Exercise for longevity – is there a best approach?

The older I get, the more I am interested in the effects of ageing on our overall health span. Ageing is unavoidable, it happens to the best of us. Listed below are some of the physiological and biological changes that can occur the older we become:

  1. Insulin resistance – this is in healthy weight older adults also, with research showing there is more peripheral insulin resistance compared to a younger population (an inability to dispose of glucose into the tissue).
  2. Decreased availability of anabolic hormones, and increased frailty with lower levels of hormones
  3. Increased anabolic resistance, so not only is there a decrease in the hormones that signal tissue growth, the muscle tissue is less responsive to the stimulus of amino acids (protein) and exercise, and there is less muscle protein synthesis in comparison to breakdown.
  4. Greater protein requirements for the same relative gains in muscle, strength and function compared to a younger population
  5. Decreased motor neuron function, therefore less neural signalling to muscle tissues and reduced motor function.
  6. Increased intracellular oxidative stress, causing inflammation and reduced cell functioning
  7. Reduction in satellite (stem) cells numbers and regenerative capacity – these cells are essential for the maintenance and repair tissues in normal physiological processes or in response to muscle damage/trauma.
  8. Elevated myostatin signalling, a protein that blocks our ability to build muscle
  9. Increased chronic inflammation (also known as inflamm-aging)
  10. Changes in autophagy, where ageing reduces our ability to clear out damaged DNA
  11. Mitochondrial functioning abnormalities, where we can’t utilise energy metabolites as effectively to fuel mitochondria
  12. Reduced ability to be physically active (due to many of the reasons listed above)

Clearly, these are not all inevitable. However, it is a long, daunting, and rather depressing list of what can occur as we age – and we are an ageing population. There is no doubt that if we don’t look after this body we have got, then we really are staring down the barrel of a loaded gun.

The list above describes many of the mechanisms to explain the loss of muscle mass and function. It’s not about being ripped or having gainz, it’s about having proper functioning of the muscle so it can work effectively in our older years – this is what is shown to have the most positive impact on our cardiovascular, neurological and musculoskeletal systems.

Inactivity is the broader environmental issue that contributes substantially to the physiological issues I have mentioned above. We need to be active – in everyday life, and with some structured activity too. Hanging out washing and housework isn’t going to cut it, I’m afraid. I see a lot of people who have this idea that you don’t need to exercise in order to lose weight, and you can do it solely on diet alone. This is true, of course, but when you embark on any weight loss plan that restricts calories (i.e. any weight loss plan that is out there), then you will lose both fat weight and muscle mass – lowering your overall metabolic rate along with it. This is one of the reasons why weight regain is so prevalent. However the powerful combination of diet plus exercise helps sustainable weight loss. And exercise isn’t just moving around the house, doing chores – this should just be part of everyday living. Data looking at the effects of exercise show that resistance training confers benefits over and above what we would see if we were just doing 30 minutes of cardio-based exercise per day, something that many of us maintain, but it doesn’t offer the same benefits.

The right type and duration of exercise:

The challenge is to get people exercising. And this is especially so for those who read what I have said above, and think that – on top of 30 minutes of aerobic training they don’t have time to do, they need to then put some resistance (or weight) training in.

This is not a call to encourage you to find an additional 3 hours in your week, though. In fact, a study that is about to be published (I heard about it on STEM talk) suggests that just 72 minutes a week in total is enough to help many of the conditions associated with ageing and poor health that I’ve mentioned above. Egan and colleagues found a combination of both resistance and cardiovascular exercise in a circuit-type setting for adults over 65 years just three times a week for 24 minutes increased walking speed, leg strength and reduced trunk fat. These measures speak to better muscular function, obviously increased strength, and will help reduce metabolic health risk. The improvements were more potent in this combined group than either resistance training or aerobic training for the same duration. It wasn’t olymic lifting from the sounds of it,  but it also wasn’t lifting pink dumbbells, either.

So this was a very long preamble to the main message: if you are currently NOT exercising, then please start. While there are modalities that are better than others, seriously, anything will be better than nothing. The study I talked about is in older adults, you likely don’t need me to tell you that any age you start is obviously better than not starting at all. AND the earlier you start, the better the overall health outcomes.

There is often an argument as to which is best; exercise or diet for improving health. That’s a weird argument to my mind. Both are important and should be prioritised if you want more life in the years you’ve got left.

stronger-effect-of-resistance-training-when-combined-with-protein-supplementation

One of the only pics I could find that didn’t involve pink dumbbells. (PC: https://www.frieslandcampinainstitute.com/)

Does HIIT take a hit on a ketogenic diet?

