Preventing post-natal nutrient depletion

Many women struggle with the after effects of childbirth and the overwhelm of having a little human who relies on them 24/7. The term ‘post-natal depletion’ (I first heard from my clinical psychologist friend Karen) accurately describes the nutrient state of a new mum, and whilst some women may experience depressive symptoms because of this, others feel general weariness and fatigue that is an expected part of being a mum. I recently listened to a podcast with the amazing Lily Nichols (well known for her work on gestational diabetes and diet) and her thoughts on the role of nutrients and if there is anything that can be done to mitigate these symptoms or help the recovery process, pre and post birth.

From a fitness perspective, if we consider the evolutionary picture, there is a definite mismatch between the activities of adults then compared to now. In activities of daily living there was a lot more squatting, lifting, lunging and pulling as part of gathering food and providing shelter. This made for a much stronger pelvic floor and core muscles than we have now. The strength and muscular fitness of the mother during pregnancy can really influence their recovery period post-birth. In addition, one of the main roles of the elders at the time of late pregnancy and childbirth is believed to have been to gather the additional calories required by the childbearing women, as it is difficult to obtain that amount of dietary energy. There was an enforced rest period post birth to help with recovery and bonding of child and mother, and this isn’t a focus in modern day life, where there seems to be real pressure to get back up on your feet after a few days and get going. From a food standpoint, the overwhelming and all-encompassing burden of being a mother to a new-born (first or third time around) makes it challenging to prioritise the nutritious meals required.

Childbirth is extremely energy demanding, whether you have a physiological (vaginal) birth or whether you have a caesarean section (c-section). For some, the double whammy of the intention to have a natural birth but, after 40 hours of labour, be whipped into surgery for a c-section likely even more so. The emotional and physical trauma relating to all of the above scenarios should not be understated, however while guidelines exist during pregnancy for nutrition, there are no real guidelines in place for postpartum recovery. The nutrient requirements of growing another human, plus the demands of labour leaves a woman in a very real depleted state, from a caloric perspective and from a nutrient perspective. It is therefore no wonder that women experience exhaustion and a depressive mood post childbirth. Furthermore, upregulation of protein turnover occurs post birth (both via c-section and vaginal) to help repair and heal tissue, and as a result of increased inflammation. This will certainly increase the requirements for protein and the amino acids responsible for musculoskeletal health.

And what about carbohydrate calories? It appears to be individual as to the requirement for most women. If someone develops gestational diabetes during pregnancy and has been limiting their carbohydrate intake, Lily suggests it is prudent to continue this lower carbohydrate approach post pregnancy for 6-12 weeks and ideally self-monitor their blood glucose responses to meals with a glucometer to assess if their levels has reduced to normal range.  There is no optimal intake amount for carbohydrate (as it isn’t an essential nutrient, the body can make it well enough), however a key indicator of individual requirement would be milk supply for the breastfeeding mother, and mood, energy and stress response may also be good indicators. Carbohydrate helps produce serotonin in the body and quality sources such as potato or kumara can be great for helping with mood and calming anxiety. There’s no right or wrong way here, but I wouldn’t recommend a ketogenic diet for most healthy women post-birth, instead aiming for a good intake of vegetable fibre and adding a couple of serves of fruit and/or kumara or potato into the day. This may take the carbohydrate content to around 80-120g per day which is still a low-moderate amount. Quality is key here.

It is well recognised that breastfeeding increases the caloric requirements of women by around 600 per day compared to pre-pregnancy,  however there are no guidelines for an increased caloric intake post-birth for women who don’t breastfeed, which may lead to some women feeling they should immediately return to pre-pregnancy food intake for fear of not being able to lose the ‘baby weight’. It is reasonable to consider that, breast feeding or not, the healing that needs to take place to recover from childbirth will require additional calories and expectations of dropping weight quickly would ideally be put on the backburner until the body is healthy enough.

From a micronutrient standpoint, there is an increased risk of anaemia with childbirth and more so with multiple c-sections. The estimated blood losses during a c-section is thought to be up to 1000ml, so it is no wonder that someone may come out depleted. And, worth mentioning, there is a clinical link between anaemia and postpartum depression, which highlights the important role of iron in the brain. In addition, the sudden drop of progesterone post-birth may create an imbalance until normal levels resume with the menstrual cycle. Coupled with fluctuating oestrogen levels, this is thought to be one of the major influences of mood and can have negative impacts. Finally, it can take time for the thyroid (which enlarges during pregnancy) to come back to normal size, and the problems this can create for thyroid function, triggering hypothyroidism or hyperthyroidism in the short term, leading to a low mood state. Therefore, along with iron, iodine, selenium, zinc and other cofactors in thyroid metabolism need to be considered.

Practically speaking, what steps should be taken to avoid post-natal depletion and adjust to the new additions to the family? Some tips from Lily Nichols:

Ideally, if possible, get strong and fit in a safe way, enlisting the help of a qualified fitness professional before and during pregnancy

While pregnant, once a week, for several weeks, purposely cook a meal to freeze for post-birth, and make sure it’s something you are going to want to eat. Casseroles, slow cooker, mince-meals, pre-cooked chicken breasts, frittatas are all things that can be frozen but if you don’t like the idea of thawing and eating these, then it’s not going to be worth making them. You may want to do this in the second trimester-beginning of third trimester, so you are sorted prior to the last few weeks when fatigue more rapidly sets in. This might require more freezer space, but this will help emulate the traditional ‘village’ feel of not having to do everything yourself post-birth. In addition, baking low sugar muffins, loaves and breads (if you’re a baker) and slicing and freezing will give something quick to consume when necessary, without you having to rely on processed refined foods. If budget allows, consider Plate Me Up, Jess’ Underground Kitchen or another company that creates prepared whole food meals to take the pressure off having to cook (and the temptation to buy take aways).

Post-birth: continue taking pre-natal supplements and look to get your nutrient blood markers taken perhaps 10-12 weeks post-birth, when inflammation and hormones that are disrupted during the pregnancy and birth have had time to settle down. This will give you a more accurate reflection of any nutrients that you may be running low in. Work with a health professional such as a nutritionist, naturopath or dietitian to provide you with good advice around quality supplements, as price of supplements don’t necessarily reflect quality.

Ensure adequate protein and fats at each meal, with a moderate amount of carbohydrate. If possible, avoid meals that are too skewed towards carbohydrate as these are going to cause blood sugar swings that will impact on energy levels and mood state. This is obviously problematic when also sleep deprived!

