanitarium’s website sound amazing, but better breakfasts they are not.

So I offer a few suggestions**.

  1. Better breakfast shake: swap out the dates for an egg and add a tablespoon of peanut butter or tahini ( for a nut-free variety). We’ve lowered the sugar content and upped the fat, protein and calories. This will at least keep them awake for a little longer.
  2. Power porridge: swap the apple juice for grated apple. Use actual coconut milk (and not coconut flavoured milk), up the amount of rolled oats to a cup and add ¼ cup sunflower and pumpkin seeds. We’ve added more fibre, protein and lowered the sugar content.
  3. Weet-bix winter warmer: swap the trim milk for full fat (so much better for growing kids and adults alike actually) – or coconut milk, up the oats, add a few tablespoons of sunflower or pumpkin seeds and ditch the dried fruit. Stir through an egg before taking off the heat.
  4. Hot Weet-bix apple crumble: add ¼ cup shredded coconut, ½ cup roughly chopped mixed raw nuts – which you microwave with 1 Tbsp butter or coconut oil to make a crumble-type mixture.

Any of these would be okay if your kid feels a bit nervous before an early weekend sports game and just wanted something small. Otherwise, they will probably need some more food to go alongside the ideas above. Some good examples would be:

  1. Leftover cooked sausages or other meat leftover from dinner
  2. Scrambled eggs
  3. Hardboiled eggs (you’ve boiled these the night before)
  4. This tahini chia loaf with some nut butter spread on it
  5. Kumara ‘toast’ – slice and toast as you would your bread and top accordingly (mine took a couple of goes on high to get it to a cooked but still firm stage. So easy!)
  6. Three ingredient pancakes made with banana and eggs
  7. Peanut butter or tahini with chopped fruit
  8. Baked kumara or potato with butter
  9. Chicken drumsticks
  10. Glass of full milk and a banana

For more awesome ideas, click here for individualised nutrition advice or sign up for online nutrition coaching.

image1 (35)

Kumara toast spread with fennel pesto and topped with tasty cheese.

*it’s not healthier, but it the 80s we thought it was. Sugar is sugar is sugar. Including dried fruit, rice malt syrup, fruit juice and coconut sugar or coconut nectar.

** Weet-bix optional

11 things you may not know about perimenopause (and 10 things you can do about those symptoms).

I know what you’re thinking. She’s too young to be writing about perimenopause, right?! Actually, no. I might feel 24 years old, but it only takes being around younger age groups to remember I’m not! Despite the ‘M’ word being almost a taboo, unwanted phase of life that some women fear (and men too!) it is a natural part of our lifecycle. What isn’t natural are the symptoms associated with menopause. Like premenstrual symptoms, the discomfort experienced through perimenopause may be common, but it’s not normal. This was reaffirmed in my mind when I listened to a fabulous interview with Lara Briden (naturopath who works with women with hormone imbalances, based in Sydney and Christchurch). A wealth of information who had some great information around why we can experience symptoms and (importantly) what we can do about them.

  1. Defined as 10 years before going through menopause, practitioners often view this as highly variable, with women from 35 years to 55 years in this perimenopausal state. The average time spent here is around 4 years. Though, as with any ‘average’ this might not reflect your experience!
  2. All hormone levels change during perimenopause. There is first a decrease in progesterone, which changes the balance of progesterone to oestrogen (some describe this as ‘oestrogen dominance’, though not all practitioners like using this term). Testosterone also declines, and this is an important hormone for sex drive. Finally oestrogen drops – and while we will continue to produce oestrogen (as this occurs not only by the ovaries but by the liver, breasts, adrenal glands and by fat tissue, it is at amounts of around 30-60% lower.
  3. Oestrogen is a major regulator of a number of processes in the body, and the sex hormones and our glucocorticoid hormones (the most ‘known’ one, cortisol) are controlled by the hypothalamus -the part of our brain who is also the controller of our sex hormone regulation – therefore it makes sense that a change in one will result in a change in all of them.
  4. Some of the main symptoms of perimenopause are
    1. Heavy periods
    2. Hot flashes
    3. Breast tenderness
    4. Worsening of premenstrual symptoms
    5. Lower sex drive
    6. Headaches or migraines (due to sudden removal/reduction of oestrogen)
    7. Fatigue
    8. Decreased sense of wellbeing (research shows that extended periods of low oestrogen, fluctuating levels of oestrogen and sudden withdrawal of oestrogen – via surgery or stopping oral contraceptive pill – is affected with lower mood)
    9. Irregular periods
    10. Brain fog and memory – oestrogen helps consolidate both episodic and spatial memory in the brain, and protects against cognitive decline as we age.
    11. Vaginal dryness; discomfort during sex
    12. Urine leakagewhen coughing or sneezing and an urgent need to urinate more frequently – due to oestrogen’s role in maintaining the vascular mucosa folds in the vagina, acting as a watertight seal.
    13. Mood swings (via fluctuating levels of hormones)
    14. Trouble sleeping
  5. Some women are ABSOLUTELY FINE and sail through perimenopause. Generally, though, those that have been on the oral contraceptive pill are more likely to experience symptoms than those that haven’t. This may be due to the difference in the hormonal balance once the pill is removed. The pill provides large amounts of synthetic hormones, and it is a huge adjustment to go back to the normal (lower) levels of hormones. Approximately 147,000 women in New Zealand take the oral contraceptive pill, of which 80% of them are on a combined pill, delivering oestrogen and progesterone.
  6. The types of hormones in the pill are synthetic and are not ‘bioidentical’ – meaning that the amounts are higher than what the body would produce AND they are in a form that the body can’t use. The pill doesn’t regulate hormones, it shuts them off.
  7. During perimenopause, women can have fluctuating oestrogen levels due to variable concentrations of FSH (released by our pituitary gland in response to a low oestrogen environment – it isn’t necessarily all low oestrogen. This could also be a result of an inability to detoxify and clear out oestrogen metabolites.
  8. A well-functioning liver is required to remove oestrogen from our body and prevent build up and associated symptoms. Our liver packages up oestrogen metabolites and removes it through our detoxification pathways. We need our inbuilt antioxidants to be firing, along with certain nutrients (selenium, B vitamins and glycine (not present in large amounts in the standard diet) to do this.
  9. Many women going into perimenopause are insulin resistant (oestrogen has an insulin-sensitising role in the body and influences glucose uptake) – this partially explains the increase in body fat (particularly around the middle) that many women experience as they progress through. This makes it harder for their body to metabolise and use carbohydrate effectively
  10. Many women going into perimenopause have a low thyroid function due to age-related changes in thyroid physiology. These include a reduction of thyroid iodine uptake, synthesis of free thyroxine (FT4) and free triiodothyronine (FT3) and the conversion of FT4 to reverse triiodothyronine (rT3). TSH levels may be slightly elevated. Luteal-phase spotting, or lumpy breasts may indicate this.
  11. Your gut? SUPER IMPORTANT!!! The oestrogen might get detoxified (packaged up ready for removal) via pathways in your liver only to be unpackaged (deconjugated) again by nasty gut bacteria which pushes it back out into the blood stream as more toxic forms of oestrogen.

