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.

One Simple Health Rule copy

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

Does HIIT take a hit on a ketogenic diet?

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

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

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

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

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

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

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

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

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

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Hungry?

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

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

Why do you fear being hungry?

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

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

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

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

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

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

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

 

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

Overcoming stumbling blocks on a ketogenic diet: a case study

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

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

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

Her diet:

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

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

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

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

Key issues I picked up:

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

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

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

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

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

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

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

Key recommendations:

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

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

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

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

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

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

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

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

Selection of healthy fat sources

Delicious, nutritious food regardless of your dietary approach.

Jan’s story: a real food success story

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

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

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

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

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

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

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

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

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

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

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

OR

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

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

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

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

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

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Delicious food! (PC: runningcompetitor.com)

Six things I think you should know about LDL cholesterol

Does bacon deserve the health halo it now seems to have in light of what is becoming common knowledge about saturated fat? Mm. Good question, and it probably comes down to context. If we were to position bacon against Flora Proactive, then that changes the question somewhat: which is better for your health? I mean, one is designed specifically to lower low density lipoprotein (LDL), aka ‘bad’ cholesterol (something we’ve been told for years to strive for) and is ridiculously expensive; the other is … well, bacon. Due to its saturated fat content (or perceived saturated fat, it contains less than 50% of its fat from saturated sources), it is always the second food which people think of when it comes to elevating cholesterol levels and causing heart disease – the first being butter.

Many clients come into my clinic with a total cholesterol above 5 mmol/L and are told by their GP that they should bring their cholesterol level down by way of eating low saturated fat, low total fat and reducing animal protein in their diet. OR (worse) go on cholesterol lowering medication (why is medication worse? Check out here and here). There are many things contributing to a higher cholesterol level, and the risk this poses to you is based on many factors. I’ve covered some of these (and what you can do about it) previously.

Here are 6 things I found useful to know about LDL cholesterol. I’m not talking about particle size, particle number, patterning of particles or Apo A or B, reverse transport cholesterol etc. Keeping it kind of simple. If you know more than your average Joe about cholesterol this will likely be a bit elementary. Otherwise:

  1. Most studies and media reports that report a reduction of risk of heart disease when taking cholesterol lowering medication focus on the relative risk. Relative risk – takes a small effect and it amplifies it. This makes the medication look far more effective than it actually is. Let’s explore what this means:

If you have a clinical trial whereby 100 people are given a placebo drug* and 100 people are given the experimental drug, you might find that 2 people in the placebo group go on to have a heart attack (2%), 98 have no adverse events. In the drug-treated group, 1 person has a heart attack (1%), and 99 people have no adverse events. The difference is 1%, however the relative risk reduction is 50% and a much more impressive number, don’t you think? Those reporting in the media certainly do.