Don’t ignore your hunger signals. Remember you need more calories currently, breast feeding or not. Eat until satisfied and trust your body and the signals it is giving you. Now is not the time for Isagenix or fasting. That said, aim to eat your meals within a 12h window, avoiding snacking if you get up to feed during the night if possible. This is reasonable given what we know about circadian rhythm and the potential deleterious effect of food intake later in the evening.

Liver, eggs, salmon, sardines and red meat that is close to the bone all contain essential amino acids and fatty acids that are important not only for baby’s growth and development, but for mum’s brain and blood sugar. Regular inclusion of these should be a priority for optimal nutrient intake.

Keep well hydrated and electrolytes up – a major source of fatigue is when plasma volume drops due to dehydration, therefore making the blood more viscous and increasing the work the heart has to do to pump it around the body.

PC: home-startcentralbeds.org.uk

Red meat doesn’t kill you (and a problem with nutrition science)

This week is world iron week. I’ve talked about iron deficiency on my blog and you will be aware of the risk factors and risks associated with iron deficiency. I know, though, there are those among us who are wary of consuming one of the best sources of iron in the diet: red meat. Because, well, you know – meat kills. The most recent of these news headlines came from this study published in June of this year.

It is challenging being an advocate for eating red meat, and (in a lot of cases) encouraging clients (particularly young and not-so-young women) to eat MORE red meat, in a climate of meat avoidance. It isn’t a popular message, particularly with the bad press that red meat consumption (and production) has received over the last few years. So I thought it timely to remind you of some of the pitfalls associated with nutritional research, and why it is problematic to rely on population based research for our nutrition wisdom. This has been well covered by people much smarter than I am (read here) and relates to the above study looking at red meat and all-cause mortality.

The Nurses’ Health Study is an observational-based study – in that, it wasn’t a study that went in to try and test the effects of a certain dietary condition, instead it merely reported on what the population was doing. The food data was collected using food frequency questionnaires (FFQ), a memory based method, to determine the intake of foods spanning a four-year period. Now, if you’re reading this, you likely think more about food and what you eat than the average population. How difficult, then, would you find it answering questions related to your food intake four weeks ago, let alone four years ago? Imagine then being someone who typically doesn’t give it a second thought. A separate analysis of the data collected in this study revealed that 67% of women and 59% of men participating reported a caloric intake so low that a 70-year-old frail woman wouldn’t be able to live on, much less people who are in the prime of their lives. It has been described as ‘physiologically implausible’. Further, the caloric intake of people categorised as obese or overweight was reported as being ‘incompatible with life’. As all nutrients we eat are attached to calories, this makes all nutrient information completely unreliable.

Secondly, any of the findings are, by virtue of being an observational study, correlational in nature and not cause and effect. Given a data set large enough, enough dietary variables and a number of statistical methods at your disposal, you are likely to see significant correlations if you go looking for them. An example I saw on a blog of Chris Kresser’s was s study reporting that eating 12 hazelnuts a day increased lifespan by 12 years. Or that two slices of bacon equated to a shortened lifespan by 10 years. Yet, all headlines reporting on the study we are talking about here, and indeed the language used by study authors, suggest causality – something that cannot be determined by observation alone. Quite possibly one of the only robust findings from correlational research is that on lung cancer and smoking, where a 2000 times increase in risk of diagnosis of lung cancer was found in those who smoked. The increased risk in the study regarding red meat consumption? 10%. In most fields of science, it takes an increase in risk of at least 200% to garner interest. In nutrition, most relative risk increases are to the tune of 10-50% in either a positive or negative direction. Almost not worth writing about. Remember, too, this is relative risk. Absolute risk (when these numbers are reported) looks quite a bit different (see infographic here, a great description).

Thirdly, the prevailing message in the last 30 years is that red meat is bad for us and we should be minimising our intake of it, something that health conscious people will make a concerted effort to do. Therefore (as the research shows) those people who tend to consume the most red meat aren’t generally those that follow public health messages. They are more likely to smoke more, drink more, do less physical activity and eat less fruit and vegetables – all things which place an individual at greater health risk. While the research statistician ‘adjusts’ for these factors by way of an algorithm, it is well acknowledged that no amount of statistics will account for these unhealthy lifestyle behaviours. This is the inverse (if you like) of a ‘healthy user bias’.

And what about clinical trials looking at the harmful effects of meat? We must put it into context. A hamburger patty served with cheese and aioli, in between two slabs of bread, along with a large side of fries and a soft drink is clearly quite different to a medium rare steak with garlic butter and a side of broccolini. The overall nutrient quality and context of the diet matters whenever we are determining the healthfulness or otherwise of a food choice. Dietary patterns matter. In line with that, there is no good evidence to suggest that meat causes inflammation, and one trial in particular (out of Australia) looked at the differing effects of one 100g serving of wild game meat (Kangaroo) and the standard feedlot beef on inflammatory markers, finding no increases in inflammation after eating the Kangaroo meat. The authors suggest that the fatty acid profile of the beef (higher in proinflammatory omega 6 fatty acids) compared to the wild game meat was the potential mechanism here, but more research was required to establish this. What would be great is to see if differences existed in a clinical trial of a whole food diet that incorporated red meat, rather than there being no differentiation between sources of red meat. Grass fed meat (the majority of our meat supply in New Zealand) is higher in omega 3 fatty acids and antioxidants as a result of the way they are raised – both of which reduce inflammation.

Finally, the tri methylamine N-oxide (TMAO) story. An increase in this enzyme (generated from choline, carnitine and betaine in the gut) is associated with cardiovascular disease and there is suggestion that red meat intake is responsible for higher levels of TMAO. However, it needs to be pointed out that fish (consistently found to be a feature of healthy diets, however you look at it) raises TMAO levels well above what is found with meat. In addition, TMAO is produced in the gut, and we know how much the health of your microbiome is important for overall health. Therefore, if someone has sub-optimal gut health due in part to a poor diet, they are likely to be at increased risk of health concerns.

There is a lot to unpack and this isn’t to try to convince anyone to eat meat if they don’t want to. It is more to remind you that nutrition science is a challenging field. Regardless of assertations made by headlines, health professionals (including me!) or your next-door neighbour, studying what people eat is rife with problems and we need to take everything with a grain of salt. Which, as you probably know,  also will not (in isolation) kill you.

