Will that high protein diet kill you?

After last Tuesday’s television show ‘how not to get cancer’ I got a number of concerned emails and Facebook messages from people questioning their protein intake. Specifically,  information that a high protein diet increases health risk and mortality. As a nutritionist who advocates a higher protein load, here’s what I’ve read about the role of protein and disease, as written by people much smarter than I am:

Information regarding health risks associated with a high protein intake has been critically reviewed by experts in the field, specifically the way the population dietary data from the National Health and Nutrition Examination Studies (NHANES) was analysed to determine that higher levels of protein increase overall health risk. The major criticisms were:

  • They eliminated half of the data points with no explanation;
  • Their definition of low protein (below 10%) should in fact be labelled as ‘inadequate protein’ as defined by the Institute of Medicine (IOM) protein ranges (10-35% of dietary energy), and in New Zealand adequate protein is 15-25% of energy in diet. The arbitrary cut-off used by the authors meant less than 450 people fell into the ‘low protein’ group;
  • The population data gathered dietary information via a single 24-hour diet recall once in an 18-year period; and
  • Body weight or body mass index (BMI) was not reported – given the clear association between excess body fat and chronic disease such as cancer, cardiovascular disease etc, this was a massive oversight.

While the paper outlined in the review also looked at laboratory trials, these were based on rodent studies and not clinical trials in humans. Differences in metabolic rate, the way we utilise nutrients and digestive tracts (the rodents more able to handle fibrous foods than ours) means that, despite interesting findings, we cannot conflate the findings here to humans, as they are not directly transferable.

Other points to note regarding research suggesting that a lower protein diet is good for longevity:

  • Many of the studies are based on rodent studies (not humans) and, in addition to what I posted above, the type of protein studied is typically casein – a dairy protein that has more potential to be inflammatory and one rodents are not naturally adapted to consume;
  • High amounts of dairy protein have been found to increase insulin, triglycerides and result in excess body fat compared to other sources of protein provided to the rodents;
  • Much of the research also show that it could be an effect of a high methionine intake which – when not balanced with other amino acids such as gelatin) for some people, can build up the amount of homocysteine (another amino acid) that increases risk of cardiovascular disease;
  • As we age, we are at greater risk of sarcopenia, dyopenia and poor health due to falls if we don’t have a decent amount of muscle mass, which requires protein to help lay down this muscle;
  • The majority of studies point to a higher protein intake being protective for quality of life as we age, not detrimental; and
  • We become more anabolic resistant as we age, meaning we are unable to lay down muscle the way we are when we are younger to the same extent. This could be as a result of both inactivity and lower levels of oestrogen and testosterone, meaning the a higher protein intake is required (in addition to resistance training).

And here is what I know regarding a low protein diet in the real-world setting:

  1. People are hungry. Women, especially, struggle to eat an appropriate amount of food when they restrict protein. This restriction (intentional or otherwise) leads to poor blood sugar control, poor appetite control and mood problems (either low mood or increased anxiety).
  2. People can only restrict for so long until it backfires. A lower protein intake might be totally fine on a Monday, things are okay on a Tuesday, but by Wednesday people are climbing the walls looking for something to eat. Or, for some, this process happens across the course of a day. This means that despite having a decent amount of food at dinner, the undereating of protein across the day leaves you standing in the kitchen at 8pm looking for something to eat and wondering why you are not hungry, but just ‘not satisfied’.
  3. Practically speaking, when you restrict protein, what is there left to eat? Carbohydrate. We eat until our minimum requirement for protein is filled and, in the absence of quality protein sources we will overeat on calories (specifically carbohydrate calories) until this requirement is met. For many, this results in poor nutrient status, poor blood sugar control and excess body fat. It’s these three things which have consistently been found to result in increased risk of metabolic disease and cancer, not the protein load.
  4. People (generally speaking) fare best when we base their meals around protein and then toggle the fat and carbohydrate around that, based on their body composition and their activity levels. For many, this is more than a palm sized serve at each meal, and across the course of the day, for most people, this is at least 100g of protein from foods that are quality protein foods. In New Zealand, we get most of our protein (according to the most recent nutrition survey – which is 10 years old, actually) from bread. Bread! Wheat derived protein is one of the lower quality sources we can eat, with the amino acids not being as easy to digest and assimilate as those from animal-based sources.