Much of the research points to the utility of a keto diet for increasing fat oxidation for longer, slower training. After a period of adaptation, athletes are then able to tap into an alternative fuel source which affords them an extensive supply of fuel at a steady rate, unlike carbohydrate (glycogen) stores which are limited and easily depleted in a moderate-long training session. Thus, it stands to reason athletes are able to go for longer than if they are straight carb-burning athletes in an endurance event – something that Maunder and colleagues discuss in this most recent paper outlining the practical application of a low carbohydrate diet for athletes of varying abilities. However many of the recent randomized trials (such as this one here) have found that performance, particularly at the top-end of the spectrum, is compromised when athletes switch to a lower carbohydrate approach. Further, the relative effort at a given heart rate is increased. You go slower, but it feels harder. Ouch. This understandably makes an athlete’s coache a little nervous to recommend their athletes go on a lower carbohydrate diet.

Interesting though, this is not the experience of many people I work with who transition to a lower carb diet. If anything, performance improves for the athlete (something I’ve written a lot about over the last few years, including this blog here). Given enough time, any reduction in power that occurs early in the transition phase appears to be reversed and the athlete comes out leaner, stronger and fitter in their endurance training. Reducing reliance on carbohydrate as a training fuel reduces the oxidative damage that occurs during training, thus inflammation is reduced. They aren’t placing their body under as much oxidative stress and therefore the athlete can train more consistently during the season with less risk of stress-related injury and illness. This may also be due to a higher presence of beta hydroxybutyrate in the bloodstream, which act as signalling molecules and increase the transcription of enzymes that encode antioxidant genes superoxide dismutase, catalase 2 and glutathione peroxidase. This helps scavenge free radicals created through training and protects the athlete from tissue damage. This may be one of the reasons why they are seeing better results with their key races.

Two of my mates felt similarly, and experienced similar benefits of adhering to a low carbohydrate diet, experiencing no detriment to high intensity training, despite what the research deemed. So they decided to test the hypothesis.

They took 18 male endurance athletes who were habitually eating a standard western diet, and randomised them to consume either their normal diet (control group), or a very low carbohydrate ketogenic diet, consisting of no more than 50g carbs per day for four weeks, and performed graded exercise tests before and after the experiment, and a HIIT session (5x3min, work/rest 2:1, passive recovery, total time 34min) before, and after 2 and 4 weeks.

The researchers found that (as expected) fat oxidation levels increased in the experimental group throughout the tests, and total time to exhaustion, performance in the HIIT session and rate of perceived exertion was no different between the groups. Ergo, the ketogenic diet did not impact the athlete’s ability to undergo high intensity training (nor make it seem harder for them). Interestingly, the level of protein in the diet was around 29%, higher than the 17% used in other studies – this could account for the level of ketones present in the blood stream that were lower at the end of the study (0.4 mmol/L), just out of the ‘nutritional ketosis’ range. The difference this may have made to the athletes’ performance, however, we don’t really know.

Many of the studies conducted that have found performance is reduced are likely too short to allow the athletes to adapt to a ketogenic diet, which is thought to take several weeks to months. Hopefully this new research makes you think twice about taking the results of a study like such as the one here, as a reason to dismiss the low carbohydrate diet for athletes.

To recap, then, of what we know is possible for athletes following a lower carbohydrate approach:

As a side note, lots of peeps look at the elite athlete who chows down on carbohydrate in racing and during everyday life and thinks to themselves that, if they can perform to that standard eating a higher carb approach, then why can’t I? A couple of points to note:

  • The elite athlete may train from 20-30 hours per week – by default they spend a lot of time in a depleted state, meaning they are likely training low glycogen as it is impossible to replenish carbohydrate at the rate they are burning it. This is going to afford them the same capacity to train in the lower carb state that provides enhanced training adaptations. The average age grouper may have time to train 12-18h a week maximum, and don’t have the volume available to get into the low glycogen state.
  • They are elite for a reason. They are able to go harder and faster than most people –psychologically they are able to hurt more and potentially go longer before they bonk – we age-groupers have more of a preservation mindset. They may also be able to train harder when in an inflamed state for this reason. I’m not saying this is ideal (far from it). I’m just putting it out there as a reason why there are professionals who are able to see results where others don’t.
  • Even at the top of the field the elite athlete can suffer, and far more than an age-grouper. Years of a nutrient-poor, carbohydrate rich diet and overreaching to the point of overtraining will leave an athlete burnt out and unable to continue on at the level they previously enjoyed. It might appear that elite athletes are bullet proof but I’m sure as you’re reading this you’re thinking of someone who falls into this category. Things aren’t always as they appear, and the golden glow of success can be pretty fleeting.
  • Of course, there are others who are just awesome and continue to turn up and take it out year after year, regardless of diet, training methods, lifestyle etc. Like the people who drink every day, smoke like a chimney and don’t eat vegetables, yet live to 102 years.
  • Re: racing high carbohydrate – that Maunder paper again – worth a read.

