Something was missing from LCDU…

Sugar took centre stage in Auckland this week, with the FIZZ conference that focused on the role of policy in reducing consumption of sugar sweetened beverages in the population, and the first Low Carb Down Under (LCDU) Auckland symposium, which saw a mix of Australian and New Zealand advocates speak about the reduction of carbohydrates in the diet.

I enjoyed the FIZZ conference, particularly the first day as both Richard Johnson (Fat Switch) and Robert Lustig (Sugar: the bitter truth) presented on biological mechanisms that clearly show the unique role that fructose has on adversely affecting our health. What a coup for the organisers to be able to bring them over to New Zealand. Perhaps most exciting (from a geeky, academic perspective) was a virtual punch up between Rod Jackson, a professor at University of Auckland, and Rob Lustig. Prof Jackson didn’t take kindly to Lustig’s assertion that nutrition public health initiatives have failed in the past. Prof Jackson views butter as the most ‘poisonous’ substance in the NZ diet  and took the opportunity on the last day as the moderator of the final panel discussion to mention again that (contrary to Lustig’s comments) we’ve been successful at reducing saturated fat intake in our diets (odd, as we were there to talk about policy initiatives targeting sugar sweetened beverages, not about saturated fat). Anyway – as an aside,  NZ consumption of saturated fat (and overall dietary fat) has reduced  over the last 20 years… but at what cost? It hasn’t resulted in better health outcomes overall. Total cholesterol levels have reduced, but this is alongside increased prescription of cholesterol lowering drugs, reduction in smoking prevalence and better access to health care. All the while obesity, pre-diabetes, diabetes, neurological disorders, cancer, stroke and mortality from chronic conditions continues to climb. It seemed that Prof Jackson’s comments were directed more towards those in the audience who were going on to speak at the LCDU symposium the enxt day – many of whom advocate the exact opposite of what Prof Jackson has spent his academic career promoting. Unfortunately we (the audience) did not get the opportunity to ask questions of the panel at the end of the conference – perhaps because it included the GM of Coca-Cola Oceania on it. Now this is nothing personal – Paul Fitzgerald seems like a nice enough guy and it’s likely he personally wants to promote health – but why include him (and Coca-cola) in the panel? Despite what they say, they are in the business of making money and driving sales, not reducing them.

Of course, there were other, brilliant speakers at the FIZZ conference, and I think it’s a fantastic initiative to target sugary beverages as a first step to reducing sugar intake in the New Zealand food supply. However, there was a real disconnect between sugary beverages and sugar overall. To come out of a lecture talking about sugar and the effects on our liver, to then go and load up our plate with sushi, sandwiches and enjoy ginger crunch for afternoon tea was just wrong, quite frankly. Sugar is sugar – be it from juice, soft drinks, cakes, slices and the refined carbohydrate from bread that is broken down into sugar in the body and pumped into the bloodstream quicker than you can say “pass me that serviette.” To serve this type of food to people at a health conference is wrong on all levels but particularly because many people attending are part of the health sector who take these messages forth into the community. This  suggests that sugary beverages are unique in themselves at promoting health problems beyond that of sugar containing foods which they don’t – they just increase the amount of sugar in the diet overall. To assume that people attending have the background knowledge and understand that is, in my opinion, wishful thinking.

The LCDU one day symposium had an entirely different feel to it – the speakers were a mix of both academics (mostly NOT in nutrition) and practitioners (doctors, nutritionists, dietitians) and included Sarah Wilson (a highlight for most of us sitting there). It was organised by Simon Thornley and Rod Tayler and was the first of its kind in New Zealand. The audience was entirely different – there were a handful of health professionals but most were along to either learn more or (more likely) reaffirm what they have experienced both health and diet-wise from following a low carbohydrate diet. I suspect that the symposium was more a case of preaching to the choir rather than enlightening people. That’s not to take anything away from the overall day at all – it was brilliant that most standing up there were not only sharing their clinical experiences and academic knowledge, but their personal stories. Among them were Cliff Harvey with his foray into low carbohdyrate diets back when it was considered bro-science and he was listening to Celine CDs (which I suspect he still does). Dr Troy Stapleton’s diagnosis of Type 1 diabetes as an adult and moving to a ketogenic diet after being unable to control his blood sugar with conventional diabetes recommendations. Dr Caryn Zinn, and her shift as a registered dietitian from conventional nutrition recommendations to a lower carbohydrate approach. This shift, in my opinion, will perhaps have the most impact in the lower carbohydrate movement given her academic background and her profession. Who better to disseminate this to the dietetic and wider health professional population than one of their own? Most importantly, the main message from all speakers was the push for real food. It was really good to see Niki Bezzant, the editor of the Healthy Food Guide, along at LCDU. The magazine takes a ‘moderate’ approach and, while it has an academic board whereby scientific experts are on hand to vet articles for accuracy, the academic world largely ignores evidence from both an anthropological and evolutionary standpoint and from clinical and personal experiences – two important elements that fill in many gaps where epidemiological studies fail, as highlighted by Grant’s talk. If anything, I hope the message that ‘it’s about real food’ – something that was advocated by all of the speakers – may have resonated enough for the magazine to start exploring what we (at AUT) and the speakers are advocating. Yes, it’s against ‘conventional nutrition messages’ but doesn’t that just highlight further that ‘conventional nutrition’ has to change?

