Jan’s story: a real food success story

When I met Jan, she had already lost 10kg through Jenny Craig but was super unhappy and hungry, experiencing bouts of hypoglycaemia (and used dates to help lift her blood sugars again, which would exacerbate the problem), had knee pain, was experiencing patterns of low mood and overall didn’t feel very good. Further, her HbA1c, measure of long-term blood sugar control, placed her in the pre-diabetic range (above 41 mmol/L). To my mind, this cut-off seems a little arbitrary. There really is nothing different between 40 and 42 mmol/L where one is ‘fine’ and healthy, and the other is ‘pre-diabetic’. Many GPs I talk to feel the same, but I digress.

We talked through her diet, which was a little like this:

  • Pre-breakfast: Cup of tea plus piece of fruit (off to do some work on the farm)
  • Breakfast: 2 eggs on toast with butter
  • Snacks: scroggin mix, fruit, rice crackers
  • Lunch: salad with greens with grated cheese and tomatoes
  • Dinner: standard kiwi dinner food, with some adjustments made thanks to Jenny Craig programme.

It certainly wasn’t a junk-food diet the way we understand ‘junk food’ to be, however it was low in protein with the balance of macronutrients geared towards higher carbohydrate choices: fruit, toast, dried fruit, rice crackers etc.

We talked through dietary changes and lifestyle changes, and I made several recommendations based on the information she provided and subsequent blood tests that she had conducted. The main shifts in her diet were to:

  • Anchor meals around protein, fibre and fat to stabilise blood sugar
  • Avoid snacking where possible
  • Removal of most carbohydrate (including fruit) to help lower her overall blood sugar level
  • Including raw apple cider vinegar around meals (to help with glycemic control)
  • Remove dairy (clinically I see many women in their late 40s and above benefit from removing dairy from their diet)
  • Supplementing with magnesium and chromium for blood sugar control, and supplements to help support her liver function
  • Slow cook meat wherever possible (to reduce the formation of advanced glycated end-products which are toxic, especially for someone with poor blood sugar control).

Over the course of the next 14 weeks, Jan has experienced the following:

  • Sleep has improved
  • Knees no longer sore when moving
  • Blood sugars have stabilised, no signs of hypoglycaemia
  • Mood has infinitely improved
  • Skin and hair are better
  • No cravings
  • Appetite is good, feels satisfied with food
  • Body composition changes: she has dropped 15 kg
  • HbA1c had dropped to 37 mmol/L (out of the ‘danger’ zone).

Importantly, her overall wellbeing is SO much better than it was. She sounds so much brighter on the phone, she feels so much better about herself and she has achieved so much. When we caught up two months ago at our previous appointment her weight had stabilised around 5 kg heavier than it is now, though she continued to notice body composition changes – her shape was changing but on the scales, it was the same. I see that frequently, and nothing is linear, of course. It can be weeks of plateauing on the scales before they shift. Is this a metabolic adaptation? Not sure. Usually it’s compliance to diet, though Jan had been consistent with her approach. Of course, there are things you can do to help move the needle a little bit if necessary, but sometimes it can just be a matter of waiting it out before the trend down continues. The key is to not be demotivated by this. Scales can be a good indicator of progress, but remember not to rely on them as the sole indicator. Luckily for Jan, she was experiencing the benefits of eating well every day, so even though the number on the scale hadn’t changed, she still felt good about her lifestyle change. Her husband has also benefited from her lifestyle change, dropping excess body fat by virtue of eating from the same food supply.

A typical day’s food intake for Jan now would be:

  • Breakfast: 2 eggs plus bacon and mushrooms
  • Lunch: salad, chicken, a boiled egg
  • Dinner: salmon, roast pumpkin and carrot and salad

OR

  • Breakfast: 3 scrambled eggs, tomatoes, spinach
  • Lunch: sushi (no rice), cabbage slaw
  • Dinner: butter chicken with cauliflower rice

If she feels like a sweet treat, she makes something like this Pete Evans nut bar, or mixes up some coconut yoghurt and frozen berries to make a sorbet-type dessert, and is completely satisfied. She was initially worried about my reaction to the nut bar, given it’s got some dried fruit in it, however she reiterated that she cut it into 30 pieces, froze it, and brings it out “not every day” to have with a coffee. Honestly, though, had she told me she ate it every day and got these physical and psychological benefits, then it is working for her regardless of what I think (in the context of an already stellar food intake). One food doesn’t make or break a diet.