  1. We need cholesterol to synthesise naturally occurring steroids in our system. It is necessary for life. It is the substrate for every sex steroid, for vitamin D, to make new neurons and new synapses to consolidate memories. Many people think cholesterol is in our body solely to clog arteries, and the lower the better. This is not the case. For example, in some populations a low total and LDL cholesterol are linked to higher incidence of depressive symptoms. A low cholesterol level may also result in less synthesising of vitamin D in the body, lower hormone production and an impaired immune system.
  2. LDL is an innate part of the immune system. When there is damage to the artery, you have susceptibility to infection, and there is evidence of pathogens present in plaques. When there is damage to the artery and artery wall, resulting in atrophy, there is an infusion of white blood cells as well as LDL cholesterol which work together to promote inflammation (for healing purposes). Blaming LDL for creating damage is like blaming the fireman for creating a fire.
  3. There is NO level of LDL that is unhealthy. There is an assumption that LDL cholesterol is inherently atherogenic and that above a defined level it is dangerous – there is something about the LDL packaging of cholesterol that causes heart disease. That’s not the case, and some experts in the field believe there is no level of LDL that should be treated with a statin. Researchers reviewing the literature have found people with high LDL with no heart disease. The cut-off of 4mmol/L or 5mmol/L depending on your reference point is an artificial distinction that has been created to suggest LDL is inherently toxic to the heart and cardiovascular system. Now there are people who have a genetic predisposition to storing cholesterol, so they have an increased risk? Actually research looking at the lifespan of people with familial hypercholesterolemia (FH, a mutation in the LDL receptor whereby the end result is elevated LDL cholesterol) have found that, aside from a subsection of the population, there is normal lifespan, with just a small number of these people going on to develop heart disease. There are people who have other genetic variants which do result in build up of LDL cholesterol, and we don’t know enough to say that a very high LDL level is NOT dangerous – however the likelihood of harm will be increased with the presence of other risk factors for cardiovascular disease, such as high blood pressure or smoking.
  4. It is not LDL that is causing heart disease. Blood cholesterol (including LDL) is high in people consuming a higher fat diet. However, research shows that other biomarkers are not only fine, but can be improved when transitioning to a higher fat diet from the standard western diet. A recent paper found that people 60 years and older who have the highest LDL live as long or even longer than those with low LDL. They have lower rates of cancer and lower rates of infectious disease.
  5. If it’s not LDL cholesterol, then what is causing a heart attack? A critical trigger factor is coagulation. We rely on the coagulation factors in our bloodstream to create a clot when we become wounded and begin to bleed. However, our blood can clot without there being a wound. High stress, tobacco smoke, high blood sugar all trigger clotting mechanisms. It looks like this:
    1. In our artery wall, there are tiny arteries which feed to the inside of the artery (called vasovasorum).
    2. Vasovasorum are easily blocked or clogged by clots.
    3. If these can’t feed our artery wall, the wall essentially becomes hypoxic and the tissue dies.
    4. When the tissue dies, the LDL cholesterol comes in to repair it, and this happens repeatedly, causing the artery wall to become thicker and thicker until it chokes the artery.
    5. When you combine this thickening of the artery wall with something that might trigger clotting of the blood (such as high blood sugar, smoking or a stressful or emotional event etc), a clot will pass through the narrowed artery,
    6. The clot will eventually block the artery entirely and the result is a heart attack.
    7. None of this is caused by LDL cholesterol.

What really matters is keeping your clotting factors inactive until they are needed. Most people (unless they are haemorrhaging) don’t need their clotting factors on high alert all the time.

So, which is better for your health? IMO – while bacon may not be a health food, I’d choose it over the Flora (preferably free range, minimal added preservatives, along with an abundance of vegetables). Flora doesn’t have a lot going for it, TBH, and while it may lower your cholesterol level, how important is that really? If your cholesterol levels are high and you’re not sure of your risk, get in contact with someone like me who can work with you to address the lifestyle factors that might be driving up your cholesterol levels and contributing to health risk.

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This bacon isn’t preservative free, however it’s the only one I could see that had less preservatives and was free-farmed, so using it as an illustration. Henderson’s is free of preservatives but only select supermarkets carry their free-farmed variety FYI

 

Fuelling the fat-adapted athlete

On August 1st I’m releasing my athlete-specific meal plan, which is a long time coming given that I consult with many endurance athletes! It’s hard to be specific with a general plan, clearly, particularly when it comes to training nutrition, so when you sign up I encourage you to contact me to see if we need to tweak the elements of this plan to suit your training.

The goal of an athlete training plan is to provide fuel where required, be strategic about the type of fuel and when to have it. I want to help make you a more efficient athlete – so your training and recovery is optimised to enable you to get out there day in, day out in the best possible shape. This will allow you to show up to the start line (or game day) in the best position to do your best. Like recovery, nutrition is vital to enhancing fitness gains from your session – eating the wrong types of food increases oxidative stress and dampens down your immune system, leaving you susceptible to inflammation, illness and injury. If you don’t recover effectively from the previous training session, your ability to get out the next time and hit certain paces/power is compromised – therefore overall fitness gains aren’t realised and you may not reach your potential awesomeness. I’ve written about this previously in more detail here.