PC: https://www.sciencefocus.com/nature/why-do-most-cows-in-a-field-face-the-same-direction/ (interesting link BTW!)

LCHF and IF for the female endurance athlete (IMHO).

Following on from the couple of blogs I wrote about Dan’s LCHF athlete lifestyle, I got a lot of messages from women regarding my opinion of it for the female endurance athlete. Great question, especially as – if you look at social media – there are nutritionists who warn against the danger of LCHF (and intermittent fasting) for women, to the point that the blanket statement is that it is harmful and not to be undertaken. Whilst it is hard to be objective in the nutrition space – all of us influenced to some degree by our own experiences – the low carbohydrate and fasting space seems to bring with it its own special degree of hysteria. The prevailing message is that both low carbohydrate diets and fasting is too stressful on the endocrine system of females (which regulates hormones) and causes a reduction in metabolism and reproductive potential. Thus, it is to be avoided at all costs. This point of view may be drawn from clinical experience of the practitioner and be dependent on the type of client they see. If their target audience are women who have struggled with maintaining a healthy weight and have problems with eating enough, then the opinion of the practitioner could well be influenced by this (and is entirely sensible!) Likewise, I see many women who’s hormones benefit from periods of intermittent fasting while utilising a LCHF protocol. What we see in clinic will dictate our points of view, regardless of how objective we try to be.

I have in the past written about the negative impact of fasting and calorie restriction on the expression of genes that regulate kisspeptin in the body, a hormone involved in our reproductive cycle. However I will point out that the effects seen in studies conducted in rodents may be more dramatic than if they were carried out as clinical trials in humans. Rodents have a much faster metabolism, thus a 24h fast for a mouse is equivalent to a 3 day fast in humans. Likewise, chronic caloric restriction over a week, where the mice lose close to a quarter of their body weight (and which is thought to be responsible for the downregulation of the kisspeptin receptors that result in negative effects) may be equivalent to 12 or more weeks. Rodent models in science are great for illustrating potential mechanisms, but can never be viewed as hard data as it pertains to humans.

Alongside any scientific data that exists, I think it’s important to step back and consider perspective here. What we should all be aware of is that there is no one right dietary approach for everyone, and often there is no one dietary approach to suit someone for the rest of their lives. As things change, so do our nutritional requirements. Low carbohydrate diet and intermittent fasting is not exempt from this – therefore to say that it is not suitable for any woman is, quite frankly, erroneous and misrepresents what we see in the literature and what we see clinically. While certainly a vast majority of the studies investigating lower carbohydrate diets have been conducted in males, there are studies showing a positive impact for overweight women with infertility. Further, it is accepted best practice to include periods of low glycogen availability in the training schedules of athletes. Even in the researchers who err on the side of pro-carbohydrate diets recommend cycling carbohydrate intake to be sometimes low, and sometimes high, to upregulate fat oxidation pathways that allow the athlete to become more efficient at burning fat. To state that no female athlete should start an exercise session in a fasted state goes against current best practice for endurance performance.

Possibly the negative impacts of fasting and low carbohdyrate diets are not about the fasting period or the carbohydrate content – it’s much more likely to represent chronic underfuelling – i.e. a lack of calories over an extended period of time, with no thought given to cycling of both energy intake and/or macronutrients. It’s just low, full stop. That’s why it is important to work with an experienced sports nutrition practitioner (like me, Kaytee Boyd, Caryn Zinn as some top picks) to ensure these training tactics are used to the advantage of the athlete in a training cycle, not to the detriment of them.

Don’t misread this as a recommendation to do all sessions in a fasted state, to undergo an intermittent fasting protocol that involves skipping breakfast every day of the week, or that everyone should adhere to a very low carbohydrate approach. If you’ve read any of my information (or followed anything I’ve suggested) then you’ll know this isn’t the case. The point of this blog is to remember that there is no one right dietary approach for everyone, and that if you’re successfully adhering to a lower carbohydrate diet with periods of intermittent fasting and feel it’s working well for you (ie no sleep, hormone, training or recovery problems), don’t be concerned with the rhetoric that exists regarding the harmful nature of this. You are your own best investigator when it comes to your nutrition, and your experience is the most important data when it comes to you.

Post on IF, cue picture of empty plate with clock. #standard (PC http://www.stack.com)

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.

Delicious food! (PC: runningcompetitor.com)

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 🙂 ).

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

10 tips to help reduce your water-bloat

I got a question on my members’ Facebook page a couple of weeks ago regarding water retention. There is nothing worse than a bloated tummy – it can not only make you feel physically uncomfortable, but can also wreak havoc on your psychological state (as many people equate the bloating to ‘feeling fat’, despite there being no relationship between the two). Further, a bloated stomach impacts on your ability to move properly. We can’t engage our core muscles, so aren’t able to move, lift, push or pull in a way that is functionally optimal. This has important implications for our core strength and injury prevention. Of course water rentention affects more than just our stomach – a long haul flight to somewhere warm can turn anyone’s lean calves into kankles due to changes in the pressure in the capillaries, causing fluid to leak out into the body tissues. There can be many reasons for this, so I thought I would investigate the most common causes and possible solutions.