She finds it is super easy for her to follow this way of eating and eating out or with other people is not an issue. She asks for dressings for salads, and sauces for steaks on the side to control how much of these she has, and to help avoid hidden added sugar or industrial seed oils that are commonly found in these foods. She is ‘busy’ but not overly active, and we are working on getting her resistance training up to help protect her bones AND increase muscle mass. These two things will help her overall health and prevent sarcopenia in later years. We are starting with home based activities for this. While she could have started this earlier, it’s sometimes easier to focus on one health behaviour and bring the others in – everyone is different though; so this needs to be considered on a case-by-case basis.

One thing she does find interesting is other people’s reaction to her weight loss, with some people asking when she will stop doing what she’s doing (as if it is a ‘diet’, which Jan isn’t on), or saying that she is getting ‘too thin.’ This regularly happens when someone loses weight and gains health; people are used to seeing a different version of them. To deviate from this can be unsettling. For others, they subconsciously take the actions of someone like Jan personally, like she (who is adopting the improved health behaviour) is doing it to highlight some failing of their own. While that might seem ego-centric of them, I don’t think it’s on purpose for most people! These people are often good friends and want to see you succeed. The important thing for Jan in this instance is to not take on board what others say and stay confident and strong in her approach.

So that’s Jan. Awesome, huh? She’s booked a holiday too – something she said she wouldn’t have contemplated previously. This has less to do with her weight (though certainly she can move around much more freely) but more about the increase in overall wellbeing that has occurred through adopting these changes. It makes me feel so privileged to work with people like Jan and share in their success. While I gave Jan the tools to guide her, the hard work was up to her. If you’re in a position to do the same, click here to set up an appointment, or check out my online nutrition coaching options here.

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Delicious food! (PC: runningcompetitor.com)

Trouble shifting body fat? Two solutions (which are free! And simple).

Lots of good things happen when you eat well (and by well, I mean forgoing the advice of the dietary guidelines and following a less processed, more whole food kind of approach). Your sleep can improve, your skin clears up, your eyes sparkle with an increase in vitality and that brain fog you were struggling with for years (it’s just age!) has cleared. Your concentration levels are second to none.

But your weight isn’t budging. And you’re frustrated as hell. I get it. I talk to many clients and online coaching members about this. If all other aspects of your health improve with the change in diet and lifestyle, then by default, excess body fat should begin to shift. But, unsurprisingly, not for everyone*.

What,then, are two diet ‘hacks’ that could help you push through the weight loss stall?  Well it could be pretty simple, actually. You could either eat more, or eat less.

Eat more

If you are consistently trying to eat fewer calories, this can backfire on you – over an extended period of time this will break down muscle tissue and reduce overall metabolic rate, sending signals to your hypothalamus to shut down all unnecessary metabolic processes as energy needs to be preserved. In this context, the last thing your body wants to do is shift body fat. This is something that the physique athletes (such as bodybuilders) have known for years and often use a ‘refeeding’ period (of more calories or carbohydrates in one or more meals per week) that sends a message to the hypothalamus assuring it that there is enough calories coming in that it doesn’t need to slow anything down, or shut any processes off. While this is used a lot anecdotally, in research we see an increase in the hormone leptin with an increase of carbohydrate calories during periodic overfeeding, though the metabolic changes are modest at best. Despite lack of scientific verification, I’ve seen many weight loss stalls broken through once calorie cycling is introduced (and overfeeding, something I term a metabolic reset meal – I should really ™ that one).

Some options could be to:

  1. Include a meal based around kumara or potato, and make it a large one (for example, jacket potato with taco mince for dinner.
  2. Have dessert – it doesn’t have to be processed, refined carbohydrate if you don’t want it to be (though it can be! 90/10 and all that…) How about a fruit crumble or real banana icecream made with frozen banana and coconut cream?
  3. Eat whatever you want, one meal a week – this isn’t a license to binge, but rather a recognition that it’s what you do typically that makes the overall difference – one meal is neither here nor there, really. Have McDonalds if you really want to (not judging or anything, though I can’t imagine why you’d want to.)

Your body responds well to changes in energy flux – consuming a higher number of calories on days where you expend more energy (ie a high energy flux) will encourage hormone signalling in your body that allows for more lean tissue to be laid down, and is great for bone health.