These 11 points may or may not have been news to you – certainly probably not to those experiencing some of the symptoms, or who have dug a bit deeper to determine the cause of the symptoms. This wasn’t a post for you to sigh in resignation and decide there is nothing you can do. Yes these symptoms and health outcomes are common – but (as stated earlier) they are not normal. Like many things, we normalise a lot of health issues because so many people experience them. We just think they are an inevitable process in ageing and moving into a different phase of life. Certainly (I gotta say), some health professionals don’t suggest otherwise so it’s no surprise many are led to believe this.

Some awesome tips from Lara as to how to start the process of mitigating symptoms – some are great DIY ones that you can put into action immediately; others will likely require the help of a practitioner who has a solid understanding of how our hormones interact – this may be your open-minded doctor, which is excellent – or naturopath, nutritionist or dietitian.

  1. Limit alcohol consumption – it impairs oestrogen clearance rates from the liver and may be one of the influencing factors in the relationship between alcohol and breast cancer risk
  2. Limit or omit dairy –dairy can increase oestrogen in the body, increase insulin release and the A1 caesin in dairy is pro-inflammatory and increases gastrointestinal inflammation (which could then push inflammation out to rest of your body).
  3. Ensure adequate vitamin D status – optimal is around 100-150nmol/L which is required for the production of all hormones, and related to other hormonal issues such as endometriosis
  4. Reduce intake of carbohydrate if following a higher carbohydrate approach, and get rid of processed, refined foods and sugar.
  5. Eat your brassicas: broccoli, Brussel sprouts, cauliflower, cabbage – all provide di-indolylmethane (DIM) which targets certain proteins in our body that help reduce inflammation and balance hormones (particularly detoxifying oestrogen). Supplementing with this is also really helpful, but only once you establish that oestrogen clearance is an issue for you – super unhelpful otherwise (a practitioner can help you find this out – and there is a test I’ve started using with clients called the D.U.T.C.H test which is able to measure each hormone and it’s metabolites in much more comprehensive detail than a blood test alone.
  6. Ensure a healthy gut: bloating, excessive gas, cramps and diarrhoea or constipation are not the normal consequence of eating (though they are extremely common). Keep a food diary to establish what might be causing your digestive upset by connecting your symptoms to your food intake. Work with a health practitioner experienced in the ‘real food’ digestive health to help not only heal your gut, but seal it too.
  7. Turmeric in therapeutic doses (more than you can get from food) helps reduce oestrogen related oxidative stress, reduce prostaglandins (inflammatory biomarkers) – opt for one that is also combined with bioperine (to make it more bioavailable) such as this Good Health 15800 Turmeric complex. The alternative is one that says it is formulated to have smaller, more bioavailable particles, and the Meriva formulated varieties have this.
  8. Iodine: low dose supplementation can be extremely helpful in supporting the pathways associated with thyroid hormone production which in turn affects the sex hormone production pathways. Again, talking to a practitioner is a good idea to establish your own requirement. However, 150 micrograms per day (and having 2-3 brazil nuts to balance this with selenium) is a safe amount.
  9. SLEEP. Hands down, the most often overlooked yet important restorative, nourishing thing you can do to support your hormone health.
  10. Meditation. Journalling. Yoga. Diaphragmatic and full belly breathing. Slowing down. Yep – stress reduction.

Regardless of if you are pre, peri or post menopausal, I think there is some excellent information here that will be helpful for hormones in general actually, and if you are experiencing some of the unwanted (and unnecessary in most cases) symptoms of hormone balance, this may give you some pointers as to how to combat them. Definitely check out Lara’s site for accessible and informative hormone related content.

PC www.gazetteinterviews.com

Let this not be you. Or your mum. Or your wife. PC http://www.gazetteinterviews.com.

 

Like what you read? For more, check out mikkiwilliden.com for individualised nutrition plans, or sign up now for online nutrition coaching and meal plans.

The Gout: what you need to know and 7 things you can do about it.

  1. Gout is an auto-inflammatory disease caused by a disorder in purine metabolism and the resulted chronic elevation of blood (serum) uric acid (i.e., hyperuricemia)
  2. Men have a higher risk of gout at a lower given blood level of uric acid, and at a lower age than women – generally 10 years earlier.
  3. Women who go through early menopause, or have estrogen deficiency are at higher risk than women who progress through menopause at a normal age, due to oestrogen’s role in increasing uric acid excretion.
  4. Insulin resistance increases risk of gout, as insulin reduces uric acid secretion. The relationship between insulin resistance and gout is more pronounced in women than in men.
  5. There is a bi-directional relationship between high blood pressure and gout: ie if you have high blood pressure, your risk of gout goes up (independent of diuretic medication that is taken), and if you have gout, your risk of developing high blood pressure also increases. High blood pressure can result in damage to kidney and a reduction in uric acid excretion, and the inflammation associated with gout can stiffen and damage arterial walls, and reduces production of nitric oxide – which helps widen arteries.
  6. Genetics play a role in determining risk associated with gout – and people with a particular genetic profile (such as those of European descent with the SNP sequence SLC2A9 as an example) have an increased risk, as do those with ABCG2 rs2231142. However, as with any genetic risk factor, lifestyle determines if these genes are switched on or off, so while this information could be useful (and more people are starting to find out their genetic profile and determine what it means for their health), it is your lifestyle habits predominately regulate overall risk
  7. Triglycerides increase in the bloodstream when people overeat refined carbohydrate foods, and recent research suggests a reduction in serum uric acid occurs when triglycerides decrease.
  8. Alcohol intake is associated with an increased risk of gout – beer more so than wine.
  9. Overall fructose load in the diet is the only type of carbohydrate that is known to increase uric acid levels, potentially because when metabolised, it depletes phosphate and therefore doesn’t help produce ATP (energy) in the body and instead increases uric acid production. Fructose from processed food (and particularly sugary sweetened beverages) can elevate insulin levels and increase risk of insulin resistance. There may be a genetic element to this also, with people who have polymorphisms in SLCA9 and ABCG2 genes responding unfavourably to a load of fructose.
  10. A large cross sectional survey found that people following a vegan diet had the highest serum uric acid concentrations compared to fish eaters, meat eaters and vegetarians, independent of smoking status or alcohol intake.
  11. While seafood is often cautioned against for people who experience gout due to its purine content, a number of studies have failed to find a relationship between seafood intake and serum uric acid levels. Those that have found a relationship may not have adjusted for body mass index (BMI), which can confound the relationship as it did in this study. Indeed, those populations who are at greater risk today (such as Maori and Pacific among New Zealand population) enjoyed a traditional diet of predominantly seafood, vegetation, tubers and gout was non-existent.