So, clinically I am not at all concerned about advocating a moderate-high protein load for most people, and the television show last Tuesday did nothing to change my view on it. A longevity diet approach which is low in protein looks promising for a week a few times a year to confer benefits of fasting related to lifespan, but in terms of a day-to-day diet it will likely leave you frail, hungry and irritable. There is not enough human data to show that this approach will lead to a longer life, but I gotta say, it doesn’t sound like an enjoyable way to live beyond 100 years. Most evidence points to muscle mass being extremely important as we age to maintain quality of life and health span. This requires adequate protein and resistance training. In the words of Robb Wolf (as said on a recent podcast), we need to “eat and move in a way that lays down as much muscle as we can now, and then fight like the devil to keep it”.

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A good source of protein, and pretty delicious (PC: healthline.com)

LCHF and the athlete: The Plews approach

Sfuels, a ketogenic fuel for endurance athletes recently had Dan Plews host a Facebook live event regarding his LCHF training and daily diet. Now those of you have listened to our Fitter Radio podcast will know Dan from the Plews and Prof segment. He’s an exercise physiologist who last year was the overall age group winner at Kona World Championships in a record time of 8:24. He’s been working in exercise physiology for the last 15 years and has a number of research papers both related to this, and in the ketogenic diet space (for athletes), one of which I posted about last year. Because I love Dan’s work (and this area in general) I wanted to outline for you what he spoke about in the Facebook live for those people, athlete or otherwise, that are interested. This week, due to length, I’ll cover the normal diet, and next week I’ll outline his pre-race and race-day strategy.

As a bit of background, Dan has been doing triathlon forever, however came into LCHF when he was at the Olympics as an exercise physiologist and came across work by Tim Noakes (who has heralded the latest Banting movement in South Africa). From 2012 he made a decision to give it a crack. Even now, though, six years after embarking on LCHF training and nutrition, Dan notes that adaptations are still occurring, and puts his incremental improvements in performance in the Ironman distance finishing times (in hours:minutes) being: 9:22, 9:11, 9:12, 8:54, 8:35 and 8.24 Kona 2018) down to not only the consistency of training , but the consistency of the dietary approach.

What is important in LCHF and endurance training? The end goal for performance is to conserve as much energy as possible – fuel availability is the limiting factor over such a long distance. We can’t store too much carbohydrate – around 2000 Calories compared to 40000 Calories of fat that is stored in even the leanest individuals. The problem, though, is that people can’t access their fat stores to exercise at a high intensity. Or even, for many endurance athletes, at a lower intensity (where we should be able to burn fat). The type of diet we eat influences our fuel preference when we exercise, and the modern diet (where carbohydrate is the predominant available nutrient) makes athletes much more reliant on carbohydrate which – like kindling on a fire – is likely to run out quickly.  We want to be metabolically flexible, that is, to burn more fat as a fuel source and only use carbohydrate when we really need it. Dan has tested his fuel utilisation in a laboratory and can burn fat at 1.3g/minute (the FASTER study reported around 1.6g/minute) – most people are around 0.6g/minute or thereabouts. However research such as that done by Volek and colleagues have shown it is possible to shift that if you go LCHF. From the testing that Dan has done, he knows that at his race intensity on the bike, an average 260 watts, his fuel utilisation is around 66% from fat stores. This allows him to preserve a lot of carbohydrate when working at this race pace intensity.

Ideally, that preservation of carbohydrate stores to use at the back end of a race when energy availability is limited should be the aim of the endurance athlete (and is extremely challenging if they are burning predominantly carbohydrate from the start). In addition, the lower LCHF diet means having lower blood glucose levels on a day-to-day basis,  important for overall health and body composition goals too. Higher sugars equals higher insulin, which is a nutrient delivery hormone – therefore there is more opportunity for fatty acids in the blood stream being stored in our fat tissue. Don’t go thinking we want rock bottom insulin levels all of the time, as insulin itself is critical for life! However ideally our levels would be low outside of the time period around meals, as elevated insulin is linked to a number of metabolic disease processes. In addition, when following a LCHF approach, we have lower stores of carbohydrate, which makes us more sensitive to the signalling for fat adaptation and upregulating of fat oxidation pathways.