Eat less

Conversely, if you’re eating too many calories on every day of the week, then you’re…eating too much. I know, can it really be that simple? Think about it: you’ve changed the types of foods you’re eating, and this has equated to better appetite regulation so you’re no longer eating because of insulin surges and blood sugar crashes. However you may still be in the habit of eating a certain amount of food which could be preventing you from dropping body fat. If you’re following a low carbohydrate, higher fat approach as a means to lose weight, a common mistake is that people eat too much fat. Don’t forget that you want to utilise some of those calories stored on your body, and part of the ‘HF’ of LCHF should come from this reserve rather than be provided by the diet. You don’t need to count calories to do this, either. It might be as simple as:

  1. Dropping out one or more snacks (if you’re in the habit of snacking) –those nuts mid-morning, the bier stick mid afternoon or the 70% cocoa chocolate at night. What is the worst that can happen? You’ll feel hungry, likely. This doesn’t mean you need the calories, it’s more likely your body’s used to eating at that time, therefore it’s anticipating a feeding period and releasing ghrelin (our ‘hungry’ hormone) because of this. It will pass. Have a drink of sparkling water and brush your teeth instead.
  2. Dropping the fat content on days you aren’t as active – this is an easy way to drop calories (thus cycling calories) – but without the feeling that you’re depriving yourself. I’m not suggesting you use products that have had their fat removed (ie trim milk), but don’t use as much added fat as you normally might on the days where energy expenditure is lower. Forgo the almond butter on your cottage cheese and berries for breakfast, omit the nuts that you’d normally add to your lunchtime salad, or serve salmon with the skin on at dinner with steamed vegetables rather than creamed or roasted ones. If you are hungrier, then up the amount of protein you consume on these days by about a third per meal (as we know that this will likely benefit body composition). This won’t make up for the number of calories you’ve saved by making these small changes.
  3. Experiment with fasting. You’ve got nothing to lose with this one and, if you do it in a way that is sustainable for your lifestyle, then you’ll naturally drop body fat with little effort. I know many people are afraid to fast for the additional stress it might place on their body. To be honest, I think there’s almost been a disservice to our stress response – we hear so often of how everyone is ‘too stressed’ and while this is true, I speak to many people who are now too afraid to exercise due to the metabolic damage they could incur due to their already stressed state. Stress is really healthy for the body – it adapts and becomes more resilient. Fasting is a type of stressor (and I’ve written about it in more detail here) and it might be the thing you need to kick your fat loss into gear. You may have more to gain from a 5:2 protocol, where your normal food intake is cut by a third on two (non-consecutive) days of the week. You may wish for this to be one meal or two smaller meals. Go easy on the activity on these days (and time your workouts to be before your larger meal), and when you do eat, make them protein and vegetable based – the caloric restriction doesn’t allow for a large fat intake, and protein will be more satiating anyway. I suggest not doing back to back calorie-restricted days- you may eat slightly more food the day after the fast (or not, it’s quite individual) and if you fast for a second day after a refeed meal, this could put you in a bit of a hungry/hangry spin.

So, these are just a couple of things you could try. Of course, there may be more going on that is preventing you from shifting fat, and that’s where talking to a professional can help. But if you’ve not tried either of the above, then give it a whirl. For a good 4-6 weeks I think. Your body needs time to adjust to a change in environment.

* Now I don’t use scales in my clinic, nor make it a blanket recommendation for people to do so as their measure of fat loss. How your clothes fit, your waist measurement, what you see in the mirror –these are far more accurate ways of assessing changes in body composition. In saying that though, some are motivated by what the scales say and if they can remove their perception of self-worth from the number on the scales, then it’s not a problem. In addition, some find them a very useful monitoring tool and can keep on target if they use scales daily – research does support the daily use of scales for helping people reach their body composition goals.

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PC: eatTV.com

Diet and body composition: 11 key take home points

The International Society of Sports Nutrition just released a position stand that reviewed the literature available regarding diet and body composition. You can read it here.  For those who want it broken down into more simple terms, I’ve distilled it somewhat into 11 key take home points. While much of this draws on literature from strength and power athletes, it is definitely applicable to the general audience too, given that resistance-based training is one of the best things you can do to support your health and body composition goals.