What to do?

  1. Look after your gut. Bacteroides caccae and Bacteroides xylanisolvens are increased, and Faecalibacterium prausnitzii and Bifidobacterium pseudocatenulatum depleted in the gut of people who experience gout, suggesting a strong correlation with the presence of gout. F prausnitzii is one of the most abundant bacterium in the gut of a healthy individual, helping produce short chain fatty acids butyrate, which is fuel for our gut bacteria, and the provision of B pseudocatenulatum improves markers of gut wall integrity. So these are pretty important! While this doesn’t necessarily mean that the provision of certain bacteria through probiotics will reduce gout attacks, it does suggest that inflammatory processes of the gut play a role in the presentation of gout and provides further evidence of the importance of a diverse population of bacteria in the gut for overall health.
  2. Supplementing with 1500mg vitamin C reduces serum uric acid and its antioxidant functions may also help kidney function by reducing inflammation.
  3. Like your coffee? You don’t have to go without if you have gout and in fact, 4-5 cups per day have found to decrease serum uric acid that isn’t seen with green or black tea, or total caffeine intake. Decaffeinated coffee has afforded similar benefits, leading investigators to suggest the phenol content (phytochemicals) might increase insulin sensitivity and decrease serum insulin, as discussed above insulin levels have a positive correlation with uric acid due to decreased renal excretion. Furthermore, xanthines, either in caffeine or in coffee itself, could inhibit xanthine oxidase – an enzyme that increases reactive oxygen species (and inflammation).
  4. Magnesium intake is associated with a decreased serum uric acid level in males, and marginal intakes is associated with higher levels of markers in the body indicative of inflammation. Magnesium is low in soil which makes dietary sources of the micronutrient not as high as they once were, therefore supplementing with magnesium of 300-600mg/day (depending on bowel tolerance) is likely a good idea. (To be honest, I’m a big fan of magnesium supplementation for pretty much anyone male or female, given it’s a co-factor in over 300 processes in the body).
  5. Tart cherry extract – not just useful for sleep – is found to reduce the prevalence of gout flare ups in cross sectional studies, potentially due to the presence of polyphenols including anthocyanins, and vitamin C found in the fruit, which have anti-inflammatory and antioxidant affects.
  6. The consumption of low fat dairy products is linked to a lower risk of gout in larger population studies.*
  7. Anecdotally (as in, I didn’t find any study on pubmed to support this), baking soda is used to increase pH level of the blood (¼ teaspoon in water), thus making uric acid in the blood able to be excreted. If you know of any studies around this that I’ve missed, let me know!)

The take-home?

While a low purine diet is often recommended as a dietary prescription for people with gout, many purine-containing foods (such as seafood and vegetables) do not contribute to hyperuricemia or gout and may in fact be protective. The effects of red meat consumption on serum acid levels are arguably hard to disentangle from other elements of the modern dietary pattern, and are often in conjunction with higher alcohol intake, lower fruit and vegetable consumption and higher fast-food intake – all contributors to inflammation in the body. In addition, the agricultural practices of the cattle industry in countries such as the US where many of the epidemiological studies that associate red meat with poor health (including higher serum uric acid levels) include the use of antibiotics, poor farming practices and animals that are grain and not grass fed, altering the fatty acid profile of the meat to be higher in omega 6, pro-inflammatory fats. Furthermore, processed and fresh meat is often grouped together – thus a steak is viewed the same as a hamburger from a fast-food outlet – the latter often being in the company of a bun, fries, mayonnaise made with industrial seed oils and a sugar sweetened beverage – the adverse effects which many, myself included, argue cannot be adjusted away by a statistician when determining risk.

*I don’t think you need to start consuming low fat dairy if right now you’re enjoying the benefits of full-fat dairy in the context of an awesome diet. I think this could well be indicative of overall lifestyle patterns. I’d be surprised if there were studies showing that risk of gout is increased in a diet that is whole food, minimally processed, an abundance of vegetables that also incorporated full-fat dairy products.

 

14 reasons to ditch the toast and jam (and 7 key tips to help you do this).

After feeling like I’d taken a trip back to 2003 with some of the sports nutrition posts and articles I’d been reading lately, I got tagged in a cool picture from a listener of our Fitter Radio podcast  – a triathlete who has switched from the traditional higher carb, lower fat diet approach to eating lower carb, higher fat, real food whilst training and commented she ‘didn’t know her 41 year old body could be the best body I have ever had’ (Woot! high fives all around!!) This coincided with finishing Mark Sisson’s Primal Endurance book.

Mark outlines 115 reasons why athletes should train and eat the Primal Endurance way. I concurred with pretty much all of them. I have added my own 2c worth, added some literature below (and cut it down to 21 for brevity’s sake). While geared towards athletes, hands down this is applicable to everyone. Everyone.

So if you’re currently eating toast and jam pre OR post training (or in general), I’ve outlined the 14 reasons why you need to ditch that junk and become a fat burning beast, and 7 key tips to help you get there.