To be metabolically efficient, we want to be strategic about when and how we have our carbohydrate, how much we have and the quality of the carbohydrate source. That is why in the plans I focus on adding fruit, kumara or potato after training if the training requires additional carbohydrate to support recovery. By removing carbohydrate from the pre-training meal/snack, we don’t have an insulin response that will drive circulating glucose (what carbohydrate is broken into) in to your muscle cells, shutting down lipolysis (fat burning). The body will be forced to use alternative fuel sources such as fat which, as an endurance athlete, we should be primed to do. The reality is, though, the modern diet that a typical athlete follows has made sugar burning the default training state, even at low intensities. Even the leanest marathon runner has enough fat calories on board to go out and run back to back races – accessing this though is the problem! Fat as a fuel source creates a lot less oxidative damage and reactive oxidative species, thereby the inflammation you experience post-training is reduced, recovery is enhanced, and you’ll be able to hit the next session fighting fit. We need to adapt from a carb burner to a fat burner for you to go out and train and not risk bonking or running out of fuel. The switch over doesn’t happen overnight, and if you’re new to this approach then training can feel pretty sluggish to begin with – but hang in there as it does get easier!

There are different approaches to fuelling depending on your goal:

Pre-training

If body composition improvement is your goal, it is best to do fasted training sessions or use coffee/caffeine as an ergogenic aid and fuel afterwards. This doesn’t mean that you’ll lose MORE body fat than if you were just to reduce calories, but it will force your body to tap into its own reserves, which (when combined with this dietary approach) I’ve clinically seen helps accelerate fat loss in the context of this eating style. For extended, longer duration >3h+ then having some fuel (as suggested in plan) can be a good idea, or starting fasted and taking on board fuel after 45-90 minutes depending on session is optimal.

If you are happy with your body composition or do not want to drop any body fat, then you can choose to take on board some fat before training – such as cream in coffee, MCT oil powder in coffee, or ketones. By fueling before training, you will shut down your own fat oxidation, but be upregulating pathways for fat oxidation, however it will be burning the fat that you consumed. This option is also good for people who have higher cortisol levels – training in the absence of any fuel can further exacerbate the ‘stress’ response from your hypothalamus (brain). Taking on board some calories sends signals to your brain that there is no need to stress. Taking the ketone supplement has been found (compared to fasting) to upregulate fat oxidation at lower given intensities; once the intensity rises to a high intensity, the opposite may be true (potentially due to the ketones being used to spare glycogen at the higher intensities).

If you struggle to maintain your weight and need to work at keeping calories high, then adding in some additional protein alongside could also be a good option – this could be a couple of hardboiled eggs, some scrambled eggs, additional fat-based calories or a smoothie based on nuts, avocado, some protein powder, coconut milk, greens, with no fruit). Again, this will provide a minimal insulin response, meaning your body will be burning the fuel you provide it (fat calories) and therefore working towards improving metabolic efficiency.

In all instances above, 10g of branched chain amino acid powder can help fuel a longer session – just mix in water beforehand.

In a perfect world, the best type of training to do if you are new to this is low intensity training; this is because your body needs to relearn how to burn fat as its primary fuel source. The ultimate goal down the line is to become metabolically flexible (ie easily shift between both sugar burning and fat burning) – and that will happen! That means the natural switch over to burning sugar that occurs when training at higher intensities will not impact on your fat-burning capabilities at the lower intensities. Right now, though, if it’s all new to you, your default is to burn glucose at that high intensity. Any shift back into glucose burning at this stage will impact on your ability to burn fat and can leave you in no-mans land when it comes to training. What I mean is, you are following a lower carbohydrate approach to diet, so there is no glucose on board as a ready source of fuel, yet you are too high intensity for your body to use fat as a primary fuel source (at this stage). No mans land.