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Hungry?

One of the things that clients fear most is being hungry. When I talk to some of them about removing snacks and eating just three times a day (or 1-2 times, depending on their individual plan), there is a look of fear that comes into their eyes. For others, though, they almost relish the opportunity to feel hungry because it has been forever since they’ve felt the grumbling in their stomach that tells them they are ready for food. This doesn’t, however, mean that they never eat! But it does affect their enjoyment of food – and, let’s face it, food is not only fuel, but it is one of life’s pleasures. One that, for many, they’ve denied themselves the opportunity to experience.

Which camp do you fall into, why do you feel that way, and how do you change your mindset around hunger (if you need to?)

Why do you fear being hungry?

In my clinical experience there are two main reasons why people are scared to be hungry. Firstly, hunger is not actually just felt in your stomach, your entire being experiences it. If your hunger comes on suddenly and without warning (you go from feeling fine to being ravenous), if it changes your physical state (ie you start feeling light headed, lacking in energy, maybe even start sweating) and your emotional state (you feel irrationally angry, sad or conversely, on something of a high before a big energy crash), then our emotion around being hungry can be one of fear. No-one likes being shunted from one emotional state to another, particularly if it comes completely without warning, which is often the case in this type of scenario. The fear of over-eating in response to this physiological and emotional state is the second reason for being scared to be hungry. When they do finally get to eat, they don’t trust they will make good decisions around food, and thus starts a (sometimes perpetual) cycle of fear, eating, self-punishment, eating….

What gives? This kind of hunger isn’t hunger at all – it’s blood sugar. Whenever we eat too little, or too little of nutrients that regulate our appetite hormones (nutrients such as protein, fibre and fat) at a meal, it is going to cause our blood sugar to drop and – in some instances – drop too rapidly. This response from our blood sugar sends an alarm signal to our brain that we are in danger (or potential danger) of having no fuel on board. In evolutionary times, this could have meant almost certain death: we wouldn’t have fuel to either fight for our life or run for our life. There may be no sabre-tooth tigers lurking around in everyday life now, but our body’s genetic blueprint hasn’t changed in that regard. Those ringing alarm bells drive us to search for food and do it fast – hence the rapid change in our physical and emotional state. The type of food our brain tells us to seek out is that which is going to deliver quick energy – sweet or starchy food. That is what will bring our blood sugar back to within normal range and get us out of the state of emergency our brain was experiencing. The problem is, though, is that the type of food we go for is the same as what got us into the blood sugar position in the first place.

No wonder you are scared to be hungry, and you feel you can’t trust yourself around food. While one option is to eat frequently (thus, almost to prevent being hungry), this isn’t the best approach. Every time you eat, you send signals to your body that you’ve taken on board fuel, therefore causing changes in your blood sugar levels and creating a hormonal environment that is more favourable to fat gain. In addition, it’s likely the types of food you are snacking on are those which created this blood sugar problem in the first instance (this is not your fault! We’ll blame the 80s-early 2000s for that, and the message to eat ‘six small meals a day’*). They may not be high in free sugar (ie ‘junk’ foods), but they could well be low in fat, fibre or protein, all potent regulators of our blood sugar. Cue the creation of the same problem as if you had just eaten a high sugar snack. Your body doesn’t know the difference without a good amount of the aforementioned nutrients to go alongside it.

If not ‘eat more often’, then what? Eat more but eat less often. The main driver of this is fluctuating blood sugar levels, therefore to combat this we need to fill up more at our meal times (be it 1, 2 or 3 times per day) to avoid a dramatic drop in them. The approach to eating I advise takes care of that for you. As I said, this physiological response is because you’ve eaten too little (or too little of the right** foods) in the first place. Your blood sugars won’t rise to the same extent, will be buffered by the additional protein, fibre and fat, so will decrease at a far slower rate, thus there will be no alarm bells ringing, and no stress response. Hunger will come on gradually (perhaps 4 hours after a meal) and, if you were called into a meeting, you would be able to concentrate on the situation at hand, rather than be distracted, irritated or hangry.