  1. Western diet is based on excess grains and sugars (and low fibre) which stimulates excess insulin production, leading to lifelong insidious weight gain, chronic inflammation and elevated disease risk factors.
  2. A high carb, grain-based diet can leave endurance athletes nutrient deficient (due to phytic acid effects on minerals), inflamed and more susceptible to the oxidative damage of the stress of training, general life and poor nutrition.
  3. The way that most people consume modern grains (cereals, breads, pasta) ends up being a cheap source of calories which are immediately turned into glucose upon ingestion and offer minimal nutritional value. There are no good reasons to consume these types of grains and many good reasons not to, especially for those who are sensitive to gluten and other anti-nutrients found in wheat.
  4. Everyone is sensitive to the health compromising effects of grains at some level, especially the pro-inflammatory effects of gluten and the propensity for the lectins in grains to cause leaky gut syndrome.
  5. Even lean people suffer from the consequences of carbohydrate dependency, such as chronic inflammation, oxidative damage, and accelerated ageing and disease risk factors.
  6. Carrying excess body fat despite careful attention to diet and a high training load is largely due to carbohydrate dependency caused by a grain-based diet and chronic training patterns.
  7. Carbohydrate dependency cycle looks like this: consume a high carbohydrate meal – elevate bloods sugar – stimulate an insulin response – shut off fat metabolism and promote fat storage – experience fatigue and sugar cravings – low blood sugar elicits stress response and we consume more carbohydrates – stimulate the fight or flight response to regulate blood sugar – dysregulate and exhaust assorted hormonal processes, and end up in burnout and weight gain (potentially lifelong)
  8. Weight loss through portion control, low fat foods and calorie burning is ineffective long term. And while we think calories burned through exercise stimulate a corresponding increase in appetite – research might not back this up. I tend to think that people are more likely to eat more because they ‘reward’ themselves OR the long slow training allows increased opportunity to eat sports ‘junk food’ and the amount of calories burnt through training is far less than you think – and overestimated more so in females in certain instances. At any rate, the secret to weight loss is hormone optimisation, primarily through moderating excess insulin production.
  9. Endurance athletes can begin to dial in to their optimal carbohydrate intake by asking themselves the question ‘do I carry excess body fat?’ Any excess body fat calls for a reduction in dietary carbohydrate intake to accelerate fat burning.
  10. Endurance athletes who already have an optimal body composition but are looking to optimise training and recovery should choose high nutrient value carbohydrates. These include a high volume of vegetables, a moderate fruit intake, kumara/potatoes and other starchy tubers, dairy for those that tolerate, wild rice, quinoa and small amounts of dark chocolate.
  11. Endurance athletes with high calorie needs who also have an optimal body composition can enjoy occasional treats, but the habit of unbridled intake of nutrient-deficient carbohydrates should be eliminated in the interest of health and performance.
  12. Primal style eating (or eating minimally processed foods) is fractal and intuitive, and when escaping carbohydrate dependency and becoming fat adapted, you don’t have to rely on ingested carbs for energy. Eating patterns can be driven by hunger, pleasure and maximal nutritional benefit.
  13. Escaping sugar dependency and becoming fat adapted gives you a cleaner burning engine, since glucose burning promotes inflammation and increased oxidative stress
  14. Ketones are an internally generated, energy rich by-product of fat metabolism in the liver when blood glucose and insulin levels are low due to carbohydrate restriction in the diet. Ketones are burned efficiently by the brain, heart and skeletal tissue in the same manner as glucose. You do not need to be on a ketogenic diet to upregulate your ability to produce ketones – you can do this via a lower carbohydrate approach.

HOW TO DO THIS: 7 KEY TIPS

  1. Step one: omit sugars, grains, industrial seed oils for 21 days. Step two: emphasis highly nutritious foods such as meat, poultry, vegetables, eggs, nuts, fish, fruits, some full fat dairy, seeds, and kumara/potato.
  2. 100g or less of carbohydrate promotes fat loss, 150g is around maintenance level and over this could promote lifelong weight gain and over 300g could promote disease patterns.
  3. While transitioning to primal there are some struggles initially due to lifelong carbohydrate dependency and the addictive (for some) properties of sugar and excess grains and wheat. Headaches, dehydration, lower blood pressure and ‘dead legs’ are all initial side effects when removing processed food. Trust me – this too will pass.
  4. To minimise side effects, start the transition in a base-training phase of your training where training occurs at an easy pace. The transition phase can take anywhere from 2-12 weeks initially.
  5. Consume salt. Don’t underestimate the importance of this! Lower circulating insulin affects your body’s ability to retain sodium (and other electrolytes) – so we need more, particularly as processed food (of which you are no longer basing your diet around) is where you got around 70% of your sodium from.
  6. You can accelerate the process of fat adaptation by instigating some of the tactics used by athletes who opt to ‘train low’ – i.e. in a low glycogen training state. Some of these are naturally undertaken if you train without eating in the morning, or work out after dinner in the evening and don’t consume anything post-workout. If you’re new to this, have a read through to establish which might suit you best, and start instigating 1-2 x per week. Don’t undertake all of them as this aggressive approach could cause too much additional stress, derailing your plans to become a fat-burning beast.
  7. The FASTER study and Peter Attia, Sami Inkinen suggests any endurance athlete can become fat adapted and deliver performances that may be superior to carb-fuelled efforts all of the way up to anaerobic intensity. This is a new and growing research space, one AUT is testing, among other Universities around the globe.
Strong, lean and awesome at 41y.

Strong, lean and awesome at 41y.

 

PS What the Fat Sports Performance – currently an ebook, about to be published is one I can’t WAIT to read as well – sure to be a goody.

10 ways to naturally reduce your cholesterol-related risk and save yourself $8.00

I was at the supermarket yesterday and just happened to be taking a picture of an iced coffee drink when someone came beside me to grab a couple for themselves and put them in their trolley alongside a pottle of Flora ProActiv margarine.

Heinous drink containing 75g sugar on the left, and overpriced margarine on the right. JICYWW.

Heinous drink containing 75g sugar on the left, and overpriced margarine on the right. JICYWW.

There’s a disconnect right there.

These margarines are not only ridiculously expensive and taste terrible (I suppose that’s the nature of margarine anyway), but consuming this spread in an effort to reduce cholesterol levels is totally misguided. Don’t get me wrong. They work. In fact, a good friend of mine did her Master’s project at the same time as I did to show their effect at lowering LDL cholesterol in a clinical trial. There have been more than a handful of randomised controlled trials that show plant sterols can inhibit cholesterol absorption and reduce LDL cholesterol.

The end goal, however, shouldn’t be about reducing your LDL cholesterol levels. You’re probably down with that anyway given you’re reading my blog. The end goal is about reducing your overall health risk, and these margarines have not been shown to do this, despite the Heart Foundation tick and the Health Star Rating. In fact, for a substantial proportion of the population, a lower cholesterol level increases the risk of heart disease (for more information, read this excellent blog post by Zoe Harcombe)

Interestingly, even the American Heart Association released a statement saying the use of sterol and stanol esters should be reserved for adults requiring LDL cholesterol lowering because of hypercholesterolemia, or as secondary prevention after an atherosclerotic event – and these have yet to be updated.

If you want the real benefits of cholesterol lowering foods, eat your plant sterols in the form that nature intended (i.e. plants), not a pharmaceutical company

Anyways.