So… the details?

Dan’s diet on a day-to-day basis:

  • Coffee with cream, collagen and MCT (medium chain triglyceride, our body can’t store this and is an easily used energy source)
  • SFuel bar (low carb snack)
  • Training – doesn’t eat during training, but if he does it may be a SFuel drink (MCT/branched chain amino acid (BCAA) drink mixed with some other compounds, but it is a higher fat option)
  • Breakfast is eggs, avocado, some vegetables
  • Lunch is tuna salad or similar. During heavier training load, he may add a bit of paleo bread (around 20g carbohydrate, similar to normal bread but this is made of better quality ingredients)
  • Dinner is salad with a steak
  • Snacks may be macadamias, almonds and pickles.
  • Fruit may come into it from time to time, particularly as the training load and intensity ramps up.

While not ketogenic in way that he eats, he will still likely be in ketosis during the day – by virtue of training and his normal diet is low carbohydrate – it’s around 80g – 100g carbs per day, thus naturally depleting his stored carbohydrate (glycogen). Ketogenesis is a is a physiological state, not a diet, thus it’s less important to stick rigidly to foods labelled as ketogenic and to think more globally about it. My athlete plan  is based around these dietary principles, and there are likely some nuances for the female athlete, but this general approach works well for most people I work with. It could be important for a carbohydrate refeed 1-2x per fortnight if following a very low carbohydrate diet, and that’s something I recommend to my athletes on the basis that hormonal responses will be favourable. This isn’t something I’ve seen a lot in the literature, but based more on clinical experience (and may be more important for the leaner athlete).

As I mentioned, I’ll cover off the race day side of things next week. However, if you’re keen to know more about what Dan recommends, then definitely check out his new site – he’s developing an online course that details specifics for coach and athlete alike, and is releasing it soon!

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Kona 2018. (PC: oxygenaddict.com)

Another reason to love coffee…

Love your coffee? Here’s another reason to pour yourself a cup. A recently published study should the consumption of a dark roasted coffee brew (500ml) daily for one month resulted in a 23 percent reduction in DNA damage to white blood cells compared to baseline levels. The protective feature of coffee is thought to be the polyphenols that are found in coffee. These bioactive ingredients (such as caffeic acid, catechol, hydroxyhydroquinone, trigonelline and the alkylpyridinium compounds) have been studied for their antioxidant and anti-inflammatory properties. They are able to mop up reactive oxidative stress (ROS) molecules that are the byproduct of metabolism. Obviously a small amount of ROS is necessary, however too much can overwhelm our anti-inflammatory and antioxidant system, causing increased inflammation and the reduction in the ability for these pathways to function, causing DNA damage.

DNA damage accelerates ageing and is the underlying cause of the growth of carcinogenic cells in the body. It leads to telomere shortening – telomeres are like small caps on the end of your DNA chromosomes, protecting them from damage, and are used as a biomarker for ageing. The study was a randomised controlled trial; therefore, it is able to establish causation (unlike a lot of nutrition research, which is largely observational in nature).It is consistent with other studies that show a reduction in DNA damage after even short term exposure (such as this study, where healthy volunteers showed a reduction in damage after only 2h of drinking coffee). The current research was conducted in both healthy men and women, and the 500ml of coffee per day equated to around 372mg caffeine daily – equal to around four cups of espresso. That sounds like a lot of coffee (and it is!) however this is consistent with other observational and clinical trial research that has shown a reduction in cardiovascular disease risk, cancer incidence and all-cause mortality for people who habitually consume around 4-5 cups of coffee per day. This latest study adds to a body of knowledge regarding the health benefits of coffee. The polyphenols mentioned above help protect us from type 2 diabetes, stroke and cardiovascular disease, with improvements being seen in glucose and insulin metabolism (important for blood sugar control), blood pressure and markers of inflammation in the body.