1. Minimize your sodium intake. Although sodium (aka salt) is an essential mineral because it’s used to regulate the fluid levels in body tissues, bringing water into the cells. Excess intake of sodium may cause excessive fluid retention in the body tissues. While the evidence behind this recommendation suggests it isn’t something that affects everyone, this may help some people, particularly those who are salt sensitive or hypertensive. Do note, though, that if you follow the types of principles that I suggest, your diet is probably quite low in salt anyway, as most salt comes from processed foods (around 70%). However, there are whole foods that are high in sodium, such as cheese, miso, cured meats and biltong, so you could reduce these, and avoid adding salt to your food to see if this makes a difference.
2. I probably don’t need to tell you to avoid eating too many refined carbohydrates – these tend to spike insulin, which causes sodium (often found in these foods) to be re-absorbed back into the kidneys, thus increasing water retention. Your best bet for carbohydrate foods are those whole-food, minimally refined varieties that have negligible sodium for a start, and that you eat in a mixed meal with good fats and proteins to help slow down the release of carbohydrate into your bloodstream, minimising insulin response.
3. Any form of dehydration can cause your body to hold onto water. Therefore, ensure that if you drink alcohol, do extended exercise training sessions, or are in a hotter environment that you remain well hydrated to offset any potential for dehydration. The fluid you lose during exercise should be replaced in the three hours after training, and at 1.5 times the amount lost – you can work out how much this is by weighing yourself before and after an exercise session. The amount of weight lost roughly equates to the amount of fluid lost. Prior to drinking alcohol, have a couple of glasses of water (this will also help slow down your drinking). And be an adult about how you drink: is it necessary to drink more than a few in any one sitting?
4. Take adequate amounts of vitamin B6 combined with magnesium. For women, prior to your period you can feel a little bloated and that you are retaining water. Interestingly, however, some research investigating the timing of this around the menstrual cycle has found bloating occurs more in the onset of your cycle (day 1) after which is rapidly declines, despite the perception of puffiness or bloating in the week prior to menstruation. This puffiness, however, could well be related to food choices in that week, as the intake of higher sugar choices can increase for some.
5. If you have water retention before your period, you may, however, benefit from taking both a magnesium supplement (at 250mg per day) combined with a vitamin B6 supplement (40mg) daily – a study found this combination the most effective for decreasing premenstrual symptoms when administered for two months by balancing your hormone levels.
6. Potassium works in conjunction with sodium, pumping fluid out of the body cells. Therefore, if you aren’t consuming enough then it could cause problems with water retention. The reality is, though, that you are following the meal plan and including plenty of vegetables, your potassium intake is likely fine. However, if you don’t have a good intake of vegetables (at least 7 serves per day) then increasing these is a good idea. This will also bump up your fibre intake, which can further help reduce fluid retention.
7. Take natural diuretics. Dandelion root has long been used to help flush water out of the body – therefore investing in a good tea such as this Golden Fields one is not only delicious (often used as a substitute to coffee), it will also be beneficial. In addition, this kidney cleanse tea from Artemis has other natural diuretics to help flush water out.
8. Exercise regularly. Exercise can help reduce water retention, not just by increasing sweating, but by moving water from the intercellular compartments to the muscles.
9. Increase your caloric intake, if only for a day. I know – this one sounds weird, but a ground-breaking study in the 1950s called the Minnesota Experiment found something interesting mid-way through their study. The study followed men on a 1500 Calorie diet for 6 months, and subjected to hours of hard labour per day. Half way through the trial the men were allowed a celebration meal, effectively increasing their caloric intake to 2300 Calories. Following a night of getting up to go to the bathroom several times, the men were a few pounds lighter the following morning. Obviously, the weight lost was water weight – but why would this be the case? Potentially the long-term calorie deficit caused an increase in cortisol levels, and this increases water retention in the body. By increasing caloric load, the body reduced cortisol levels and this reduced water retention.
10. Reduce overall stress load. As we have just discovered, higher cortisol levels will increase water retention, therefore anything you can do to reduce stress is going to impact favourably on water loss. Let’s not forget the impact that high stress levels have on blood sugar levels, inflammation and fat gain (to name just three areas it impacts). While stress is a perception of a situation, and changing your mind-set is one of the best things you can do to lower stress levels, ensure you are getting adequate sleep, time in nature, time with loved ones and taking time just for yourself. These are going to help lower your cortisol levels and combat any stress-related water retention.

So… not a definitive list, but hopefully a few pointers to help you get to the bottom of your fluid retention issues and make some improvements. For more individual advice, don’t hesitate to contact me for a consultation or for online nutrition coaching. Further, if you’re in the Bay of Plenty, Queenstown, Nelson or Wellington regions, then I’m headed your way for an evening of ‘real food’ talk – click here to find out more information and to book tickets!

PC: https://legionathletics.com 

 

LCHF…why isn’t it working for me? (Part 2)

Last week I posted three reasons why many people undertaking a LCHF diet stall with their success or never get it off the ground to begin with. The following delve a little deeper into the less obvious reasons why people struggle with their diet, and offer some options to help troubleshoot.