Here are 10 ways to naturally reduce your risk related to cholesterol and save yourself $8.00

  1. Eat more vegetable fibre. Fibre is the ‘f’ word that is super important but doesn’t receive nearly as much press as the other ‘f’ word (fat). Current recommendations are 28g for females, and 34g for males and we are currently consuming an average of 20g per day. Fibre comes in a few different forms and while soluble fibre has been found to lower cholesterol absorption – this is not the most important aspect to my mind. A few people (who may have a genetic defect that makes them hyperabsorb fibre, or have a defect on their LDL cholesterol recpetors which limits their cholesterol uptake and removal) would benefit from this in particular. Moreso, eating more plant based fibre shifts us back to an eating pattern that, as Eaton & Cordain point out, we consumed for over 99% of human evolution. And while estimations of fibre intake of Hunter Gatherers vary (as pointed out by Steve in this excellent blog post), the point is: we don’t eat enough of these plant-based foods and we need to eat more AND more from the sources of foods which are as close to their natural form as they can be. You’ve heard of the 5 a day campaign? I say we should aim for 9 – and mostly vegetables. This is particularly true if you do have underlying inflammation that is driving up your cholesterol level. There different types of fibre and soluble fibre is known to absorb cholesterol and remove it from food you eat and your bloodstream. This level of detail is certainly useful if you have a genetic predisposition towards a high cholesterol level which places you at risk (i.e. familial hypercholesterolemia). However, to keep it brief: if you’re currently barely managing three serves of vegetables a day – work on increasing vegetables in general. Natural sources of fibre from plants will deliver soluble and insoluble fibre, along with resistant starch. This is a good place to start.
  2. Ditch processed food. Sounds dramatic I know – and it’s not realistic to ‘never eat anything in a packet’. However if most of your daily calories come with a nutrient information panel and an ingredient list, then you seriously need to reconsider what you are putting into your body. Processed food is devoid of nutrients in the forms your body requires, contains additives and preservatives, some of which have a dubious health profile and takes very little energy to digest. This leads to peaks and troughs in your blood sugar levels, poor appetite control and the potential to overeat.
  3. Ditch sugar. No surprises here. Sugar not only increases your risk of metabolic syndrome that can result in type 2 diabetes and increased cardiovascular disease risk, it drives almost all inflammatory pathways in the body. Thankfully though, if you try hard to stick to #2 above, you’ll do this by default. Do note though, minimising sugar includes all forms of sugar – including the ‘natural’ forms. If you’re unsure of what a sugar is, print out this PDF which tells you the 56 different names to burn into your brain for your supermarket shop.
  4. Lose weight. Or, more specifically, lose body fat. Being obese is an independent risk factor for cardiovascular disease, type 2 diabetes, neurological conditions and some cancers. Yes there are certainly limitations with how we define ‘overweight’ or ‘obese’, but you don’t have to rely on tools to establish whether or not you need to lose some additional fat around the middle. You know this yourself.
  5. Increase your intake of omega 3 fatty acid rich foods (think salmon, mackerel, herring and sardines) and consider an omega 3 supplement if you don’t eat fish. I know – you’re thinking ‘what about plant-based sources’? truth is, these don’t contain the type of long chain fatty acids that are most beneficial for reducing risk of chronic disease, and their conversion rate into those forms is quite poor. Eicosapentanoic acid (EPA) is the omega 3 that is involved in reducing inflammation, and if you do have high cholesterol and inflammation, then a supplement such as this Nordic Naturals could be worthwhile taking. While a very recent clinical trial failed to show improvements in total cholesterol with the addition of an omega 3 supplementation, it did show a reduction in fasting blood sugar, triglyceride levels and c-reactive protein (a marker of inflammation in the body). And as I said, your cholesterol level might not be the most important metabolic marker to focus on anyway. Vegetarians especially would benefit from supplementation, and an algae supplement would provide a similar benefit.
  6. Get out in the sun…. and get your vitamin D levels checked. There is an association between low vitamin D and poor metabolic health – studies have shown a link between high sunlight hours and lower cholesterol levels at a population levels. This is due to the exposure of skin to the UVB rays that uses cholesterol to create vitamin D. However, a large percentage of New Zealander’s are below adequate levels. For best and safe practice, sun exposure, minus the burning, for 10-15 minutes where parts of your skin not often seen by the sun (for maximum absorption) are exposed (think: armpits, abdomen – unless you’re young and gorgeous) is best. The thing is, though, the sun doesn’t hit the earth at the right latitude to get any of those rays to produce vitamin D in winter, so we can be lagging even more coming into spring. So supplementation could well be required. In addition to the mechanism above, studies (like this one) have shown that higher dose vitamin D supplementation can lower cholesterol and inflammatory markers in women. If supplementing, choose a supplement that also includes vitamin K2 to help vitamin D’s absorption such as this Clinicians one.
  7. Alpha-lipoic acid (along with other antioxidants vitamin C or E) can provide antioxidant support to help reduce your overall health risk associated with cholesterol levels (i.e. reduce inflammation and oxidative species) by increasing the activity of your body’s antioxidant defences. If you’re wanting to spend your money on actively lowering your cholesterol, these relatively safe supplement options are a better idea than margarine.
  8. Your thyroid, your gut, your genetic profile can all influence your cholesterol profile. If your cholesterol is more than a bit elevated, consider investigating other reasons for this. FYI it’s now easier to get your LDL cholesterol tested, rather than calculated, including those which are more atherogenic, such as VLDL, oxidised LDL if you do have concerns. You can work with a practitioner to do this.
  9. Exercise. Free and long known to improve metabolic health. The arguments for or against the benefit of exercise for losing weight are irrelevant. Mood, lean muscle mass, cardiovascular fitness and general all around awesomeness will increase. It doesn’t mean you have to slog it out in the gym. Body weight exercises and some short, sharp, intense exercise a couple of times a week – combined with walking and general movement as much as you can – is most effective for health and wellbeing. If you like to track your details then get a Fitbit or a Garmin or similar. If you obsess over numbers then don’t.
  10. Stress less. Sleep more. And if you are losing weight, and doing all of the above, wait for your weight to stabilise before worrying too much about your cholesterol levels, which can be elevated during this time.

 

Body weight exercises from the 7min workout - not a bad place to start. (http://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/)

Body weight exercises from the 7min workout – not a bad place to start. (http://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/)

PC:triathloncompetitor.com.

An endurance athlete’s ‘real food’ success story: making it work for you.

I got this email this week from a client that I have worked with since just before mid-year. She is an endurance athlete that came to me as her overall energy levels were low and she was carrying a few extra kilograms that she wasn’t used to.

We chatted through not only nutrition but lifestyle-related changes that she could make to help support her busy lifestyle. This included changes to her diet, additional supplemental support, working on sleep-related behaviours and finding the middle ground between ensuring adequate energy levels and losing body fat to a level that was sustainable and achievable. You can appreciate this is a delicate balance! I discussed with her that when we sorted her energy levels, the body fat loss would take care of itself – she was aware of this and that her energy levels were the priority.