However, it rarely happens that an athlete is always training low intensity, even in their off season. Therefore supplementing with an exogenous ketone supplement (such as Pruvit) provides your body with fuel the way a carbohydrate gel provides glucose. Ketones are the byproduct of fat metabolism, and when you burn fat as a fuel source, your body generates these to support metabolism. At a high intensity if you’re new to this, taking exogenous ketones provide you the fuel to enhance fat oxidation before your body has the machinery in place to do it for you. Otherwise the intensity will force your body to switch back to glucose burning. Remember, in the initial phases of your fat-fuelled approach, your body has to upregulate the machinery required for fat adaptation – it isn’t the default fuelling response. Any opportunity to switch back to burning sugar, it will take it.

Taking the ketones (along with MCT oil powder) will provide the fuel you need for the training without the need to use glucose, and is recommended in this instance. Further, ketones aid in recovery from longer sessions, and most athletes I work with who use them experience reduced inflammation, less excessive hunger, and can go for longer at a higher given intensity without an increase in their heart rate or perceived effort. Most have also experienced improved body composition due to these reasons. My recommendation is to have ½ sachet of the ketones and you can include 10g of MCT oil powder with it prior to your session.

During training:

 Shorter training up to 2h, low-mod intensity

Nothing – perhaps water, or an electrolyte fluid (no carbohydrates required*)

 Medium length from 2-3h low-mod intensity

Evaluate how you feel, take some MCT mix (see below), Superstarch (30g/hour in 750 ml bottle), ketones as below (sachet in 750ml bottle, 1/3 bottle hour), otherwise just electrolyte fluid.

Longer training: over 3h

36g MCT oil powder + 20g BCAA + ¼ tsp salt in 750 ml bottle OR sachet ketones, 18g MCT oil powder + 20g BCAA in 750ml bottle – ¼ bottle per hour AND every 45 minutes have something small, solid, food based: ¼ – ½ Cliff bar, 30g cheese, hardboiled egg, small handful cashews, ½ UCAN superstarch bar, homemade bar (such as apple pie blondie).

If including high intensity intervals

Try carb rinsing: 5-10 minutes before starting effort, have a glucose tablet, thereby trickling in carbohydrate – this method tells your brain you’ve had carbohydrate onboard without taking anything on. OR have sachet ketones in drink bottle as above.

*may need something if getting into it for first time, and suggestion is the ketone supplement here to help aid the fat oxidation pathways.

 Post-training

If body composition improvements are a goal, train around your meals so you don’t need to eat in addition to them, also can create a ‘train low’ environment by withholding food for around 45-75 minutes to further enhance fat oxidation. If higher intensity effort, include 10g BCAA powder in water post-training to preserve muscle mass.

If happy with body composition, then you can do as above or add in a protein shake with around 25g protein, use unsweetened almond milk to help provide calories and preserve muscle mass. Having the other ½ of your ketone sachet here can enhance recovery. Include 10g BCAA in water post-training to preserve muscle mass.

If you struggle to maintain your weight (or you are training hard again in next 8 hour period), then adding in the protein shake as above, plus serve of good quality carbohydrate such as kumara, potato, a piece of fruit can provide calories plus easily digested fuel to support recovery. Including the other half of your ketone sachet here can enhance recovery and include 10g BCAA in water post-training to preserve muscle mass.

In all instances, if the training is long, then I think the benefits of post-workout fuel outweigh ‘train low’, especially if you have a heavy or longer session the next day as a lot of ultra runners or triathletes do.

This isn’t definitive, and someone else will have a different approach, however these are generally the guidelines I have used that work with clients and that may work with you.

Remember, though, the best way to get fat-adapted is to adopt a daily diet that supports fat metabolism – click here to sign up to my plans and use the above guidelines to support your training.