4. Fat doesn’t fill you up. For some people, they don’t feel satisfied when swapping out their carbohydrate for more fat. If it takes a few handfuls of nuts or half a block of cheese to feel satisfied, then there can be some serious increase in calories that isn’t compensated for by an appropriate increase in satiety from the meal. Yes, cheese and nuts contain protein, but to be honest I treat them more as sources of fat than I do protein. If this is you, then.
   1. Increase the portion of protein you are consuming with your meals. I know many people are scared to consume more protein because protein can be broken down into glucose in the absence of carbohydrate, therefore pushing up their blood sugar levels. For people on a ketogenic diet (where 80% of their calories should come from fat), or those metabolically damaged (whereby there is a dramatic change in blood glucose response from a protein-rich meal), this may be a problem. For most people though? upping protein by 1/3 of a serve is no biggie. Still hungry? Up the protein some more.
   2. Drop out some fat –make room for the added protein by dropping out some of the fat – you could start with ½ – 1 serve and see how satisfied you feel when you do that. A serve of fat is typically 1 tablespoon of oil or butter, or ¼ avocado.
5. You’re eating too much in one meal. A lot of people move from three meals a day, to two a day, to a ‘minimal food during the day’ approach, to sit down to a large meal at night, especially if they’ve been in the LCHF way of eating for a while and are further tweaking it. This may be awesome for some people, but not all. Eating most of your calories in one meal can, though, wreak havoc on your metabolic blood markers (such as blood glucose levels and insulin), increase fat gain, inflammation and reduce your day-to-day energy if this eating pattern doesn’t suit you. You’ll know if this is you, and if it is then:
   1. Spread your food intake out across 2-3 meals to lighten the caloric load and see if this makes a difference to your energy or other more objective markers mentioned above.
   2. Remember you’re still a rockstar even if you have to eat more often.
6. You’ve got a high intake of dairy or nuts. Some, especially women, are not suited to high amounts of dairy or nuts, and when the begin to include more of these foods – ones they’ve avoided for years due to their fat content – they have a weight loss stall they can’t move past or, worse, they begin to store fat around their middle. While some suggest cheese is a food akin to crack, research investigating the addictive properties of the protein in cheese have not found this to be the case. Of course, if you personally can’t stop at one slice and find you’re eating the block, then perhaps it is for you. Nuts can also be trigger foods for some people, and they find it difficult to stop once they’ve started eating them. Ditto with a jar of peanut butter. What to do?
   1. Omit dairy for 30 days – sometimes it’s not the dairy per se, it’s the amounts that you’re eating it in that need to change. Removing it entirely will allow you to change your habits and then reintroduce it.
   2. Omit nuts and/or nut butter as per above in #6a.
   3. Swap snacks to those that are predominantly protein-based rather than fat based – despite the satiating effects of fat, for some, it’s just not like having protein. A hardboiled egg or some leftover chicken wrapped in lettuce or nori sheets (my current obsession) may satisfy you more.
7. Genetically this isn’t the diet for you. If metabolic markers such as cholesterol, blood sugar or inflammatory factors go skewiff then it could be the LCHF approach doesn’t suit you. Genetic variation in the ApoE gene (ApoE4) is associated with LDL cholesterol not being recycled very well, and therefore it’s more likely to hang around the bloodstream and increase the chances of it becoming either oxidised or being transformed into smaller LDL particles, both highly atherogenic. Variants in the gene FTO can increase risk of obesity in the context of a high saturated fat and low polyunsaturated fat intake and may increase risk of high blood sugar and diabetes in individuals already overfat. The PPAR genes plays a role in ketogenesis (the oxidation of fat for energy) and storage of fat by activating genes associated with fatty acid transport and metabolism. Variants of this gene (particularly PPARa and PPARg ) are associated with increased risk of high triglycerides, total small dense LDL cholesterol and type 2 diabetes in the context of high saturated fat to polyunsaturated fat intake. Further, individual glycemic (blood sugar responses) vary considerably for the same amount of carbohydrate in food, suggesting there are a lot of factors to consider when determining the best diet for you (such as genetics, gut microbiome, activity level, stress etc), not just its macronutrient content. How to figure out if LCHF is not the diet for you? A few things to consider:
   1. Are you losing weight? If so, then wait until your weight stabilises and then retest your numbers – your body recycles triglycerides that are released from adipose (fat) tissue, therefore your triglyceride levels can appear high, but it is transient.
   2. Don’t get your cholesterol levels measured if injured, if you haven’t slept properly or you’ve been under significant stress. Cholesterol levels can change easily based on environmental triggers.
   3. Some people notice their cholesterol increases specifically in response to dairy fat, others to coconut fat – experiment for 6-12 weeks by dropping these out of your diet and get your cholesterol levels retested to see if this brings a drop in your numbers. Replace it with foods that have a more balanced fatty acid profile (such as lard or beef tallow) and foods high in monounsaturated fat or omega 3 fats, such as avocadoes, olive oil, nuts, seeds, salmon, mackerel, sardines.
   4. Here’s one I prepared earlier (and by ‘one’, I mean, ‘post on reducing your cholesterol naturally’. And by ‘naturally’ I mean ‘without Flora Pro Activ’).
   5. Get more in-depth testing of your cardiovascular disease risk profile – cholesterol is one measure and possibly not the most important one. CRP, fibrinogen, LDL particle size, number, oxidation and patterning can all give you more information than the run-of-the-mill lab test can. Contact me as I can help you arrange this testing which, for the most part, your doc might not even be aware of.
   6. Consider getting tested to find out your genetic predisposition (either through your doctor, or I can assist via Fitgenes gene testing).
   7. Consider dropping your fat intake, upping your protein intake and perhaps your carbohydrate intake too – ala the Zone diet approach. Despite its gimmicky name, it’s proven itself to be very effective for blood sugar stabilisation and blood cholesterol management. Some people just aren’t meant to eat a higher fat diet.
8. You’ve got an intolerance you didn’t realise you had. Going LCHF means, for many, significantly increasing fat content in the diet from the obvious choices: cheese, nuts, seeds, avocados and coconut products. However, while these are awesome in terms of the nutrients they deliver, they can cause digestive issues in a number of people. Avocado, coconut, nuts and seeds are moderate-high in FODMAPs – a type of carbohydrate that can cause bloating, abdominal pain and other irritable bowel symptoms in many people. Further, the inclusion of larger amounts of cream, cheese or full fat yoghurt can be problematic due to an intolerance to the dairy protein or fat which can result in similar IBS in susceptible people. If you’ve been following a low-fat diet for many years, enzymes that help digest the fat and protein may be downregulated, so your body might not cope with the additional amounts. Sometimes it is a matter of backing down and building up, and sometimes it is that these foods just don’t agree with you. What to do? One of these tips may help:
   1. Follow a lower FODMAP approach to see if removing these foods settles down your discomfort. Doing this for at least 21 days and reintroducing a different food one at a time can pinpoint which one in particular might not agree with you.
   2. Introduce fermented foods as per #3e above to re-establish healthy bacteria in your gut.
   3. Replace dairy fat for alternative fat choices: nuts, seeds, avocado, coconut oil, beef tallow, lard.
   4. Ensure you chew your food properly at each meal to break it down, include lemon juice in water in the morning, and apple cider vinegar with meals to stimulate your digestive system, and consider ox bile supplement or a digestive enzyme that has lipase and/or pepsin enzymes to help you break down the fats and proteins.
9. You’ve upped your alcohol intake because red wine and white spirits are “allowed” on LCHF. This might not even be intentional, but dropping your carbohydrate intake can lead to increased alcohol cravings, especially if your fat intake is too low, or your food intake is too low, or your stress levels are chronically too high. Or perhaps, you enjoy a moderate amount of alcohol but are continuing to gain weight on the LCHF diet.
   1. Be honest about how much you are drinking. Regularly consuming a ‘large’ as opposed to a ‘standard’ pour at the pub? Cracking open a bottle one night and then drinking to finish it off? Your plan to be alcohol free during the week has reduced to being alcohol free Monday – Wednesday? Evaluate if this is a problem for you … or not!
   2. Go alcohol free 5 nights a week, and enjoy a glass of whatever you fancy on the other nights. Ideally not those lolly water vodka mixes, but if you don’t like red wine, then choose something else. It’s not a deal breaker.
   3. Eat enough during the day so you’re not craving alcohol in the evening. This may mean including some additional starchy carbohydrate in your lunch meal – it doesn’t mean you’re not ‘low carb’ – as that in itself is a spectrum. This can really offset your cravings. Try it for 14 days to see if there is an effect.
   4. Lighten the load by choosing to have a low-fat meal if you drink. Old Skool 90s ‘dieting’ approach – those fat calories will only be missed by your adipose tissue, which is where they will be directed to when consumed with alcohol (which is processed first and foremost).
   5. Drink to ensure you are hydrated before you have your first alcoholic drink. This is like 101 really – we always drink more when we are thirsty, and then when we drink more, we become uninhibited and then all hell can break loose, right?
10. Food timing: If you’re beginning your day with breakfast at 7am and winding down with a cup of tea and some dark chocolate at 10pm, you may be doing yourself a disservice. Eating over a time period of more than 12 hours can be deleterious to health. Recent research has found that restricting the eating period to 12 hours or less can improve insulin resistance and glucose tolerance, and reduce breast cancer risk even when the calories remain the same. Anything you consume that requires processing of any sort by the liver – including black coffee or herbal teas – will begin the metabolic process. When we eat is also important as our appetite hormones are on a circadian rhythm (food being an important signalling molecule for hormones), and eating late at night – even if overall eating window is short – can be problematic for your liver. The benefits derived from intermittent fasting (such as these) can still be realised if your version of fasting includes coffee in the morning, however it appears actual fasting (nothing but water) for at least 12 hours is most beneficial for metabolic health.
    7. Try to keep within a 12 hour window for consuming anything other than water. If you struggle with remembering to do this, there are apps that can help. It’s not as hard as it might seem – if you have breakfast at 7.30am and are done eating by 7.30pm then you’ve nailed it.
11. You’ve focused entirely on diet without giving pause to consider other aspects of your lifestyle that contribute to your wellbeing. Lack of sleep, chronically elevated stress levels, over or under activity can all contribute to some of the common complaints people attribute to diet which have nothing to do with the food.
    1. Evaluate your sleep – are you getting to bed at a reasonable hour? Able to sleep through the night with ease? Feel refreshed waking up?
    2. Evaluate your physical activity – are you doing enough? Are you doing too much?
    3. Evaluate your stress levels – are you trying to do too much? Feeling overwhelmed? Or conversely is there not enough stress to keep you stimulated and motivated?