I’ve talked before on the health benefits we see in coffee, and though this is great news for coffee drinkers, let’s not forget there is a fairly substantial proportion of people who are sensitive to the caffeine in the coffee and can’t tolerate its stimulant effects. Caffeine is metabolised in the liver, with the CYP1A2 enzyme responsible for detoxifying most of the caffeine. Our ability to produce this enzyme is coded by our genes, and there is variation as to how active this is for each individual. Those that have an active gene are able to metabolise caffeine efficiently, therefore the stimulating effects of caffeine are mild and short-acting. This may affect their enjoyment of caffeine and clearly their ability to tolerate it. The opposite is also true – someone with reduced activity of the gene will metabolise caffeine more slowly and its effects will be longer lasting and more noticeable. You can find out your genetic ability to tolerate caffeine through a Fitgenes DNA test(PM me for more information).  In addition to the genetic differences, environmental elements also influence our ability to tolerate caffeine. Even if you are a fast metaboliser, stress and lack of sleep can impact on caffeine’s effects – ramping up cortisol levels and with it anxiety and blood sugar dysregulation. Three coffees a day when on holiday and in a relaxed state may not be a problem, however when a work deadline is looming and you’ve been running on little more than petrol fumes rather than sleep, it is a different story.

With the present research, as the health benefits are from polyphenols present in the coffee, rather than the caffeine, the reduction in DNA damage may well be seen in decaffeinated coffee too, with previous research finding benefits with regards to type 2 diabetes and liver damage when consuming both decaffeinated and caffeinated coffee. has found health benefits from drinking this. However, without clinical trials to confirm this, at this stage it is unknown.

Coffee cup with saucer and beans on wooden table.

Obligatory cup of coffee (PC:stockphotos)

Should you take probiotics after a round of antibiotics? The answer may surprise you!

Two recent studies have recently been published that cast doubt on taking probiotics to help recover from a course of antibiotics. Crazy right? Ask anyone and they would tell you the opposite (as I would have). However sometimes research comes out that contradicts what we would previously have thought, and we have to be open to the idea that what we believed was in fact incorrect. The saturated-fat-heart-disease hypothesis is a clear example of dietary dogma that has been turned on its head* (and the difficulty that people have getting their heads around).

Gut health 101: The gastrointestinal (GI) tract is like a hollow tube, and the cells of the GI tract are covered by a thick protective gel, and that is the mucus layer (the inside cells of the gut are called the lumen). Each of these areas have a distinct microbial community, however these are rarely studied as they are difficult to get to (unless you have an invasive colonoscopy). The stool microbiome is also part of this gut picture and is the most often studied proxy marker as the gut microbiome and these are often used interchangeably (i.e. the bacteria you see in the stool is what we would expect to find in the gut). Interestingly, one study found that the stool microbiome is not representative of the gut mucosal or lumen microbiome, which really presents a challenge to any practitioner or patient who wants a better understanding of their gut health. It also doesn’t tell us about the gut endothelial microbiome which may be the closest to explaining our gut health as it is the closest bacteria to the gut tissue. They found that there was only a 20% correlation between the stool and the gut microbiome. While stool testing can be helpful for identifying pathogens or parasites, it’s not so useful for us to understanding the presence of ‘good’ or ‘bad’ bacteria. Stool testing is one piece of the puzzle, but it’s better alongside other tests (such as a SIBO test).

When you take probiotics, the presence of these in your gut is transient, and this is something that people are unaware of. Hundreds of trials have showed the safety and efficacy of probiotics in benefiting people, but it’s not typically through the colonisation of our gut. Like many things, we are different in the level of colonisation that occurs when bacteria is introduced into the gut – some people are more permissive than others, and some are really resistant to it. The researchers were not able to determine exactly what makes someone a ‘permissive’ coloniser and a ‘resistant’ coloniser, however suggested that the presence of certain bacteria in the gut may play a role in this. However, they are still beneficial despite this – with significant changes in the gene expression of people who took the probiotics (19 downregulated and 198 upregulated genes), confirming the idea that probiotics work at a cellular level and can enhance the activity of genes in the gut, aid in digestion, stimulate the immune system etc.