  1. There is a vast multitude of diets and within these, several subtypes of diet. Low fat, low carb, higher protein, Mediterranean, low calorie… and these will all work work to reduce body fat given the right conditions. As a practitioner, we need to be familiar of the evidence supporting each diet type to make informed recommendations to the people we interact with, both at an individual and population level. As someone who is interested in losing body fat, know that no ONE diet is going to suit everyone, and if you’re trying to follow something because your mate is too, but you’re not seeing the results, then potentially it’s not the right plan for you. Seems simple when I write it down – but I think important to remind you.
  2. All body composition assessment methods have strengths and limitations. It’s good to bear in mind the limitations of using just scales as the only indicator, as this doesn’t account for fat mass loss. I’ve had numerous clients basically freak out that they have gained a kilogram overnight because they’ve eaten something high in carbs (causing your body to hold water) or they have done a hard training session (inflamed tissue). It is impossible to gain kilo of fat over a week, let alone a night, but the obsession with scales can make even the most rational person a little … less rational. Thus, if you use the scales, then think about how this makes you feel. And do it at the same time each week, on waking, after you go to the bathroom – etc. IE try to make it consistent. Ditto re: skinfolds – choose a practitioner who is skilled and stick to the same person so any errors are at least consistent errors.
  3. While it’s not about ‘calories in, calories out’, as that is far too simplistic, we do need to create a deficit in calories to drop body fat. Don’t freak out by the next bit of (evidence-backed, science-informed) information: The more fat you’ve got stored, the quicker you can lose this body fat without losing too much muscle mass by creating a large calorie deficit. The leaner an individual is, it is better if the caloric deficit isn’t as dramatic, to help preserve muscle mass. We can use calorie cycling to do this (ie higher calories for some days, lower for others across the course of 7-14 days, such as the 5:2 approach), or a consistently lower calorie approach, whatever fits in with the individual and their adherence. This study found that working on a weekly reduction of 0.7% of body weight better than 1.4% for preservation of lean muscle tissue.
  4. A wide range of dietary approaches (low-fat to low-carbohydrate/ketogenic, and all points between) can be similarly effective for improving body composition, and this allows flexibility with programme design, which is great – again, there is no one right approach for everyone. AND there is no one approach that will suit the same individual all the time – context, physical activity, stress, budget etc will all affect the suitability of an eating style that will improve body composition. This in part could explain why Weight Watchers, which helped you drop weight in the past, is not working now – regardless of how many points you are under at the end of the day/week. Being flexible rather than dogmatic will go a long way to finding a plan that suits you. I will also add, however, that something based on minimally processed food contains more nutrients – this will nourish your body and provide nutrients to ensure metabolism, brain and gut health are optimised while shifting excess body fat.
  5. When protein amounts are matched in the diet, there doesn’t appear to be an approach that reports a meaningful reduction of fat when we look at different macronutrient composition. All are as effective as each other – it’s sustainability which is the factor to consider. If an individual is insulin sensitive, research shows they are going to be able to lose weight on a moderate carbohydrate diet and potentially perform better on that than a lower carbohydrate diet. The reverse is also true. In addition, when adding resistance training to the mix, in some instances insulin sensitivity is improved. Therefore, knowing your metabolic health markers initially can help you determine what dietary approach might work for you.
  6. However, a ketogenic diet has been shown to have appetite-suppressing potential in part due to its effects on our appetite hormones (as explained in this review), resulting in a spontaneous caloric restriction. That said, for some this may only happen initially and clinically I have seen that this affect appears to wear off. (Note, this is my clinical observation).
  7. Increasing dietary protein to levels significantly beyond current recommendations for athletic populations (up to 2g/kg body weight) may improve body composition as in line with the ISSN’s position stand. It is also much more satiating for those of us who aren’t athletes, particularly in a restricted calorie state (as I’ve discussed here). There is also evidence that increasing protein in the diet beyond 3g/kg body weight and creating a calorie surplus can increase muscle mass and decrease fat mass simultaneously- I know! It’s like magic! Except very difficult to eat that much protein for a lot of people.
  8. Time-restricted feeding (which I’ve written about here) combined with resistance training is an emerging area of research that has thus far shown mixed results with respect to body composition (ie see here and here, however eating within that restricted window does allow for improvements in metabolic health. Much like cycling calories, the window of time that people choose to eat should be based on individual preference in a way that is easy to be sustained in everyday life. There is more to gain from having a good resistance-based training programme and adequate protein (in the context of an awesome diet) than worrying if your eating window is 8 hours a day or 9 hours a day.
  9. Do we starve our metabolism, thus slow it down and lead to fat gain if we restrict calories too much? Only in the context of a restrictive caloric diet and in the absence of resistance training where muscle mass has reduced, and energy expenditure has reduced. This can be mitigated when these are accounted for (see here and here).
  10. In addition to this, clinically what seems to work well is having a metabolic reset meal, where more fat/carb calories are consumed (which some might call a ‘treat’ or ‘cheat’ meal, particularly in the fitness industry) – this might be 1-2 meals every 7-14 days depending on the individual and their goals.
  11. There needs to be more research on women, older adults
  12. There needs to be more research on meal frequency and timing combined with different caloric loads, and with different training regimes.

Despite all of the above, a member of my online nutrition coaching system shared with me her experience with improving overall health (and metabolic markers – prior to embarking on her regime her HbA1c was in ‘pre-diabetic’ range). She found focusing on a higher fat approach, coupled with water fasting helps her control her insulin resistance and overall health much more than focusing on protein intake. While a few years ago this would have set alarm bells ringing in my head, the longer I’m in the game the more I understand that it is so individual as to how someone will respond to a dietary approach. Being willing to experiment with different protocols will help you figure out what works best for you regardless of the research papers.