Of course these factors contribute to how your body responds to the food, but it isn’t the food per se. As I said last week, this isn’t a definitive list, however if any of these resonate with you then try some of the ideas I’ve listed, or enlist the help of someone like me to guide you to the best approach for you.

PS: I have organised a few talks over the next couple of months to talk about making a real food (aka LCHF) approach work for you. At the moment I have:

• Takapuna 23 March @ Streetwise Organics, Byron Ave
• Hawkes Bay 6 April – location TBC
• Queenstown 25 May – location TBC

…with others to come, so watch this space 🙂

Yes, I created this pic myself 🙂

 

Do you need to snack? Here’s 31 ideas just in case (and because you’re awesome).

Sometimes you just want some new ideas. Or it’s a day where you just feel like mooching around and making a few things in the kitchen.

Snacking. As I said earlier this week on Facebook, I’m not a fan of snacking for most people as it often means they haven’t eaten properly in the previous meal, thus their need for a snack is due to roller coasting blood sugar levels which affects their stress hormones, energy and mood.

However, sometimes you just need to snack. And if you’ve eaten what you normally KNOW is a balanced meal with plenty of vegetables, a good hit of protein and some fat, but still feel hungry – then you should probably eat. And if you’re not sure what a balanced meal looks like, then check out Jamie’s blog discussing the Heart Foundation’s take on paleo – he outlines what his meals look like. Pretty simple. (And do read the whole post – it’s GREAT).

Ignoring your hunger cues is not good in the long term – yes, even if your goal right now is to lean up, if you’re eating well and exercising appropriately, then it’s likely your muscle mass is increasing and you need to feed it! Don’t use the scales as a guide to your progress – this is gravitational pull – nothing more. In the last 6 months I’ve gained 10 kg to help restore hormonal equilibrium to my over-stressed body – and while on paper it might look like a lot, visually it’s not what you would imagine it to be, as I’ve kept up weight training and gotten a lot stronger. Of course I’ve got more body fat, but I’m a lot healthier too because I’ve got more muscle; it’s had the opportunity to grow as it hasn’t been broken down to use as fuel (which can happen when you’re over-stressed). The scales tell you nothing about the composition of your body. To under fuel (even when trying to lean up) would put your body in a catabolic state, stripping muscle and potentially bone too if you go too low in calories (protein is the major component of bone, you know).

The more you listen to your body and NOT eat to a schedule, set calorie number or macro nutrient goal, the better you will be at at figuring out what your body needs. For most people, we lose this ability at a very early age, because we are told to ‘eat everything on our plates because there are starving children in Africa.’ I feel sorry for parents actually, as almost everyone I know blames their parents for a certain lack of intuition around their eating. It’s not their fault. They were told the same thing.  The good news is, though, is that it’s not irreversible. We just have to start being more aware of what we eat (processed food which is quickly digested, low in fat or protein and not satisfying), how we eat (fast, slow), where we eat (at the table? in front of the TV?) and how much attention we are actually paying to what we eat (device use, TV etc). Here’s some quick tips about mindful eating. You can retrain yourself to listen to your body. It just takes time and effort, but it will be worth it. I’ve just ordered this book too – I’ve heard great things about it and think it will be a really valuable resource.

So back to snacks. Muesli bars, low fat fruit yoghurt and snack packs of Snax crackers are going to leave you hungrier than before you ate them. They are developed to provide the sensory pleasure to your brain that makes you want to eat more (called a Bliss point). They are also high in processed carbohydrate or sugar (especially that fruit yoghurt, these new yoghurt pouches have 4 teaspoons of sugar, around 3 of them from added sugar) which are just best avoided.

Here’s 31 other ideas in case you need some more inspo.