And what if you fall into the other camp, when you are never hungry? The main reason for this is often due to the first scenario – you are pre-emptively eating, thus never allowing yourself the opportunity to digest food and wait for your body to send signals to your brain that you are hungry. More often than not, this is because you are scared to be hungry (so, back to the first reason then). However, there is also another factor I see that impacts on appetite – and it is stress. If you are in an elevated state of ‘doing’, and are constantly on the move, stress hormones can suppress your appetite – therefore eating is somewhat of a chore, something that you feel you should do and therefore you don’t enjoy it. Conversely, you don’t eat which leads you to overeating later in the day when you are finally able to relax. Interestingly, a lot of clients report that, in both scenarios I have described, they continue to eat after having a normal (or larger) size meal because they are not satisfied.  This is usually despite the fact that physically they feel full, but emotionally they are somewhat empty. If you don’t take the time to enjoy your food (and it’s something you derive pleasure from) then no amount of additional food at this time is going to make you feel better. In fact, most people report feeling worse. Taking the time to sit down and enjoy your food helps you to listen to your body and eat when you are truly hungry.

*like anyone knew what six small meals a day were – most examples were enough to feed a 110 kg body builder, not a person trying to maintain a size they felt comfortable at.

**foods higher in protein, fibre, with added fat for satiety.

 

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This caterpillar was, in fact, very hungry. (PC: scholastic.com)

Overcoming stumbling blocks on a ketogenic diet: a case study

I had a client contact me for an email consultation this week. She was frustrated as, despite following a ketogenic diet (where carbs are restricted to 30g or below, over 70% of calories should come from fat, and protein is moderated), she was unable to get into ketosis.

I had a look at her food diary and could quite quickly see where I thought she could change things to help enhance her ketogenic approach. With her blessing, she’s allowed me to share this with a wider audience. Like many things, if one person is having challenges finding the right balance in their diet, there are likely many more people doing very similar things and potentially experiencing the same frustrations.  I focused on some of the main issues I saw.

You’ll notice there are foods that don’t align with ketogenic diets OR would be included in any diet for someone wanting to shed fat. We (the client and I) spoke on that in general, as clearly she knows this (i.e. cheesecake). The points I focused on were those that can trip people up that she might not be aware of. I’ve screenshot her food diary, and then my comments are below.

Her diet:

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Major points – unable to get into ketosis despite sticking to under 30g carbohydrate per day. This is measured by a blood ketone meter, and she wondered if she needed to add more fat to do this. Her overall goal is weight loss.

The thing with weight loss and the ketogenic diet, if you follow the advice from Phinney and Volek, pioneers of the ketogenic diet space, part of the energy your body needs to consume should come from your own fat stores, and not be provided for by diet. It’s a common misconception, as I see many people embark on a ketogenic diet for fat loss purposes but the opposite occurs – they gain weight. A common strategy at this point is to further reduce carbohydrate intake and bump up the fat. However, this will often further exacerbate weight gain (and frustration around the approach). Worst case scenario here is when the frustration leads to ‘to hell with it’ and that low carb diet is supplemented with all manner of processed refined carb junk food because ‘what’s the point? I can’t do this anyway, I’m useless and it’s not working for me.’ Clearly the end result of this self-punishment is further fat gain, some horrible carb cravings and a bad psychological state. Needless to say, I don’t think adding in more fat is the answer in this instance (and for this client), however I do think that tweaking what she is already doing is going to help.

It’s also good to remember that blood ketones aren’t the be all and end all – these indicate ketones in your bloodstream but sometimes, when these are low, this just means we are using them for energy – which is what you want! This is more likely to be the case in an athlete rather than anyone who is generally just active. In this case example,  I think the diet is the main reason for her not being in ketosis, rather than that the client is using ketones efficiently. However,  it is worth remembering that if you are following a ketogenic diet and are not seeing the expected results on the blood ketone meter.

Finally (and something I mentioned to the client) you don’t need a ketogenic diet to successfully lose weight, and sometimes focusing instead on the pointers I give at the end, regardless of ketosis, will give the same end result. Something like my online menu planner and individualised nutrition coaching. However, I would recommend in that instance to up the protein (double the recommendation I give you) and drop back the fat intake, as people often find that far more satisfying and easier to adhere to – which ultimately is THE most important thing with any dietary approach.

Key issues I picked up:

  • Too much protein in one sitting/in general
  • Processed foods
  • Dairy
  • Unintentional free sugar

1.Milk –  both the sugar in a cup of milk and the protein (whey) will raise insulin levels, thus put you out of ketosis. This is true of skim and standard milk.