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The fuel I used pre-half marathon at the beginning of my marathon training program: 1/2 ketone sachet, MCT oil powder, coffee and PB.

No willpower when it comes to food? Read this.

‘ The chocolate bar calls my name. No, really – I can’t NOT eat it if it’s in the house.’

Many people I talk to lament that they can’t control themselves when it comes to sugar or junk food – that they don’t have the willpower to say ‘no’ despite their best efforts. This implies that they have all the control. Now I’m not saying there isn’t an element of discipline that may initially be required when changing the way you eat, especially for people who have lost touch with their appetite and satiety signals which can happen when the food eaten drives unfavourable hormone responses in the body; a phenomenon which is common in the current food environment. However, there are other more powerful forces at play here. Your No physiology has far more say in your food decisions than you think, and I’m going to cover one of the main ones I see (and one of the easiest ones to correct) that will help people control their food intake, rather than let their food control them: the blood sugar rollercoaster

This is one of the biggest drivers of cravings in my experience. The type of diet that many people follow is either carbohydrate heavy or devoid of protein and fat. Both situations are going to set your blood sugar up for rise and fall of (what can be) epic proportions. When carbohydrate is broken down into the bloodstream into glucose, this takes our blood glucose level out of homeostasis (normal). One thing our body likes is homeostasis – a blood sugar level too high or too low will send signals to the brain that this needs to be corrected. The greater the fluctuation, the louder this signal is. Insulin is the hormone responsible for removing glucose from the bloodstream to be used immediately for energy or to store it for later use (in our muscles and liver) and return the blood glucose level to homeostasis (normal). However, a meal that has a large amount of carbohydrate (a high carbohydrate load) will accelerate this process, as will a meal that has minimal protein or fat (even with a lower carbohydrate load, as the proportion of carbohydrate will still be greater). This is because insulin responds first and foremost to carbohydrate, with a minimal response to protein containing foods, and (for most people) a negligible response to foods predominantly containing fat. When this process is accelerated, insulin moves too much glucose into cells and our blood glucose level rapidly drops to below normal (an over-correction). The signal to our brain therefore becomes a panic signal: blood sugar has dipped below normal and needs to be rapidly restored – enter sweet food cravings as our brain recognises these foods are going to return our blood glucose levels back to within that normal range much quicker than, say, a salad. Along with the cravings, we may experience ravenous hunger (where 15 minutes earlier you felt fine), irritability (‘hangry’) and (in particularly bad cases) dizziness, light-headedness, sweating and vision loss.

The quicker the carbohydrates are digested (especially in the absence of fat and /or protein), the higher the rise and fall in blood sugar, and the greater the effects on energy and subsequent cravings for food (and ‘lack of willpower’). You may be fine for the morning and rapidly cave in post 3pm. Or it might be that Monday and Tuesday you are sweet, but by Wednesday you are raiding the kids ‘treat’ box in the pantry.

This isn’t just an issue with regards to blood sugar management and fat loss goals, but more importantly it can make you feel pretty rubbish. So many people start a tirade of negative talk that they weren’t able to say ‘no’ to a paleo muffin or chocolate biscuit, that they have ‘failed again’ and they ‘may as well finish the entire packet as it’s the last time they’ll eat X food again.’ Or their inability to resist a sweet treat clearly indicates they aren’t worthy of whatever health goal or life goal they’ve set themselves, and will eat junk food as a form of punishment (or undereat to try to get it under control), and so starts the rollercoaster ride of the blood sugar crash.