A surprising finding from a second study was that probiotics slowed the recovery of the gut microbiome after a round of fairly potent antibiotics. In fact, this is what I (and other practitioners) always recommend their clients do. Flooding the system with good bacteria has been thought to prevent the adverse effects of the antibiotics. The study wanted to see how the probiotics affect the long-term gut ecosystem after a single dose of the broad-spectrum antibiotic ciprofloxacin and metronidazole (to ensure all gut microbiome was wiped out). This particular study (conducted in both mice and humans) split the participants into three groups: one took no probiotic and were left to spontaneously recover; one group took an 11 strain bacteria probiotic for four weeks immediately upon finishing the antibiotics and the final group actually had what is called an autolagus fecal microbiome transplant (aFMT) – this is when a person takes capsules of their own fecal matter that had previously been collected when their gut is in a good space. Remember, the gut doesn’t like change, so what better than to replace the bacteria with some of your own? The results found that treating the gut with a course of probiotics delayed the return of the normal gut microbiota by as long as five months after stopping the probiotic treatment, and microbiota diversity stayed low too – well lower than the group who took nothing. In fact, the researchers found the group left to their own spontaneous recovery had no major differences in their stool microbiota within 21 days post-antibiotics. This is so different to what we understood about the ability of the gut to recover post-antibiotics. Again, there will be differences in what practitioners recommend, but to the best of our knowledge we thought that it took a good 18-24 months for the gut to fully recover from a round of potent antibiotics. This is actually incorrect too: previous research (when you delve further) shows that this may be the case for one or two strains of bacteria, but the majority actually recover fairly quickly and the composition of the gut microbiota resembles pre-treatment composition.

The gut microbiome is resilient, perhaps more so than what I (and others) had believed. This is only good news!

The researchers found the lactobacillus in the probiotic was what prevented the colonisation of the native bacteria in those that took the probiotic. This is the most commonly used bacteria in most probiotic strains. Again, this doesn’t mean that probiotics are NOT helpful in general (from the immune regulating benefits and what I’ve mentioned above) and we also don’t know how other probiotics which don’t contain the lactobacillus bacteria affect the gut (such as the yeast saccharomyces boulardis). There are so many different combinations of antibiotics and probiotics out there – and this is specific to this particular strain of probiotics and the type of antibiotic used. So it’s by no means the nail in the coffin for probiotics post-antibiotics, however it does call into question the broad recommendation and is something worth talking to your health practitioner about.

*I’ve linked to one academic’s thoughts, and could have also linked to many many more (and studies) such as this one or this one. But this isn’t a post about saturated fat so I didn’t.

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LIttle microbiota in your body are more resilient than you think… so we may need to leave them to do their thing. PC: oregonsportsnews.com

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.

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

Food rules.

I’m all for flexibility when it comes to what people eat. Labels like ‘vegan’, ‘paleo’, ‘keto’ for a lot of people aren’t particularly useful (even when self-imposed) if that means the structure of their food intake is tied up into the ‘rules’ of that particular diet. People panic when they are out of their own food environment and unable to eat according to the rules of their dietary ethos. While there are those who intuitively know they don’t need to rigidly eat the same foods or meals to be able to progress towards their health goals, this isn’t a widely appreciated concept. For some, diet ‘rules’ can create a certain degree of neuroticism around food; people argue it is a form of orthorexia at its worse – I’m not sure I agree with that, given the complexities associated with diagnosed eating disorders. Regardless, if the anxiety around food exists, it can lead the person to turn down invitations where their dietary rules will not be able to be adhered to, thus becoming socially isolated from their normal circle of friends. Or they may still attend with the intention not to eat, only to ‘cave in’; one small snack becomes a bit of a binge-fest because they have ‘blown it all.’ Both of these situations can make a person feel pretty terrible, and do nothing for their self-esteem.  You can see why, then, there are people who are adamantly against ‘rules’ around food.

