Coffee: your friend or foe?

Coffee. It’s like the world’s favourite elixir. Mine included. For an athlete, there are many studies supporting its use as an ergogenic aid for athletes – helping reduce rates of perceived pain and effort, improving muscle fibre recruitment and enhancing glycogen repletion post-workout. These benefits are individual, however, and while research suggests that genetic differences in our ability to detoxify caffeine could account for this, it is not a universal finding. This is something true for athletes and non-athletes alike.

Other features of coffee are also salient for all individuals. Caffeine is ketogenic; not only can it help mobilise fatty acids to be used for energy, it increases the presence of ketones in the bloodstream – hence it is a good pre-workout fuel to help elicit fatty acid oxidation pathways and provide fuel for the workout in the absence of glucose. This doesn’t necessarily translate in additional body fat loss (more important lifestyle strategies are required for that, such as a caloric deficit, resistance training, reduction in stress etc), but can encourage these energy pathways to be upregulated, helping in the process of becoming adapted to a lower carb dietary approach.

Coffee improves insulin sensitivity and glucose tolerance (potentially related to the polyphenols present, though the mechanism is currently unclear), therefore enhancing the effects of both a lower carb approach, or a plan that includes fasting (either intermittent fasting, super-fasting, or a 5:2 approach such as the one in my fat-loss plans). Further, anyone doing my accelerated fat loss plans who have that 16h intermittent fast on the ‘fasting mimicking’ days could experience a more potent effect from the fast by including black coffee alongside water as their beverages of choice.

Autophagy, where our body starts to clear out damaged cells from the liver, heart and muscle tissue, is one of the benefits of fasting as you know. In mice models it might take just 16 hours for this to occur, in humans it is likely to take a lot longer given the differences in our metabolic rate (a mouse has a faster metabolism). Consuming caffeine on an empty stomach (or as part of a fast) promotes autophagy, which theoretically would shorten the time that is required to fast to stimulate this process. It also triggers AMPK, an enzyme that inhibits fat storage, promotes fat burning and activates antioxidant networks. These properties are thought to underpin much of the purported health benefits of drinking coffee.

It IS a balance though – if you’re following a fasting protocol, working out, and reading this at 3.30am in the morning, it’s a good sign that your brain is wired – raising cortisol to the extent that it’s (quite obviously) disrupting sleep. When we fast, like exercise, it places a stress on the body – this is where many benefits come from, as your body responds and adapts, becoming more resilient. However, too much of anything is too much! If coffee on top of your fasting regime or exercise program (or, life in general) is causing this stress response, then it is worth dialling it back a bit (or go 1/2 and 1/2 with decaf) to see if this changes your stress response.

Caffeine (or coffee), though, may not be good for anyone with gut issues. As it can stimulate the stomach cells to release more gastric juices, aiding in digestion, we often hear that too much coffee promotes a highly acidic environment and as such, could increase the risk of damage to the cells and subsequent gut issues. The literature, though, reports that caffeine does not negatively impact gastric or duodenal ulcers, and in fact when administered in vitro, could help repair cells damaged by inflammatory bowel conditions such as ulcerative colitis, and is also protective for the mucosal layer of the gut. Research suggests this is because caffeine increases blood flow to the gastrointestinal tract. Conversely, caffeine can lower the tone of the oesophageal sphincter – the valve that controls the release of stomach acid into the oesophagus, thus may promote heartburn and reflux.

With all research studies, it’s important to remember you are your own best investigator when it comes to how coffee affects you. I’ve said this before, but a good point to reiterate. The best advice, then, is to pay attention to how you feel when you drink coffee. Does drinking coffee make you more wired, especially when you fast, indicating it stimulates your stress (or cortisol) response? Does it give you reflux or heartburn? Does it upset your digestive tract more than settle it? Everyone has a different tolerance level to coffee, and further, our ability to detoxify it may also be different. If you feel great when you have coffee, and you don’t have any gut-related issues, then it is likely absolutely fine for you. If you notice an irritated gut, or you feel a bit wired, then it isn’t worth persevering with coffee for the purported health benefits – in your case, it might be making things worse.

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Ahhh… coffee 🙂

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.

Time restricted eating: when you eat matters

Intermittent fasting is an increasingly popular phenomenon among people wishing to improve their body composition and their overall health – almost as much as consuming the latest superfood.

Intermittent fasting (or time restricted eating, as it is known in the scientific literature) is when we restrict our eating during the day to a window of from around 8 hours to 12 hours, and has been popularised by the fitness industry in recent years. There are different ways to approach it, though from a health perspective, eating earlier in the day to allow for the feeding to align with our body’s circadian rhythm may optimise the health benefits for overall longevity. Fasting has been a practice undertaken for centuries in some cultures, and research reports favourable effects on many markers of metabolic health, including blood lipid profile, blood glucose metabolism and hypertension when these populations have been studied. More recently, researchers have investigated different time restricted feeding protocols in relation to risk of cardiovascular disease, neurological disorders, diabetes and some cancers using rodent and human trials. The longer time spent fasting may have pronounced health benefits, though recently a more conservative method (of even an 11 hour fast) has emerged as being beneficial for certain populations. Indeed, time restricted eating is being thought of as an easy to implement, effective lifestyle intervention that could help improve appetite control, markers of overweight, inflammation, blood glucose metabolism and hypertension, all reducing risk of cardiovascular disease, diabetes and some cancers. This recent small study found that late night (or prolonged eating periods) increased fasting glucose, blood triglycerides, insulin and weight gain.