While I’d like to say it’s really easy to figure out which foods are most likely to cause this process, recent research tells us that there is wide individual variation. You are your own best investigator when trying to figure this out. It is useful, of course, to know where carbohydrate comes form in the diet and starting to explore how these foods affect you specifically. You can use an app like Easy Diet Diary, My Net Diary, Fat Secret to help you determine where the carbohydrate is in your usual diet if all of this is new to you. That said, an energy dense, carbohydrate source is more likely to trigger a blood sugar response. These include (but are not limited to):

  • Dates
  • Other dried fruit
  • Honey
  • Rice malt syrup
  • Bread
  • Pasta
  • Rice
  • Cereal (including Nutrigrain, Cheerios, most cereals with a Health Star Rating)
  • Honey
  • Coconut sugar
  • Kumara
  • Potato
  • Grapes
  • Fruit juice
  • Vegetable juice with a fruit juice base
  • Vegetable juice with beetroot/carrot base

This doesn’t mean that all of the above choices are bad! At all, however, in the wrong amounts, and when eaten in isolation of other food choices, these are more likely to spike your insulin levels than other foods. Artificial sweeteners do not get a free pass either, unfortunately, with some showing the same physiological effects as sweet foods, eliciting a glucose/insulin response.

So… it’s not willpower, people – it’s physiology.

The easiest and *best* way that helps mitigate this is NOT a supplement. While these can be useful in certain situations or medical conditions, for most people it comes down to food timing and balancing. Protein and fat don’t have the same insulin effect, so they are not going to cause the same blood glucose rollercoaster that carbohydrate does. Incorporating these as the majority of your energy source is going to slow down the digestion of the carbohydrate you eat and the subsequent rise in blood glucose. Without reaching the same ‘highs’, your blood glucose doesn’t have the same drops – and cravings, hunger and crashing energy levels are FAR less likely. Fibre from non-starchy vegetables are another way to have this effect and help maintain a homeostatic state.

Despite what I say, what other experts tell you or what the literature or dietary guidelines tell us, you are your own best investigator when it comes to figuring out what works for you. One of the easiest ways to measure how food affects your blood sugar control is to assess the qualitative signs after eating: do you feel like falling asleep after a carb-based meal? Do you get moody, irritable, ‘hangry’ a couple of hours after eating? Are you fine, fine, fine, STARVING a few hours after eating? These are all good indicators that your blood sugar is in control of your actions (rather than you). From a quantitative perspective, getting a glucometer (finger-prick blood glucose reader) from the pharmacy and testing your blood sugar two hours after eating a particular food or meal is another good way to see how this affects your blood sugar levels. If it lurks above the 7 mmol/L mark at this point, then potentially the carbohdyrate type (or the context with which you ate it) isn’t ideal for you. Remember, this isn’t just about the food you’re eating at that time, it has implications for your food decisions later in the day. This is potentially more important if you find you have ‘no willpower.’ If you need help figuring out what to do from here, contact me for a consultation, we can sort it out.

Finally, pro-tip: when eating a meal, eat the protein and vegetables before tucking into the carbohydrate component. This will lower the post-prandial glucose response and the overall effect on your energy levels, levelling them out as opposed to leading to a crash.

Random porridge post

I have been having a bit of a hankering for porridge – it’s cold and winter, after all. But I’m one of these people who, after having oats, has a blood sugar plummet within an hour – even with a decent hit of protein powder added which should help stabilise my blood sugars and keep me full.

So over the last few years I’ve been having some porridge alternatives. Here’s five that I have found to be quite delicious that I mentioned on our Fitter Radio podcast.

(PS Have loads more like this (and completely different ones!) – sign up to my monthly meal plans and online nutrition coaching to get plans, recipes, shopping lists and access to my brain through a messaging service, emails and a Facebook member’s page 🙂 )

  1. Flaxseed chia porridge: good fats, good protein and will keep you full
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Flaxseed chia porridge

2. Banana chai porridge: a nice spicy sweet start to the day (you won’t notice the cauliflower)

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Banana chai porridge

3. Almond butter porridge: grain free and filling

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Almond butter porridge

4. Lewis’ chia porridge: fuelling an endurance athlete who has type 1 diabetes since ages ago

5. Walnut chia porridge: seriously delicious, you won’t be missing oats with this one

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Walnut chia porridge

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 🙂 ).

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