As an endurance athlete she often trained at both ends of the day and came home late, stayed up a little later than she thought she should, and relied quite a bit on carbohydrate-based choices such as bread and cereal to boost her energy levels during the day. While she didn’t recognise it, I immediately flagged this as one of the reasons she was feeling exhausted. She was also hungry a lot, eating at multiple times during the day. This was another indicator that her food choices were not geared towards an optimal balance of good quality carbohydrate, protein and fat. A detailed discussion on her diet proved this to be true.

This client was very motivated to feel better, and took the suggestions that I made and found a way to work them into her lifestyle. We had four sessions together, the last being just before a race that she was doing – the first one for her in a while.

I asked if she minded if I shared her email – she was happy for me to do so.

“Thanks for the item on Thyroid on Fitter Radio this week – it was really helpful. Good to know low thyroid is not something you are necessarily stuck with for life.

Following our catch-up at the end of September I just thought I’d update you with how things have gone since then, and where I have found a really comfortable place with training and nutrition.

Update:

So in summary, I performed well at my last race and was very happy with my placing in my age group. I really noticed that getting extra sleep made a big difference to how I felt, two nights before the race I had 9 hours and felt amazing the next day.

My weight has stabilized at around 53kg so I think this is possibly the happy place for my body, and it’s the same as it was a couple of years ago when I was running at my best.  I feel good at this level and I’ve figured out how to keep it there – for me it’s:

  • at least 7.5 hours sleep;
  • not eating late; and
  • doing some kind of activity in the evening, even if that’s just a walk.

Food wise, what seems to be working and manageable is:

Prep: (crucial to ensuring that I’ve got options available during the week):

  • Bulk making a week’s smoothies at the weekend, then freezing and using during the week
  • Ordering Primal Kitchen for weekday lunches and weekend main meals
  • Making a few wraps at the weekend for weekdays when I do something straight after work. For example, Farrah chia wrap* with Vital Vegetables Slaw, lemon juice, a flavour (Thai spice mix, peanut butter or salsa) + a protein such as smoked salmon or chicken

*yes I know it’s has wheat in it and is a carb but it seems to give me enough energy/and is practical – if I eat fewer carbs than I am I don’t seem to have enough energy.  I have tried other things instead of a wrap like cabbage leaves/sushi sheets/… but they just don’t work as well, they fall apart. The thing that does work is the Vietnamese rice paper wraps but they are very fiddly so I would tend to buy the Farrah wraps instead – very good place in central Wellington to get them! 

Breakfast – usually 5:30-6:30 depending on day

  • Smoothie and a hot drink + a spoon of peanut butter – I usually make the smoothie quite thick and eat it out of a bowl with a spoon!
  • If I’m doing something hard-ish like a swim squad or a run/bike then I have something else too. This tends to be either a sachet of plain oat porridge with the smoothie on top, or 2 hard-boiled eggs with some salt (or on a race day 1-2 x banana depending on length or race).

Mid morning – usually have a coffee with rice milk but don’t need to snack much now. If I do it’s 1-2 Brazil nuts

Weekday lunch – usually eaten around 11am-noon

  • Primal kitchen – 1/2 a warrior size shared with partner + handful baby spinach
  • 2 squares of dark chocolate and maybe a couple of strawberries.
  • Raspberry white tea

Mid afternoon – usually have a Redbush tea with rice milk but don’t need to snack now. If I do it’s a carrot and maybe a few almonds.

Weekday dinner – on days when I do something around 5 or 6pm in the evening, I just eat this around 4pm which seems early but it gives me fuel for the activity then I don’t need to eat a meal later. This way I get a semi-fasted thing happening (as per train-low principles) without it feeling hard. And it means I don’t eat a bunch of rubbish in the afternoon. So it works!

  • Wrap
  • 2 squares of dark chocolate
  • Redbush or green tea

Evening – Usually have a hot drink (not caffeinated), and maybe a swig of wine or my partners beer, but I don’t need to snack as much now – if I do it’s because I’ve just been for a hard-ish training session or MTB ride, and, something like a gold kiwi and few nuts does the trick.

Weekends, similar but we have Primal Kitchen in the evening but I try make sure we eat early, like by 6. For lunch something like sardines on toast if at home with salad, or eggs on toast if we are at a cafe.

Overall

It’s working well and although probably to you getting Primal Kitchen for most of our main meals will probably seem like a bit of a cop out!! But actually takes the stress out of everything – otherwise I would end up doing all of the thinking ahead/planning for both of us on food and basically end up spending more of my free time on it which to me wouldn’t feel fair! (My partner is wonderful but he just isn’t as organised as me and has lean genes and the fastest metabolism on earth so can eat anything. To him, super healthy food isn’t so much of a priority). I think it also works out the same cost or cheaper, definitely frees up some time and makes logistics easier. I’m sure at some point in my life I’ll enjoy doing more food prep and cooking more but this works right now and keeps the balance of effort fair!**

I am planning on giving up triathlon after this summer and just focus on running, mostly trail running and doing other stuff I enjoy for fun.

So, that’s it! Thanks for everything and your podcast, the whole experience of getting nutrition consultation has been a really positive one and the result for me has been to shift a good couple of kilograms and change my mental attitude in a very positive way.  :) ”

You can see from the discussion of her food choices, her diet isn’t low carbohydrate per se – though it is definitely LOWER in carbohydrates than it was. There is a lot more protein here than what she was having, and overall the nutrient density has improved.

Overall I think this is such a good ‘real food’ success story and that’s why I asked if I could share it. Does she eat ONLY non-processed food? No – however it’s all about context and finding the middle ground with what can be achieved in the context of the individual’s lifestyle.  That, to me, is success.🙂

Merry Xmas.

 

**to be clear, I don’t think that getting meals from a place like Primal Kitchen (or ordering through My Food Bag etc) is a cop-out at ALL. I think it’s a smart strategy to help people meet their nutrition goals and not fall back into bad habits that could contribute to poor overall health status. It’s really interesting here that it works out MORE cost effective too. It saves on buying food that they would have to throw out as they haven’t found the time to cook it. It also saves the temptation of just having toast or cereal in the evening, or a sandwich that doesn’t provide enough protein and important nutrients. Primal Kitchen is a great choice.

 

Navigating the school lunchbox: Ella’s first week.