What was missing, then, from the LCDU symposium? The people who I feel would have benefitted being there the most. The health professionals at the FIZZ conference who advocate for a reduction in sugar beverages but view cutting sugar as an extreme approach. The academics at the FIZZ conference who don’t acknowledge an evolutionary perspective or the mounting evidence of improved health outcomes at the individual level, just because they haven’t occurred as part of a clinical trial.  The dietitians and nutritionists at the FIZZ conference who take the ‘everything in moderation’ approach and see no problem with telling people to eat processed refined carbohydrate as part of a ‘healthy balanced diet.’  All of the speakers at LCDU had similar, if not the same academic and clinical training as the mainstream health sector. They’ve taken a different approach because they realise that, by doing what they’ve always done, they will only get the same result. And it’s just not working. A tax on sugar sweetened beverages is a good start but we need to think bigger. If there is going to be any impact on overall health related to reducing sugar intakes then we need to advocate for more.

(For those who are tired of me pontificating on nutrition as a philosophy and are really only reading this for a practical tip of two: follow the link on this page to Rob Lustig’s you tube lecture and watch it if you haven’t already. And dry those plastic bags you use to take your food to work on your window):

Slap these dudes on your window and watch them dry. Thanks for the tip, Sarah.

Musings this week…sugar related.

I received a phone call this week from a Campbell Live reporter, asking if I could recommend someone who had recently cut sugar from their diet that they could interview for their upcoming news item investigating sugary beverages in the diet. I believe this is to be aired in the coming week to align with the FIZZ symposium (a conference reviewing the effects of sugary beverages on health) which is being held in Auckland. To be honest, I was quite excited. I had a couple of people who immediately sprung to mind: one client who I have been consulting with who had made major changes to his sugar intake and successfully lost 15 kg to date, and a client of a dietitian friend of mine, who’s dietary changes had not related in weight loss but reduced inflammation of the prostate. When I relayed the stories of both men to the reporter, there was not the anticipated enthusiasm that I expected. Fair enough, I guess he is not a health professional and likely wouldn’t recognise the significance of the information I relayed (though, as a guy, I thought he might be somewhat interested). After pausing for a bit he tried again ‘And what about people who have just cut out sugar?’ Initially I was a bit confused. “Oh, they did cut out sugar, a ton of it. However, this was not by just focusing on sugar per se, this was by focusing on eating less processed foods.”  He got it…but remained underwhelmed. Cutting out processed foods and recommending whole foods clearly wasn’t going to make for compelling viewing in his opinion. I wished him good luck for his story and hung up the phone.

It got me thinking. What was it, then, he was wanting to write about? In his mind, what did ‘cutting out sugar’ actually look like? Perhaps he’d read the article on Stuff that appeared last week suggesting that cutting sugar was the domain of the extreme dieter and he was looking for tactics that were a little more…extreme. Anyway.