1. A couple of hardboiled eggs (boil a dozen at the start of the week and make your way through them. They’ll last a good 5 days unpeeled).
2. A couple of cooked chicken drumsticks (meat that is closer to the bone is far tastier and there are far more nutrients than just pure muscle meat).
3. Half an avocado, seasoned with salt and pepper.
4. Around 40g cheese (not Edam. Unless you really enjoy it! Full fat dairy has many important health benefits which for some reason got overlooked with the updated food guidelines. Didn’t they read my blog?
5. Meatballs – make these and freeze in single serve packs to have an easy go-to snack. Try my sesame miso meatballs.
6. Almost 4 ingredient chocolate chai brownie. No sugar added at all (I promise).
7. Raspberry coconut berry bites.
8. Lemon coconut lunchbox treat. Again, no sugar was harmed in the making of this deliciousness.
9. A scoop of protein powder with minimal added crap (such as Clean Lean Protein, Vital Health, Balance Natural Whey powder) + ½ cup of full fat Greek yogurt topped with berries. There are many better quality protein powders now available on the market. And while protein powders aren’t my go-to for every day eating, those people who are more active and require protein to support their lifestyle, OR for people who for some reason can’t or don’t eat animal source protein, they can be a good addition to the diet. However there are many CRAP products out there, with a lot of additional fillers, preservatives, additives for flavour, thickeners etc. Check the ingredient lists.
10. Half an avocado with 1/2 can salmon mixed in, lemon juice, salt and pepper.
11. Steam some greens (broccoli, brussel sprouts, beans) + drizzle with 1-2 tablespoons of olive oil or butter, add salt and pepper.
12. Vegetable chips (bit of prep) but thin sliced beetroot, carrot, parsnip, tossed in bag with 2 Tbsp olive or coconut oil + spice of choice OR salt/pepper – baked in preheated oven of 170 deg (350 deg far) for 10-12 min.
13. Tamari almonds from Alison’s Pantry. These are dry roasted, unlike many that you find that are roasted in vegetable oils.
14. A handful of Pure Delish cereal (look for 10g/100g or less sugar per 100g) – I love this cereal but to be honest, as a breakfast I’m not going to recommend it as a go-to. I think the brand itself is great, and perfect for tramping/camping as an easy breakfast option. But if you want to ensure you’re not going to go hungry, start your day with a bit more protein. This would fill you up but it is easy to over eat in order to feel satisfied.
15. The only plant that would survive a nuclear holocaust chips, like these Ceres Organics ones. Hello. Delicious, but wow – expensive! Obviously super easy to make these yourself (many delicious ways to do this).
16. Kelp leaves flash fried in coconut oil with salt (a great source of iodine, a mineral important for our thyroid function which isn’t easily available in the food supply for people who don’t enjoy seafood). This kiwi (and local to me!) product is seriously tasty.
17. Dried meat snacks (Biltong, bier sticks) – such as Canterbury I love Epic bars in the States but while some are made with quality NZ meat, they aren’t available here. It’s hard to come by a brand which is minimally processed, so definitely read the ingredients list. Jack Links (despite the great radio adverts which I think are awesome – is NOT a great product. When you try Canterbury V Jack Links, you can taste the difference too – alongside the addition of preservatives other than spices and salt, it is a sweeter product, with 20g of sugar per 100g product, compared to between 1-3g per 100g for Canterbury.
18. Crackers free of grains, such as Little Bird or Flackers – or make your own. Super simple and a lot cheaper too. There are a lot of variations to these, here’s mine.
19. Apple slices layered with a tablespoon of peanut butter + 1 tsp chia seeds mixed through
20. Meedjol date sliced lengthways, with salted pistachio nuts stuffed inside. This is small and not at all lower carb. Delicious though.
21. Large tomato, scoop out middle, crack an egg in, grate some parmesan cheese, bake in a 180 degree oven till egg is cooked.
22. The Vegery snack wraps: hello delicious! These would be a great lunch on the go or for a snack. Try the apple and coffee one with some peanut butter and grated carrot. Delicious.
23. ½ cup cottage cheese + ½ small sliced banana + a handful of walnut halves.
24. Rice paper (which has been dunked in warm water to soften, then patted dry, wrapped around sliced avocado, a slice smoke salmon, cucumber, grated carrot, snow peas.
25. Lightly toast a handful of sunflower seeds in a pan, then pop some into a pitted avocado half, salt + pepper. Delicious change of texture.
26. Cheese + sliced red pepper sliced wrapped in ham that has been sliced thinly off the bone.
27. ¼ cup hummus (ideally home-made, like Jamie’s one, he is awesome) + teaspoon of pesto in bottom of jar, carrot/cucumber sticks standing up in them. Try to choose a pesto that has an olive oil base, such as this Genose one – not one that is made on a canola oil base.
28. Apple slices cooked in coconut oil and topped with haloumi, a’la Sarah Wilson style.
29. A leftover sausage, split into half lengthways, with some cheese grated into it and mustard, heated in microwave.
30. A slice of my tahini chia loaf with avocado. Yum.
31. 2 squares of 90% Lindt with a teaspoon of almond or peanut butter. Decadent. You’re worth it.

And I’ve plenty of other ideas where these come from. If you would like more individualised help, check out my services page or sign up to my online nutrition coaching system – it’s free for 28 days for you to try!

PC: www. revive.ca

11 things you may not know about perimenopause (and 10 things you can do about those symptoms).

I know what you’re thinking. She’s too young to be writing about perimenopause, right?! Actually, no. I might feel 24 years old, but it only takes being around younger age groups to remember I’m not! Despite the ‘M’ word being almost a taboo, unwanted phase of life that some women fear (and men too!) it is a natural part of our lifecycle. What isn’t natural are the symptoms associated with menopause. Like premenstrual symptoms, the discomfort experienced through perimenopause may be common, but it’s not normal. This was reaffirmed in my mind when I listened to a fabulous interview with Lara Briden (naturopath who works with women with hormone imbalances, based in Sydney and Christchurch). A wealth of information who had some great information around why we can experience symptoms and (importantly) what we can do about them.