However, I don’t agree that there shouldn’t be any structure around what, how, and when a person eats.  I think you’ll know I’m not suggesting this structure should equate specifically to a dogmatic dietary regime, such as only eating ‘paleo’ or ‘raw vegan’. I’m talking about rules that take the decision making out of some pretty common every day food experiences. Let’s face it, most people have a lot going on in their lives – we make 35,000 decisions per day (apparently!), 200 of them are food-related, though we are conscious of about 12-15 of them. Many people don’t have the bandwidth to be directly  making decisions about what to eat day-in, day-out (hence food plans like mine are awesome, btw). That’s what makes it so easy to ‘succumb’ to takeaways at the end of the day (I say ‘succumb’ as I know many people think it’s lack of willpower. Well, no, it’s more decision fatigue than anything else). Dogma around diet is, after all, the appeal of following it – someone else has deemed what you can eat and what you can’t. This takes the thinking out of it and works perfectly fine… until it doesn’t. And it doesn’t take long for it to start causing more headaches than not. The type of rules, then, that I’m thinking about are those which are akin to brushing your teeth. You just do them, they are non-negotiable. Once you get into the habit of them, you don’t even have the think about it.

The types of rules I’m thinking about include:

  1. Never eat standing up (therefore omitting mindless snacking).
  2. Brush your teeth after dinner (to avoid snacking later in the evening).
  3. Have at least one serve of vegetables at breakfast, and 2-3 at lunch and dinner.*
  4. Put all junk food in the house in an opaque container and keep high up in the pantry, so they aren’t having to see it every time they open the cupboard to prepare meals (out of sight, out of mind).
  5. Choose a protein choice (meat, eggs, fish) and vegetables first when eating a meal out, and then (if still hungry), choose something else. This will fill you up, so there is less room for other foods that are easy to overeat.
  6. Order dressings and sauces on the side (so you can control how much you use).

Instead of feeling anxious about having to decide what to eat, then constantly second-guessing what to do, simple guidelines like these can help you make better decisions in any context. They take the thinking out of it, therefore less energy is wasted and they aren’t constantly ruminating about what to eat. This creates less anxiety and neuroticism, and people can feel empowered and confident in their food decisions.  It’s less about the availability of specific food choices and more about way food is eaten, the environment it is eaten in, and the type of food. You don’t need to be perfect to be awesome, you just need to be consistent, and consistently approaching food in the same way (not deciding that you’ve ‘blown it all, so you’ll binge’ whenever you make a choice not deemed ‘suitable’ as part of your dietary regime).

From clinical experience, I find most people respond well to strategies such as those mentioned above.

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If only it were this simple. (PC: theironyou.com)

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 🙂

My diet approach: less rigidity and more ‘real life’

A couple of comments on my Facebook page, a comment from a client that she wasn’t  ‘my perfect client’, and a post from one of my good nutritionist friends inspired me to have a bit of a think about how I approach nutrition, or the expectations that others have of my nutrition approach.

Whenever I put something out on social media, people will read from it what they will – I want them to comment and engage (why else would I put a post up?)  One of these was a comment I got after posting a recipe up on my page. Someone commented that she was very concerned that I say I follow a minimally processed diet approach, yet used a protein powder in my pancake recipe, clearly a highly processed ingredient*. She’s not wrong – protein powder is highly processed for sure, even the brands that I use and recommend others do: those that don’t have a lot of added ingredients bar the protein powder, some flavouring and stevia-based (or thaumine) sweetener . It got me thinking though. This person was annoyed that I was straying from their perception of what I advocate. If I could include protein powder in my recipes, clearly I’m not an advocate of the real food approach. How could people trust anything I say if I suggest that protein powder is okay? I wasn’t living up to her expectations of me, and she was disappointed.

It’s a tough balance: when I changed my philosophy around food I think I was a lot like other people – went too far in the extreme of finding the perfect real-food approach in an effort to ditch processed food. Legumes and all grains were off the menu (regardless of dietary tolerances, as this was the ‘perfect paleo’ way). All bread was to be avoided at all costs. Only drink red wine (less sugar) … It was 95% of what you’d call a ‘primal’ approach.