Related to this, the release of a study that models the effect of a 20% tax increase on sugar-sweetened beverages on reducing premature deaths in New Zealand. There were some good questions raised on one of the author’s blog (Tony Blakely) as to how best allocate the additional revenue gained from this increase in tax. My concern has always been that a price increase hits those who are disproportionately represented in the adverse health statistics – people who are in the lower socioeconomic groups might consume more sugar beverages, but lack access to information as to why they should consume less. Any government intervention in this way, as pointed out by the authors of the paper, needs to occur as part of an overall government strategy to promote healthy eating. I really hope then that we get a change of government this year as let’s face it – prevention is not a priority for our current government.  Of course the other point raised was that industry could then focus on producing more zero-calorie beverages as a substitute for their full-sugared counterparts. A win-win, apparently. A Twitter conversation between Jamie and Anastasia of Whole 9 South Pacific and Tony Blakely addressed one of the questions that I was interested in – the author’s stance on the inclusion of artificially sweetened beverages in the diet and the health implications of such – revealed the willingness of the author to investigate the research more in this area. As an aside, this really does illustrate the power of Twitter and other social media platforms to allow people to engage with researchers about their work in real time. Better still to see people in Tony’s position welcome an opportunity to have a discussion and don’t shut down the conversation before it has a chance to start. The sign of a true academic. But I digress.

I’m a realist – the food industry is not going anywhere, so perhaps we should embrace this and work with them to find solutions (such as the zero-calorie beverage options). However sometimes it might appear that food companies are working to be a part of the solution (i.e. the smaller serving sizes, the artificially sweetened beverages, the muesli bars highlighting that they are ‘under 100 Calories’ on the labels) when in reality this just maintains their stronghold on our taste buds and our wallets. Money spent on diet soft drinks or mini-sized packets of corn thins is less money available to spend on fruit, vegetables, eggs and other sources of foods that actually contain nutrients. Further, anyone who has read Michael Moss’ book ‘Sugar Salt Fat’ will know what I’m referring to when I talk about the ‘bliss point’ – an optimal level of flavour in a food (combining fat, sugar and salt – depending on the food in question) whereby the level of deliciousness is almost (but not quite) at the point where it satisfies – hence we can’t stop eating it.* It’s what food manufacturers spend millions, if not billions, of dollars and years developing (click here for a good debrief). To be able to engineer a food that we crave is a much better business model than that which is designed to satisfy cravings – how else would you drive sales? As has been pointed out by Marion Nestle (and others) before: the food industry is not in the business of promoting health – they are in the business of making money. Therefore if we look to them for the solution to the chronic health crisis set to cripple both individual and population health, we run the risk of shooting ourselves in the foot.**

Sorry, Coke. I don’t buy it.

Like the war against tobacco, the war against the food industry (and, in this case, the soft drink industry in particular) is undoubtedly going to be many years in the fighting. However, the recent media attention related to our sugar consumption serves to increase awareness of the impact that sugar has on the health of the population in general. If this encourages people to move away from processed food and embrace more of a whole food diet, then that can only be a good thing. Even if it doesn’t make for compelling prime time viewing.

*Interestingly this guy on his blog mentioned that the bliss point could also extend to TV serials, whereby the producers ended each episode at the exact moment that will be guaranteed to keep us hooked until next time. This explains why we get bored during a three hour movie, yet binge watch our favourite TV shows. As someone who has almost caught up on the entire series of Downton Abbey during three weeks over January, I am inclined to agree with him.

**Yes of course I realise this in an idealist perspective. However, it’s my blog so I’m entitled to put it out there :-).

Fear of fat holding you back?

Guilt-free. A term I used to throw around with reckless abandon when talking about food and nutrition. Regardless of your nutritional leanings, you see this everywhere with reference to foods you ‘should’ be eating and foods that shouldn’t be on the menu. Even though the term itself is referring to a supposedly innocuous food choice, it’s the unintended message that no longer sits well with me. The very notion of ‘guilt-free’ foods implies that we should feel guilty or ashamed for eating foods that are not desirable. Over the last couple of years I’ve  moved away from thinking about food in this way. It wasn’t even a conscious decision – I just noticed that I used the term less and less when discussing food choices with people, making me more aware of the term when I saw it. Our eating behaviour has so much more to do with psychological, sociological and emotional factors than just the food itself. If a food is deemed to be ‘guilt-free’ then often times it’s a version of a food we typically associate with being a treat: such as a muffin or cake. That it now contains meedjol dates instead of refined sugar, or almond flour in place of wheat flour gives it an immediate ‘health halo’ and we treat it almost like a health food. Which, clearly, it isn’t. Similarly, a food deemed as ‘bad’  we tend to eat it quicker, often not engaging in the actual process of eating, and we eat more of it at any one time as it’s the last time we will ever eat that food. This negates the very reason for consuming it in the first place, as we typically eat them for pleasure and satisfaction. Except almost the opposite it true; instead of pleasure we feel guilt.