1. Defined as 10 years before going through menopause, practitioners often view this as highly variable, with women from 35 years to 55 years in this perimenopausal state. The average time spent here is around 4 years. Though, as with any ‘average’ this might not reflect your experience!
2. All hormone levels change during perimenopause. There is first a decrease in progesterone, which changes the balance of progesterone to oestrogen (some describe this as ‘oestrogen dominance’, though not all practitioners like using this term). Testosterone also declines, and this is an important hormone for sex drive. Finally oestrogen drops – and while we will continue to produce oestrogen (as this occurs not only by the ovaries but by the liver, breasts, adrenal glands and by fat tissue, it is at amounts of around 30-60% lower.
3. Oestrogen is a major regulator of a number of processes in the body, and the sex hormones and our glucocorticoid hormones (the most ‘known’ one, cortisol) are controlled by the hypothalamus -the part of our brain who is also the controller of our sex hormone regulation – therefore it makes sense that a change in one will result in a change in all of them.
4. Some of the main symptoms of perimenopause are
   1. Heavy periods
   2. Hot flashes
   3. Breast tenderness
   4. Worsening of premenstrual symptoms
   5. Lower sex drive
   6. Headaches or migraines (due to sudden removal/reduction of oestrogen)
   7. Fatigue
   8. Decreased sense of wellbeing (research shows that extended periods of low oestrogen, fluctuating levels of oestrogen and sudden withdrawal of oestrogen – via surgery or stopping oral contraceptive pill – is affected with lower mood)
   9. Irregular periods
   10. Brain fog and memory – oestrogen helps consolidate both episodic and spatial memory in the brain, and protects against cognitive decline as we age.
   11. Vaginal dryness; discomfort during sex
   12. Urine leakagewhen coughing or sneezing and an urgent need to urinate more frequently – due to oestrogen’s role in maintaining the vascular mucosa folds in the vagina, acting as a watertight seal.
   13. Mood swings (via fluctuating levels of hormones)
   14. Trouble sleeping
5. Some women are ABSOLUTELY FINE and sail through perimenopause. Generally, though, those that have been on the oral contraceptive pill are more likely to experience symptoms than those that haven’t. This may be due to the difference in the hormonal balance once the pill is removed. The pill provides large amounts of synthetic hormones, and it is a huge adjustment to go back to the normal (lower) levels of hormones. Approximately 147,000 women in New Zealand take the oral contraceptive pill, of which 80% of them are on a combined pill, delivering oestrogen and progesterone.
6. The types of hormones in the pill are synthetic and are not ‘bioidentical’ – meaning that the amounts are higher than what the body would produce AND they are in a form that the body can’t use. The pill doesn’t regulate hormones, it shuts them off.
7. During perimenopause, women can have fluctuating oestrogen levels due to variable concentrations of FSH (released by our pituitary gland in response to a low oestrogen environment – it isn’t necessarily all low oestrogen. This could also be a result of an inability to detoxify and clear out oestrogen metabolites.
8. A well-functioning liver is required to remove oestrogen from our body and prevent build up and associated symptoms. Our liver packages up oestrogen metabolites and removes it through our detoxification pathways. We need our inbuilt antioxidants to be firing, along with certain nutrients (selenium, B vitamins and glycine (not present in large amounts in the standard diet) to do this.
9. Many women going into perimenopause are insulin resistant (oestrogen has an insulin-sensitising role in the body and influences glucose uptake) – this partially explains the increase in body fat (particularly around the middle) that many women experience as they progress through. This makes it harder for their body to metabolise and use carbohydrate effectively
10. Many women going into perimenopause have a low thyroid function due to age-related changes in thyroid physiology. These include a reduction of thyroid iodine uptake, synthesis of free thyroxine (FT4) and free triiodothyronine (FT3) and the conversion of FT4 to reverse triiodothyronine (rT3). TSH levels may be slightly elevated. Luteal-phase spotting, or lumpy breasts may indicate this.
11. Your gut? SUPER IMPORTANT!!! The oestrogen might get detoxified (packaged up ready for removal) via pathways in your liver only to be unpackaged (deconjugated) again by nasty gut bacteria which pushes it back out into the blood stream as more toxic forms of oestrogen.

These 11 points may or may not have been news to you – certainly probably not to those experiencing some of the symptoms, or who have dug a bit deeper to determine the cause of the symptoms. This wasn’t a post for you to sigh in resignation and decide there is nothing you can do. Yes these symptoms and health outcomes are common – but (as stated earlier) they are not normal. Like many things, we normalise a lot of health issues because so many people experience them. We just think they are an inevitable process in ageing and moving into a different phase of life. Certainly (I gotta say), some health professionals don’t suggest otherwise so it’s no surprise many are led to believe this.

Some awesome tips from Lara as to how to start the process of mitigating symptoms – some are great DIY ones that you can put into action immediately; others will likely require the help of a practitioner who has a solid understanding of how our hormones interact – this may be your open-minded doctor, which is excellent – or naturopath, nutritionist or dietitian.

1. Limit alcohol consumption – it impairs oestrogen clearance rates from the liver and may be one of the influencing factors in the relationship between alcohol and breast cancer risk
2. Limit or omit dairy –dairy can increase oestrogen in the body, increase insulin release and the A1 caesin in dairy is pro-inflammatory and increases gastrointestinal inflammation (which could then push inflammation out to rest of your body).
3. Ensure adequate vitamin D status – optimal is around 100-150nmol/L which is required for the production of all hormones, and related to other hormonal issues such as endometriosis
4. Reduce intake of carbohydrate if following a higher carbohydrate approach, and get rid of processed, refined foods and sugar.
5. Eat your brassicas: broccoli, Brussel sprouts, cauliflower, cabbage – all provide di-indolylmethane (DIM) which targets certain proteins in our body that help reduce inflammation and balance hormones (particularly detoxifying oestrogen). Supplementing with this is also really helpful, but only once you establish that oestrogen clearance is an issue for you – super unhelpful otherwise (a practitioner can help you find this out – and there is a test I’ve started using with clients called the D.U.T.C.H test which is able to measure each hormone and it’s metabolites in much more comprehensive detail than a blood test alone.
6. Ensure a healthy gut: bloating, excessive gas, cramps and diarrhoea or constipation are not the normal consequence of eating (though they are extremely common). Keep a food diary to establish what might be causing your digestive upset by connecting your symptoms to your food intake. Work with a health practitioner experienced in the ‘real food’ digestive health to help not only heal your gut, but seal it too.
7. Turmeric in therapeutic doses (more than you can get from food) helps reduce oestrogen related oxidative stress, reduce prostaglandins (inflammatory biomarkers) – opt for one that is also combined with bioperine (to make it more bioavailable) such as this Good Health 15800 Turmeric complex. The alternative is one that says it is formulated to have smaller, more bioavailable particles, and the Meriva formulated varieties have this.
8. Iodine: low dose supplementation can be extremely helpful in supporting the pathways associated with thyroid hormone production which in turn affects the sex hormone production pathways. Again, talking to a practitioner is a good idea to establish your own requirement. However, 150 micrograms per day (and having 2-3 brazil nuts to balance this with selenium) is a safe amount.
9. SLEEP. Hands down, the most often overlooked yet important restorative, nourishing thing you can do to support your hormone health.
10. Meditation. Journalling. Yoga. Diaphragmatic and full belly breathing. Slowing down. Yep – stress reduction.

Regardless of if you are pre, peri or post menopausal, I think there is some excellent information here that will be helpful for hormones in general actually, and if you are experiencing some of the unwanted (and unnecessary in most cases) symptoms of hormone balance, this may give you some pointers as to how to combat them. Definitely check out Lara’s site for accessible and informative hormone related content.

Let this not be you. Or your mum. Or your wife. PC http://www.gazetteinterviews.com.

 

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