2. Protein cookies: the type of sweetener/fibre used to make it a lower carb item can also spike insulin. For some people it is definitely a dose response thing going on – they can eat ½ cookie no problem, but a whole one will kick them out of ketosis. For any items like these, and if you do have blood glucose or blood ketone meters, it can be good to get a reading after a certain dose to see what effect they have for you. At any rate, highly processed goods can still negatively impact on blood sugar and appetite regulation in the absence of them being carb-based.

3. Coconut water – contains 3g sugar per 100ml or thereabouts. Any amount of free sugar in the diet is going to impact pretty quickly on your blood sugar levels if you haven’t just finished exercising, and kick you out of ketosis. The types of carbs you want to be having in your diet are specifically non-starchy carbohydrates -the majority of any carb sources coming from green leafy vegetables, other colour vegetables, perhaps some pumpkin/carrot depending on their effects on your blood sugar.

4. Grapes: any fruit is going to impact on your blood sugar levels, and particularly grapes – even if you stick within your limit of carbohydrate, the sugar from these are going to hit your bloodstream pretty quickly and cause an insulin response, thereby lowering ketones, especially if eaten outside of a meal that contains fat and/or protein (both of which slow down the glucose from hitting the blood stream). Fruit is typically best avoided on a ketogenic diet, aside from lemons, grapefruit, some berries.

5. Protein content of meals: for most, these need to be lower unless an individual is athletic. If struggling with getting into ketosis, it can be good to lower protein consistently to 1g/kg ideal body weight. For this particular client, this is 65g per day. Many days are consistently above this. In addition, the amount of protein in any one meal makes a difference – ideally, not more than 30g protein in any one sitting and, for you, likely 20g in a meal. This is obviously going to differ from person to person – as mentioned, athletes who have a greater energy output can generally get away with more protein (and more carbohdyrate) compared to a person who is sedentary or just lightly active.

6. Timing of food: eating within a restricted window (and not eating later in the evening) can help a ketogenic diet – our liver’s ability to metabolise carbohydrate is dictated in part by a ciracadian rhythm;  we are naturally more carbohydrate sensitive in the AM, less so in the PM, so carbs are likely to spike insulin more in the evening. In addition, fasting naturally upregulates ketone production and can help accelerated ketosis. Further, snacking can (for some) keep them from being out of ketosis, so 3 meals, or 2 meals plus a snack is recommended.

Key recommendations:

1. Drop protein down in each of the meals so you are averaging approximately 20-25g at meals.

2. Time any foods that have a greater amount of carbohydrate in them for after exercise (ie lower sugar fruit, or nuts that have a higher carb count such as cashews). The body doesn’t need to rely on just the action of insulin to deliver carbohydrates to cells in this instance, as we have receptors called GLUT-4 receptors in our muscles and in adipose tissue that can take up carbohydate and are activated post-exercise. Remember, an increase in insulin suppresses the production of free fatty acids, the precursors to ketone bodies.

3. Engage in exercise to help upregulate ketone production – aerobic/weight training.

4. Fasting for 14h at a time to help body produce ketones. Now for women, fasting can be a great tool, but can also backfire (read more about that here). Generally speaking, the fasting approach can be something that is incorporated 1-2 x per week if fat loss is a goal, and on other days, opt for a 12h window between dinner one night and breakfast the next day. The most important thing, though, is to be aware of negative changes to energy, how you feel, mood and sleep patterns – all underlying signs of a stress response that you might not be able to cope with.

5. Focus on diet quality – so the carbs, protein, fats are coming from whole foods and not processed or snack foods – ie protein cookies, fat bombs etc

6. Remove drinks / foods that contain easily digested carbs even if they fall within the carb count for the day. You’ll feel far more satisfied (and it is far more nutritious) to get your carbohydrates from green leafy vegetables which also contains a good amount of fibre.

7. Dairy – stick to hard cheeses and forgo the softer cheese/milk.

These are just some pointers from this client’s diet; another practitioner may pick up others. I will reiterate my point, however, in that a ketogenic diet, when done purely for weight loss, isn’t always the best approach and, for alot of people, unsustainable and too much like hard work. If you’re struggling to get the balance right and not seeing the results, then there are definitely other alternatives out there – one which will fit your lifestyle, eating behaviour, budget and allow you to lose weight with far less effort. It’s adherence that is key. Let me help you with that.

Selection of healthy fat sources

Delicious, nutritious food regardless of your dietary approach.

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.