There are many types of food that can create this feeling. One of the major hurdles that people struggle initially with when moving away from processed foods to a more whole food diet is this ingrained guilt and fear associated with consuming fat. Fat makes you fat, therefore we should avoid it at all costs. I certainly had it. When everything I consumed was ‘light’, ‘low calorie’, ‘diet’, and the healthfulness of a food was measured by its fat content. With over double the calories of carbohydrate and protein, any food which could be substituted for its lower-fat counterpart was sought out and promoted. Naturally, then, a diet higher in processed food was inevitable as some kind of human intervention had to take place in order to remove the fat and replace it with something close to palatable that could be consumed guilt-free. A lot of the time this was additional sugar or a sugar-substitute. If you’ve been eating the fat-free version of foods for years then it’s not always easy to throw away the Flora light and replace it with the butter tray. This is not the case for everyone, obviously. A lot of people rejoice they no longer have to choose the green lid milk over the blue. However, particularly women who have dogmatically followed a low fat diet for years, the opposite is true  when letting go of these foods in favour of a ‘more food, less ingredient’ style of eating. When talking with clients about making the initial changes, they report a dislike for the taste of butter, fattier cuts of meat or a full fat, unsweetened yoghurt. Some even report feeling physically nauseous. There is certainly a psychological aspect to this. I remember when I was 8 years old I pretended to be sick so I could stay at home. I faked it so well that the apricot yoghurt mum gave me actually made me throw up (and avoid fruit yoghurt for a good 7 years). Dare I say, many females become vegetarians in their teenage years and remain so for years as a misguided way to lose weight, claiming that they don’t like the taste of red meat. It’s not until they begin eating meat again that they realise red meat doesn’t actually taste that bad.*

Typically, these are adjusted tastes; there was once a time where we thought trim milk was insipid, low fat cottage cheese was watery and and edam cheese was bland. Once our taste buds had adjusted, we could smell a full fat milk cappuccino a mile away. It is not just a psychological hurdle to overcome, indeed research last year found that taste buds physically change (one of the first scientific studies to ‘prove’ what anecdotally we have been saying for years). It does take time, though – and repeated exposure to a previously disliked food eventually results in acceptance. This physiological response to fat in food extends to the digestive processes. Certain enzymes responsible for the digestion of fat in the gut may be down-regulated if that pathway has not been utilised, therefore some people physically have problems digesting a diet higher in fat after years of omitting it from their diet. People with poor functioning liver or gall bladder may also have problems digesting fat, as the liver is the site of nutrient metabolism, and the gall bladder is responsible for secreting bile that is essential for fat digestion. Further, if you have irritable bowel syndrome and a sensitivity to FODMAP containing foods (specifically polyols), and have included additional coconut-based products in your diet, then this could explain some of the gastrointestinal distress.

When I talk to clients about a whole food diet naturally higher in fat, many experience the initial fear (and potential guilt) of eating more fat. They don’t trust themselves to add fat to the diet for this reason, as they don’t believe the effects of a higher fat diet – stabilising blood sugar, helping the delivery of fat soluble vitamins, increased satiety and an overall calmer mood state – will allow them to regulate their appetite. Too many years have been spent over-consuming ‘guilt-free’, nutrient-void processed foods which provide calories (less of them) but no nourishment. For these people, the psychological and physiological hurdles are such that it may take months or years to overcome. However, there are some things you can do to mitigate these and slowly increase the fat in your diet:

1. Do it slowly. Instead of focusing on adding a lot of additional butter, olive oil, coconut oil to your food, just think about not removing the fat that is already present. Instead of automatically going for the low fat cream cheese, pick the regular variety. Choose the standard milk as opposed to the trim milk. Go for the darker cuts of meat on a chicken as opposed to the lean breast (a lot more nutritious) and don’t worry so much about removing the skin. Eat butter.
2. Listen to your appetite. Fat has the ability to make you feel more satisfied after eating it, so really try to tune into your hunger cues and stop eating when you feel satisfied, not stuffed.
3. Add a small amount of butter to steamed green vegetables. You do not need to drown them in it. This will help increase your absorption of fat soluble vitamins A, D, E and K which require fat as the vehicle to be able to be utilised. As your taste buds adjust, you can increase the amount used.
4. Add olive oil-based dressing to your salad greens.
5. Increase the ¼ of an avocado to ½ an avocado.
6. Make your omelettes with the whole egg and not just the egg white.
7. If you do have a sluggish digestive system, helping support your liver by drinking raw apple cider vinegar in water 20 minutes before meals helps stimulate stomach acid and can help detox the liver. Bile salts help stimulate the production of bile from the gall bladder, essential for the digestion of fat.
8. Add nuts and seeds to your smoothies and salads.
9. Choose coconut cream to mash into pumpkin or kumara instead of milk.