My friend Helen and I were chatting about her daughter’s first week at school, an event I knew had been causing some apprehension. Over the last few years Helen has been changing the food supply in the family, and while it was much easier for her than she anticipated, getting the kids on board has been a very gradual process. When the children are at home for meals, it’s much easier to eat a minimally processed diet and parents have a much better idea about what their children are eating.  Possibly more of an issue though is that at home kids aren’t surrounded by other children and their brightly coloured, sparkly packaged food which might make their homemade lunches both different and a little mundane. I know a lot of parents have this concern – starting school is both exciting and scary for parents and children alike; the last thing either want is to increase this by appearing different from the masses. I asked Helen to write about how that first week went as I was sure she could offer tips to help other parents navigate the lunchbox.

I have been dreading this week. My little girl has started school and neither of us was entirely ready for it. On top of that, the thought of preparing enjoyable and nutritious lunches every day has been freaking me out! How would I cope? Would every day be a battle? Would I have to accept defeat and make sandwiches?

One week down and I realise lunches were the least of my worries! It’s been an emotional roller coaster but one thing that has actually gone OK is the lunch box so I thought I’d share my experience. The first thing to consider was the lunch box. We let her choose her own and the Sistema ‘Quaddie’ is working well. The fact that other children in the class have it is a big plus too.

Day 1

Lunch was prepared the night before and this has now become the routine. We had slow cooked lamb and veggies for Sunday dinner and thankfully she enjoyed it so much she asked if she could have it in her lunchbox the next day. I couldn’t believe my luck! So on her first day of school, off she went with lamb, kumara mash, roast beetroot and feta. The previous week I’d been complaining how she would never have dinner-type meals for lunch and there she was asking for it.  Selecting non-chewy pieces of meat was the key (slow cooking helped massively here) and using smaller plastic containers within the bigger box to stop things getting messy.

Lunch isn’t until 1pm so the children take a small brain snack as well as morning tea. The brain snack we were told should be a piece of fruit – a bit of a problem when your daughter doesn’t like fruit. We don’t have an issue with that, given her love of a variety of vegetables. She said she would have a small piece of banana but this was the one thing that came home uneaten on Day 1. Nuts, yoghurt with ‘special sprinkle’ (based on this Sarah Wilson granola), cheese, a few rice crackers and a homemade dark chop chip muffin based on this I Quit Sugar recipe were all eaten and (I think) enjoyed. Ella told me there was too much food but nerves were probably affecting her appetite.

Day 2

Lunch was chicken goujons – made the previous week with a Pete Evans crumb recipe (such as this one) and then frozen – more veggies (buttered), a hard-boiled egg, cheese, nuts, yoghurt. Same result as Day 1 – all eaten, partly due to the teachers encouraging the children to eat everything in their box. This actually upset Ella a bit – she eats when she’s hungry and doesn’t want or need to be forced to eat. I deliberately put in more than I thought she would need so that a) she would have choice and b) there would definitely be enough. I said I’d have a word with the teacher if it became an issue but thankfully it doesn’t seem to have.

Day 3

Lunch was going to be meatloaf but due to a mini meltdown about being scared of school and not liking meatloaf, it was removed and alternatives were offered. I’ll try not to let this happen too often but I was desperate for her to be happy during what was becoming an upsetting week. When she turned down one of her favourites – a tuna mayo sandwich on seed bread – I realised this was more about not wanting anything at all than about not wanting meatloaf. I think if I’d offered her ice cream that day she would have said no! We took her brother to daycare, came home, had a game of Monopoly and tried again! I let her look in the freezer and choose anything she liked….she chose a piece of salmon, leftover from one of our dinners the previous week. We usually buy a bigger piece of salmon than we need and pop the leftovers in the freezer in bite sized chunks so they can be defrosted for lunches.

The night before I’d made some seed crackers so these went in too, along with some cheese and other bits and pieces and the verdict that night…..I want exactly the same tomorrow!

I won’t be doing this every week but it was so good to see her happy, off I went to the supermarket to buy some salmon! And we did it in reverse…I cut off a couple of inches for her, cooked it for 2 minutes in the microwave and we had the rest the next day.

Day 4

This was the same as Day 3, with the addition of some buttered green beans. Meanwhile her little brother Tom had the uneaten meatloaf from the previous day (another Pete Evan’s creation) and loved it! I told Ella this and to my surprise she said she would like it in her box the next day. So Day 5 was sorted. Fortunately she is happy with eating food at room temperature due to us not having facilities to heat her baby food when she was younger and we were travelling. More green beans, carrot and dip, some almonds and peanuts, yoghurt and ‘no grainola’, and seed crackers and cheese finished off the box. Oh and a small beetroot that she pulled from the ground herself earlier that day. So we have a system and so far so good. She’s even eating a little bit of fruit each day – a one inch slice of banana with skin removed and no trace of any stringy bits!

Reflecting on our first week…

The food is fresh and real but I’m not slaving over it every morning or night. I realise now it’s just filling a box with whatever’s on hand, having shopped for the basics at the start of the week.
I’m no longer stressing over creating real food versions of typical lunch box items, or worrying that she needs a completely different box every day. When the box has the variety of nutrients in it that hers does, and she likes it, much of it can stay the same each day.

I’ll make a batch of ‘no grainola’ and seed crackers every Sunday and hopefully a different homemade dip each week (I’ll use rice cruskits sometimes if I run out of seed crackers or for a change). And perhaps once a month a loaf of grain free bread to sandwich some tuna mayo in one day. I’ll make and freeze meatballs, goujons, muffins and mini egg frittatas that can be pulled out and defrosted overnight. When we BBQ I’ll put on extra meat and in the morning when I make myself an omelette to take to work, I might make it bigger and put a slice in her box.  I’ll hard boil a pan of eggs and when I cook veggies I’ll always do extra. When the weather heats up I’ll freeze yoghurt or a smoothie before it goes in the box.

I see now that I’d built the whole lunchbox thing in to a bigger deal than it is and I’ve gone from being daunted by the prospect to quite excited by what good food I can pack her off with each day. Our kids have had a couple of years of living a balanced real food lifestyle – by which I mean that most meals and snacks are unprocessed and nutrient dense, but ice cream, pizza and cake are enjoyed occasionally. They are the much enjoyed treats that they were when we were kids. She knows these aren’t everyday foods and really enjoys a wide variety of vegetables (especially when tossed in butter) and other whole foods. It’s just the norm for her and I hope it can stay that way.

She’s active, with a healthy metabolism so it’s not about her lunch box being low carb, it’s about it being as nutrient dense as possible. It’s about it containing foods that will give her energy and help her body and brain develop. I love that she will grow up thinking a real food lifestyle is the norm, where you make things rather than buy things and even grow them yourself where possible. I hope this becomes the norm for more kids her age.

My husband and I are in total agreement about what we are doing and although I am doing most of the preparation, it is a shared responsibility that he will happily take on when needed. We start the day with an awesome breakfast and finish it with a wholesome dinner, so even if the box I make doesn’t get touched, or it isn’t perfect every day, it won’t be the end of the world.