When healthy adults eat meals that are identical in terms of macronutrients (ie carbohydrates, proteins and fats) and caloric load at breakfast, lunch and dinner, the postprandial (ie. after eating) glucose response to the meal is lowest after breakfast and highest after dinner, even though the meal is identical. This is one example which suggests that our metabolism, and response to food, changes across the course of the day (see here). We are diurnal creatures – we do most of our activities during the day (including eating, working, exercising) and we rest at night. This is controlled by our internal clock in the brain, the superchiasmatic nucleus (or SCN) which in turn influences smaller internal clocks (or oscillators) in the peripheral tissues of our body. These clocks control thousands of genes within our body, including those that regulate our metabolic processes, which accounts for around 10% of our entire genome. While light is the major cue for the SCN in our brain, timing of food intake influences the circadian rhythm in the other tissues, including the liver, which has implications for metabolism. This tells us that our basic metabolic physiology is supposed to behave differently according to the time of day – this is everything from making neurotransmitters, to making insulin, to glucose transport inside of cells, to fatty acid oxidation and repairing cellular damage. It makes sense then that when we eat has just as important implications for our health as what we eat. Research investigating the health effects of fasting has found that anything that breaks the fast will break the fasting period, including no calorie options such as black coffee and even herbal teas. This is because there are compounds within these fluids that require breaking down by the liver. That is not to say that people don’t experience benefits from fasting if they consume a hot beverage earlier in the day (as is often recommended to help get through the morning hours and comply with a 16:8 protocol) or limited calories (for example, 50 calories), however longevity benefits may well lie within the strictest definition of fasting.

With the advent of artificial light, and the changing structure of work schedules (combined with the increasing busy-ness of everyday life), this has elongated the period of time that people eat, which has negative health consequences. While you may have heard in media reports of scientific studies that eating late at night makes no difference to overall weight loss, the focus on weight ignores the more important, underlying metabolic and chronic disease risk that eating late into the evening can have on health outcomes. It may be easier to regulate appetite too, as  research suggests that appetite hormones respond more favourably to eating earlier (8am to 7pm) than later (noon – 11pm), and the level of satiety achieved with this could prevent overeating. This is relevant with time restricted feeding as research has shown that more frequent eating patterns can be detrimental to metabolic health if consumed close together. One study found that participants who ate excess calories consuming their food over three meals and three snacks had increased visceral (stomach) fat deposition, liver triglycerides and lower liver insulin sensitivity compared to those consuming the same number of calories over three meals. The snacks were consumed later in the day, and after each meal, so elongated the overall eating period.

Animals limited to 9-12 hours feeding period, but not limited in the number of calories they eat have experienced benefits including decreased fat mass, increased lean muscle mass, improved glucose tolerance and blood lipid profile, reduced inflammation, higher volume of mitochondria (the energy powerhouse of our body), protection from fatty liver and obesity, and a more favourable gene expression. In humans, research studies suggest that eating within a time restricted window of 11 hours (say, 7am to 6pm) is associated with a reduction in breast cancer risk and occurrence by as much as 36%. Earlier eating time has resulted in more effective weight loss in overfat people, and every 3 hour increase in fasting duration was linked with 20% reduced odds of having an elevated glycated haemoglobin (HbA1c), a marker of long term blood sugar control. For every 10% increase in calories consumed after 5pm there was a 3% increase in c-reactive protein, a biomarker used to measure inflammation (the underlying process that, when elevated long term, can influence risk of diabetes, cardiovascular disease and some cancers). Finally, when meal times were constructed earlier in the day this resulted in a 10% decrease in c-reactive protein. Eating within a 12-hour window improved sleep and weight loss within an otherwise healthy population. You can see then, the myriad of potential benefits to eating within a time restricted eating – could it be worth trying to fit into your lifestyle? And if so, how to do it?

There are many different time restricted eating protocols to choose from – and the type of fast you choose to do really comes down to what works for you. The 16:8 protocol that seems to be most popular is a little aggressive for anyone new to fasting, and this may ultimately leave you feeling hungry, cranky, and vulnerable to overeating later in the day – undoing any potential health benefit that has been shown in the research. Indeed, many people I see that try this as their first experience report that they can successfully get to 11am or lunchtime without eating, but once they are home from work, no amount of food will keep them full, eating right up until bedtime.  My advice is to start a little more conservatively. Given that (in an ideal world), we sleep for 8 hours a night, not eating in the 3 hours leading up to bed time should be a good place to start for most people, thus it gives that 11 hours where some of the health benefits begin to be realised. From there, once adapted, you could try to push it out by an hour. While the most potent benefits occur with the strictest definition of fasting, the blood glucose and lipid improvements, along with fat loss can still occur in those whose definition of fasting refers to calories, not coffee and tea as mentioned above. That the benefits occur in the absence of caloric restriction is important to reiterate, however by restricting the eating period, many people also reduce overall caloric intake, which can further improve overall metabolic health and body composition. Fasting doesn’t appear to be something you must do every day to see the health benefits either, and even 3-4 days a week could be beneficial for metabolic health.

That said, this reduction in calories and extended time NOT eating may not be good for all, especially if your notice increased anxiety, sleeplessness or disruptions in hormone balance, so it is always best to proceed with caution. It would also be prudent for any individual with a health condition to discuss with their health professional before embarking on time restricted eating, especially the more aggressive protocols.

(PS I’ve got dates booked for Nelson, Wellington, Dunedin and Christchurch for my talk! Click here to find out more details, would love to see you 🙂 ).

clock

As with many things, it could be all about timing…