Physically, you’ll soon adjust to a higher fat content without associated gastrointestinal distress. Psychologically, while you may not initially trust that you can increase the fat without gaining weight, you just need to remember to cue into your hunger cues and notice how you feel after eating. What really counts aren’t the calories – it’s the quality of those calories. Incorporating more of what is offered naturally in the way of food choices is far more nourishing and satisfying than any kind of packaged snack. However, if you choose to eat packaged snack foods then just do it and don’t feel guilty.  Regardless of what you eat, the concept of ‘guilt-free’ foods and the unintended meanings should have no place in determining what we eat or, more importantly, how we feel.

*Obviously I’m not talking about all vegetarians, as there are many reasons why people choose not to consume meat. This is, however, a common one.

Problems on a low CHO diet?

If you are reading this then there is a good chance that your diet is proportionately lower in carbohydrate (CHO) than the standard New Zealand diet (or you are considering making the change). More and more people are jumping on the low carb bandwagon and for good reason, particularly if your CHO intake was based predominantly around bread, pasta and other refined products. By default, switching to a whole food diet will naturally lower your CHO without thinking too much about it.

In my clinical experience, most who adopt a low CHO diet feel fantastic. Not only does this remove a lot of the aforementioned processed food, but they are also increasing their intake of natural fats and good sources of protein, and their vegetable intake. Their meals and snacks (if they have them) are balanced and often their nutrient-deprived bodies are finally getting the energy they’ve been seeking. However, in amidst the reports of glowing skin, greater health and bucket loads of energy, there are still people who struggle to find the right balance of nutrients, timing or the low CHO diet is exacerbating other underlying health issues that need to be considered. Depending on the reason for following a low CHO diet, increasing the level of CHO may not be an option for that person. If you fall into this category, then other strategies should be considered to address the problem. While this not intended to be a definitive list, here are some more common problems that people experience, and some possible solutions.

Energy: While it might just be a matter of tweaking the diet to better balance the micronutrients, people can experience a drop in thyroid function due to reducing their CHO intake, especially if this is done without consideration of other nutrients such as fat and protein. Symptoms of this (among others) could be:

• hair loss
• weight gain
• cold hands and feet
• insomnia
• thinning outer third of the eyebrow
• fatigue.

This may be due to two reasons. Acutely, our evolutionary response to low blood sugar is, in the first instance, to recognise it as a threat to our survival, and therefore we must make moves to convert glycogen to glucose to dump into our blood stream. Cortisol, a stress hormone, is responsible for that. Therefore the levels of cortisol can increase. Chronically, if moves aren’t made to correct macronutrient balance, the concommitant effect of this happening repeatedly is to affect pituitary gland function –  exhausting it and reducing the signalling to the thyroid to produce thyroid hormones necessary for function. In addition, insulin is required for conversion of t4 to t3, and one of the byproducts of a low CHO diet (importantly) is to reduce insulin levels in the blood. When increasing CHO isn’t an option, other strategies to help correct this include

• Ensure adequate selenium, zinc and iodine levels. These minerals are all important in supporting thyroid health. Iodine forms the backbone of t4 and t3, and can be found in seafood, iodised salt and kelp (predominantly) in our diet. A kelp supplement can be a good way to increase iodine and this should be done in the presence of supplementing selenium also – 200 micrograms (ug) per day is recommended, and selenium can be found in brazil nuts and fish. Zinc is found in substantial amounts in oysters, followed by organ meats. If you aren’t much of a fan of either, then 15-30 mg per day of zinc picolonate (taken at night) is recommended.
• Reduce goitrogenic compounds in the diet. These inhibit the function of the thyroid. Foods containing goitrogens include strawberries, kale and broccoli (a more complete list can be found here)