I know she loves good food and will eat if she’s hungry. Where possible I’ll get her involved in making and choosing things but at the end of the day, she’ll get what she’s given, just like I did and I turned out alright! It will not be a hassle but it will get as much thought as our meals do…it should shouldn’t it?

Post-script: Ella now enjoys sushi every Friday, just a few pieces. She loves it and it makes for an easy lunch day for us.

 

A few quick thoughts on the Ministry of Health Eating and Activity Guidelines for Healthy Adults

After over a year since the Ministry of Health asked for submissions to the draft food guidelines, they have finally announced an update. Undoubtedly they were waiting for the lead taken by the US who are in the process of updating theirs and, looking at ours, it’s a shame that New Zealand didn’t man up and take the lead from Brazil last year, who focused not only on food but non-food related factors related to eating behaviour, such as the eating environment, the social environment and food advertising. Anyway.

As in the first draft, there has been little more than just wordsmithing of the existing guidelines that were last updated in 2003 in this new document, the Eating and Activity Guidelines. While there is a paragraph on the end that recommends choosing ‘whole food’, (which is great, I do really like this), for the most part the guidelines remain largely unchanged from the existing ones and therefore aren’t in line with that recommendation.

While there has been an extended period of time between the original draft and now, and the guidelines say they are based on best available evidence, to my mind this actually is NOT evidence in some areas. As part of the Human Potential Centre we wrote a submission to the Ministry of Health and provided them some of this best available evidence. This hasn’t appeared in the final update. While unsurprising, it is still a bit disappointing.

The full guidelines are here and I just thought I’d give a quick summary of where I feel the Ministry could have improved the guidelines for the health of the population.*

Enjoy a variety of nutritious foods every day including:

  • Grain foods, mostly whole grain and those naturally high in fibre

Pasta and noodles and couscous and cereals aren’t whole grains. They may have been whole grain once (as they are grain products!) But they are FAR from whole grain despite what it says on the packet. Sorry. Regardless of whether they say ‘whole grains’ or not, there are few whole grains in the diet. Barley might be one. As Prof Mann from Otago has said ‘most wholegrains in the food supply aren’t intact and are equivalent to a bag of glucose (read this here for a dietitian’s view on the post – and then check out who his clients are or have been….cough cough).

With this in mind, and with two thirds of New Zealander’s categorised as overweight or obese, a growing number of people being diagnosed with pre-diabetes and type 2 diabetes (and many more estimated undiagnosed) it is perplexing that there is a focus on foods which are as nutrient devoid as the packaging they come in (i.e. pasta). Not all carbohydrate sources are created equal, and your naturally occurring carbohydrate sources such as potato, kumara, yams and fruit are far more nutritious sources of carbohydrates for people who can tolerate them. It’s not about ‘no carb’ – it’s about quality carbohydrate. The recommendation to include pasta, cous cous, bread and cereals –processed, refined carbohydrate foods – is in contradiction to the awesome recommendation to choose whole foods.

  • Some milk and milk products, mostly low and reduced fat

This is NOT the most up to date research. Many many epidemiological studies support the use of full fat dairy being beneficial for weight management, heart health, gut health in all age groups. Ministry of Health is scared to say ‘blue milk’ as it contains saturated fat (in context of whole food diet in normal amounts, this isn’t an issue.’ MOH should read my blog post on why full fat dairy has important health benefits that can’t be gleaned from low fat. And…. Full fat dairy is far more satiating than low fat. We feel fuller and are able to better manage blood sugar levels and with it mood, concentration and overall energy. We’ve been buying into the low fat message for far too long and it’s about time we kicked that to the curb.

  • Some legumes*, nuts, seeds, fish and other seafood, eggs, poultry (eg, chicken) and/or red meat with the fat removed (Eat less than 500 grams of cooked red meat a week.)

A large proportion of New Zealanders are both iron and zinc deficient and red meat is the richest source of these nutrients, along with fat soluble vitamins and antioxidants such as Co-Q10 which play important roles in the health of our cardiovascular, digestive and musculoskeletal systems. Most dietary iron comes from breads and cereals which contain nutrients which bind iron and prevent absorption. There has been the recent IARC report suggesting that red meat is a carcinogen, and while it’s important that red meat intake is moderated to a palm size portion as part of a meal, it’s good to be aware of the critiques around the red meat issue (such as this and this). I do wonder, though, if there are differing health effects in populations eating red meat in places such as New Zealand, where our beef and cattle industry (predominantly grass fed, no antibiotics or hormones) is quite different from the hormone, grain-fed, antibiotic administered environment of that in the US.

In addition – as you know, it’s the processed meat that we need to be more mindful of. Luncheon and saveloys and chargrilled (burnt to a crisp) sausages on the BBQ should be avoided.

  • Choose and/or prepare foods and drinks with unsaturated fats instead of saturated fats (SAFA).

We’ve been over this a LOT I know – check this out and this out. Abnormal amounts of anything is going to tip the balance in the wrong direction health wise, especially in the context of a diet that is also high in refined carbohydrate. It can also be problematic for people consuming large amounts in the context of a real food, low carbohydrate diet actually. So it is individual. However there is a difference between consuming ridiculously large amounts (i.e. a bulletproof coffee for breakfast alongside bacon and eggs fried in butter) and encouraging people to choose butter (a minimally processed food) instead of margarine or other industrial seed oil spreads (highly processed) to sauté their green beans in.

In addition, while the guidelines say that it’s beneficial for heart health to replace saturated fat with polyunsaturated (PUFA) fat, I’ve asked some smart people about this and replacing SAFA (or any fat) in the diet with PUFA may only beneficial when the diet is deficient in nutrients such as antioxidants provided by the seed oil, or if the diet is deficient in PUFA (never really seen in New Zealand. Further, the real benefit comes from long chain omega 3 fatty acids (from fish for example) rather than seed oils, which are certainly beneficial for health, including heart, brain and vascular health.

So… while it’s great there is the inclusion of the paragraph that encourages the consumption of real food that is minimally processed (and on that most people are in agreeance), the continual promotion of grain-based foods, low fat dairy and plant-based polyunsaturated fats such as seed oils goes against this recommendation. I don’t know if this paragraph is merely a nod to the growing awareness the consumer is having with regards to their food (rather than a genuine recommendation) or a lack of understanding of what ‘minimally processed’ means. It feels like they have their feet in both camps, but it could only serve to confuse people who are navigating an already confused food environment.

*someone else much smarter and more articulate with more time could probably do a more indepth review.