Like most people, though, I have settled in an approach to eating that is more practical to real life and, frankly, less exhausting. I have my diet non-negotiables –for me, I don’t touch diet soft drinks and chewing gum. In fact, I had a dream a few months ago that someone offered me a piece of gum and I took it. I woke up in a panicked state. This is because around 6 years ago I couldn’t go a day without having Wrigley’s Extra gum, and now I am scared that if I have it again that it would be a quick slide back into a daily habit that I couldn’t stop (even though when I gave it up it was literally like a switch had gone off in my brain and I couldn’t imagine having it again). I don’t have food allergies, so unlike other people, there isn’t anything that I must avoid or I’d be seriously compromising my health. That said, if I was eating the way I did during my Master’s degree at Otago, I couldn’t last during the day – I’d regularly have to nap in the afternoon under my desk after a diet coke and a massive ciabatta bun from Il Panificio bakery for lunch, which was backing up a large milky trim cappuccino and a dark rye sesame bun for breakfast. A carb overload and no fat or protein will do that to me (and a lot of people) – and don’t get me wrong – I LOVED it (and still would!) Just not how it makes me feel and, unfortunately, now I know too much about the long-term implications of eating such a nutrient-void diet). Huh. And I was doing a Master’s in nutrition at the time…

For everything else, though it is more about dietary principles rather than strict rigidity. Less religion and more realness. I try to avoid vegetable seed oils and artificial sweeteners that impact on blood sugar levels. However, if there is a dip that someone has brought along to a dinner party that has canola or sunflower oil as the second ingredient, I would likely have some if I thought it sounded nice, even if I wouldn’t buy it myself.  I avoid eating soy – especially products that use it as a cheap protein filler as you’ll find it in many packaged goods, though by now living in a vegetarian/vegan household, I eat organic tofu around once a week – and really enjoy it. I consume gluten when I have (for example) a date scone, or I really feel like toast. This might be once a fortnight. I drink wine. I have 3-4 alcohol free nights per week, but enjoy red wine (and coming into summer, white wine too – even though it has a higher residual sugar count). Not a lot – 1-2 glasses, and what they serve at the local bar is probably a more generous pour than we have at home. I like chocolate. I eat Quest protein bars (the varieties that don’t have sucralose as a sweetener in them – some do, some don’t) and use these as a bit of a stop gap as when training intensity ramps up (as it has over the last couple of months). I’m just hungrier in general and am not always organised. Despite their ‘organic’ label, these are about as far away from real food as you can get.

We buy white bread – the stock standard cheap loaves – as this is one of the only things that never comes home in the school lunch box during the week. If you’re wondering, I don’t think there is too much difference between white and multi-grain bread, really – it is all rubbish. I don’t eat it myself (any toast I have would be out at a cafe, a more delicious type of sourdough or ciabatta, probably), and can justify it till the cows come home but truth be told, getting any food in some kids can be difficult, so if they will eat a white bread egg or cheese sandwich that is going to at least fill them up, then so be it. A friend of mine commented on how she laughs when I post about lunchbox options for kids – and how (for her at least) it’s just a little unpractical and/or even if the kids show interest one day, the next they won’t have a bar of it. Now I get it. I really think I didn’t have a true appreciation for this and if I can somehow crack the nut that is ‘school lunches’ then I’d probably be a gazillionaire. One day. Maybe. (And if you have any bright ideas that I might not have thought of, pass them on!)

So, yeah. I still call my dietary principles ‘minimal processed food’ relative to the food environment and where I was at 7 years ago. Sorry to disappoint or concern anyone. Or perhaps this just makes you feel a little relieved that, despite best intentions, it doesn’t read like a perfect food environment or a perfect food diary, even for someone with my nutrition qualifications and practical experience. But that’s real life, and we do what we can. Some days are awesome, some weeks are awesome, and some, well, some just aren’t. That’s life, right? And when the dust settles, I’m pretty happy with it actually.  If you do what you can and have the best intentions going into it – then you’re always going to do better than if you didn’t try at all.

So please don’t think you have to be perfect – I’m not and nor should you stress about striving to be so. If you want some guidance at reaching your ‘happy spot’ click here to book a consultation or check out my online nutrition coaching services.

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