Another reason why people (and particularly athletes) might struggle is that the diet isn’t high enough in total dietary energy or there is an imbalance of fat and carbohydrate at each meal. Some people (women in particular) are extremely good at cutting things from their diet (in the first instance) and can sometimes find it hard to pick up additional foods (i.e. fat). Their version of a low CHO high fat diet might well just be a low CHO, low fat diet. In addition, not balancing nutrients appropriately at each meal can result in low blood sugar throughout the day, and the feelings of faint and dizziness could be a function of this hypoglycaemia. In my experience, there is no set ‘prescription’ on total calories if lacking in energy, it’s more about increasing the amount of total food at each meal, perhaps adding another serving of fat or increasing your portion of protein until hunger is satisfied and blood sugars are levelled out from meal to meal. For athletes, upping the CHO (particularly after training) can certainly help with replenishing muscle glycogen stores. For others, suggestions to help manage this might include:

• Increasing protein in the morning meal to minimise blood sugar variation throughout the day.
• Increasing the amount of fat in each meal by adding avocado, coconut, olive oil dressings, butter to meals (in the context of a low CHO diet, this is ideal).
• Increase dietary carnitine to increase fat utilisation: if the body isn’t geared towards burning fat as a fuel source, there is a potential that enzymes required for this is downregulated. There will always be some variation here, and certainly the strategy to increase food will help, given that carnitine is found in meat and dairy products. In addition, supplementing with L carnitine could help support this pathway. Carnitine is required for fatty acid transport across the mitochondrial membrane, making it available for energy. While this supplement has been studied extensively in athletic performance (and not found to be beneficial), if you aren’t a regular consumer of foods rich in carnitine (such as dairy and animal products) you may benefit from this to help stimulate the pathway in the first instance.

Adrenal fatigue: If you are experiencing this, supplements to help support the rebalancing of hormones can help. Maca powder (which is quite popular now and fairly widely available) has been found to be useful in a small number of clinical trials, and anecdotally it’s often purported as an adaptogen – something that helps support the adrenal gland. Botanicals aren’t my area of expertise, but supplements such as Good Green Stuff by NuZest contains plenty of these, and here is a list of the common herbal varieties. I’ve talked a little bit about adrenal fatigue in a previous post which provides some other strategies for adrenal health, such as an adequate intake of vitamin b5 and vitamin C. Ideally in this instance you would work with a health practitioner to plan a path back to adrenal health.

Gut health: People lowering their CHO intake can experience a change in gut microbiome. Depending on the level of CHO restriction and the types of CHO in your diet, you gut bacteria may change for the worse as part of a low CHO diet. People often report digestive issues such as constipation, and this may be reduced bulk in the diet, reduced water moving through the small intestine or a lower production of serotonin. Serotonin is produced through CHO in the diet, and is a feel good hormone. Ensure that you have enough CHO from non starchy vegetables. Indeed there is room for a substantial amount of these despite quite severe CHO restriction. These, along with fermented foods, can help form good types of bacteria in your gut that support digestion. Non starchy vegetables contain resistant starch which feeds bacteria in your colon and forms short chain fatty acids (such at butyrate) which is used as an energy source.  Take 5HtP (as a precursor to serotonin, important in gut motility), chamomile tea or chamomile pills to help with constipation, or probiotics. Eat fermented foods such as sauerkraut, kimchi, a full fat yoghurt with beneficial bacteria in it if your CHO restriction allows this. Prebiotics in the form of fructoligosaccharides and inulin can also help (if not following a low FODMAP diet).

Sleep: back ending your CHO intake for the evening can help mitigate sleep problems. CHO produces serontonin – a precursor to melatonin, the hormone important for sleep and including a substantial amount of your CHO in evening meal can help reduce sleep problems. While some people have heard protein aids in sleep, in fact protein increases cortisol production and therefore (as they are competing hormones) melatonin production is reduced. Choosing cuts of meat from the bone that are higher in natural fats and reducing protein portion in the evening could help here. Gelatin (naturally found in these cuts) can also help with promoting the onset of sleep as it’s rich in glycine, not found when you remove fat from meat and just eat the lean protein portion. In addition, the higher protein breakfast option helps reset cortisol production (which ideally would peak in the morning and decrease across the course of the day).

Like I said, not a definitive list of potential issues OR solutions, just a few that you might find useful. I would recommend sitting down with a doctor or health practitioner to delve further into solutions in order to restore your energy if there are underlying issues at play. I will add though that sometimes just increasing your CHO intake will mitigate many of these – particularly if there is no specific health or athletic reason for being as low CHO as you might currently be. If all you have done is cut CHO without much thought to daily amounts, just monitoring it for a week or so could give you an idea if you are restricting more than necessary. CHO isn’t evil that must be avoided at all costs. That’s more the processed, refined food-like substances that fill supermarket trolleys on a weekly basis.