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!)

The Plews on racing LCHF

Last week I detailed Kona Ironman age-group champion Dan Plews’ daily and training nutrition using a LCHF approach. How does this change in the lead up to an event, and what does he do on race day?

Like conventional sports nutrition principles, there is somewhat of a carbohydrate loading phase pre-race. This isn’t the 500-600g of carbohydrate that is recommended for most athletes in the three days before (which generally leaves an athlete feeling lethargic and bloated), however it is more than he would generally eat. Don’t forget that tapering for a race is, in effect, carbo loading, as the muscle glycogen stores are not depleted during training and it allows them the chance to be replenished and not in the deficit they normally are. Based on Rowlands paper which showed that a higher fat diet with a preload of carbohydrates, he’s dialled in his approach that Dan now feels works really well for him. He lifts his carbohydrate intake from the 80-100g he typically eats in the days prior. On the Wednesday (for a Saturday race), he will include additional potato or sweet potato in his evening meal, taking him to ~125g carbs per day. This increases to ~175g per day on Thursday and Friday (the two days before the race) – including fruit alongside the potato or sweet potato. In addition, he makes sure snacks etc on hand are low carbohydrate so  not to be caught out during the lead up period with having to rely on the petrol station or four square options. If you do have to rely on these, and are looking for lower carbohydrate, then biltong, cheese snacks, even lower carbohydrate protein bars can be good stop gaps. On race morning before Dan’s Kona race he opted for was porridge: oats with a bit of Super Starch added, which is a slow release carbohydrate to not inhibit fat burning, and is a higher molecular weight carbohydrate, so it is easier to digest.

During the race:

Despite research studies in this area using a ‘train low glycogen, race low glycogen’ model to determine the efficacy of a LCHF approach for sports performance, in practice Dan follows what practitioners advocate: a ‘train low, race high’ model. Ideally, the train low approach has enabled you to increase your efficiency to burn fat as a fuel source in addition to using carbohydrate that you have stored or take on board, thus maximising the amount of fuel you have available. Dan takes in around 50g carbohydrate per hour;  because he is very efficient at burning fat, he doesn’t need as much carbohydrate as he would otherwise. A real benefit of this is that it minimises the likelihood of gut issues many endurance athletes experience during a long event – the more carbohydrate fuel you have to take on board, the more opportunity there is to get the dose wrong. Importantly though, the more fatigued you become, the more your body will divert blood supply away from the gut to the muscles, and thus impacting on your ability to digest the fuel.  During Kona Dan used energy blocks with gels on the bike, and a couple of gels with some swigs of sports drink or coke during the run. His paper Different Horses on the Same Courses outlines how to take this individualistic approach to fuelling, as will his online course that you can sign up to by clicking here.

Finally, post-race, Dan gets back on board the LCHF approach fairly swiftly, as he has seen the impact that a higher carbohydrate fuelling day has on his blood glucose level across the course of the following week. It certainly doesn’t reduce down to normal levels the day after, and it’s likely that inflammation and muscle damage impacts on this too. Your best bet is to (as soon as possible) get back to your LCHF diet and help your recovery process.

LCHF for the top end:

Whilst LCHF is increasingly more accepted in the endurance space as part of the approach, what about at that top end – does it limit performance there? There is very little quality research on this, however Dan’s research group found that there was no detriment to perform high intensity intervals (as I blogged about here), but the jury is definitely out on this point and I wonder if, like many things, it is individual. A person’s ability to metabolise fat as a fuel source and use it at a higher intensity is trainable for sure (that’s what fat adaptation is all about), but there could be individuals who are less able to produce ketones to be used for energy – this is speculation though on my part. Yes, there is a down regulation in pyruvate dehydrogenase which helps turn stored carbohydrate into glucose for energy, however the importance of this is questionable given the increased availability of fat for fuel, and there may be other enzymes upregulated to counteract this change in the fuel use. A potential way around this issue (and to ensure glucose metabolism is continued on your LCHF approach) is to do higher intensity efforts in training that force liver to convert glycogen to glucose – thus keeping glucose oxidation pathways high. I’m also beginning to recommend that people take on a small amount of glucose pre-high intensity sessions if they are beginning the fat adaptation phase during a training cycle that incorporates higher intensity efforts. Ideally your fat adaptation phase will occur during base training when we can keep intensity low. But that isn’t always possible. Fifteen-20g glucose prior to training for these high intensity sessions can keep output high but is unlikely to be enough to “ruin” your adaptation process. Again, there is no research behind these numbers, but from a practice perspective I’ve seen this work well.

Finally, you know I’m an advocate of ketones to help support training whilst lower carbohydrate, and it certainly has helped me and many of my clients. We don’t at this point know enough about ketone utilisation in the body and whether taking exogenous ketones downregulates the body’s ability to produce them. This is an emerging field we are looking at with interest with regards to dosage, timing, type of ketone supplement etc. There has been decades of research into carbohydrate as a performance enhancer, and we can probably expect that it will take a few years of research for these questions to be answered in the science research space. Trying them yourself is likely the best approach to see how they impact your own performance (and I can help you with that).

Plews at Kona (PC http://www.trizone.com.au)

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.

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

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

Flaxseed chia porridge

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

Banana chai porridge

3. Almond butter porridge: grain free and filling

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

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 🙂 ).

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

LCHF…why isn’t it working for me? (Part 1)

It’s about this time of year that I start seeing people come through my doors needing some minor (or major) tweaks to their LCHF eating approach. There are usually one of two scenarios.

Scenario #1: When they embarked on LCHF they saw ALL of the benefits they heard about, effortlessly shedding body fat, boundless energy (in training and afterwards), improvement in skin tone, hair condition, sleep and digestive problems. But lately the opposite is true. Despite seemingly nailing this LCHF lifestyle, they’ve noticed they are lacking energy, gaining weight (especially around the middle), latest blood tests have seen their cholesterol levels have shot up (and perhaps triglycerides), they are unable to sleep… … yet if anything, they’ve instigated (and nailed) the hacks they’ve read to optimise their LCHF eating approach. What gives??

Scenario #2: They’ve given it a good go on their own for the last 5 weeks, following it to the letter and despite this, it’s ‘not working for them.’ Worse, their husband/workmate/training partner has taken to it with ease.

Frustrating, much?

While we are all individual as to what is going to work for us, the LCHF approach is a really good one for most people, most of the time. Despite that, there are small things that can derail your best efforts to improve your diet, so I want to cover off the basic (and more nuanced) reasons people don’t fare well on a LCHF approach, and some tips on how to overcome them. I’ve ended up splitting this post into two parts as it was so long!

1. Too low carb. The internet is a wonderful and terrible thing – information is everywhere, everyone is an expert and the version of paleo/LCHF/JERF that you’ve adopted based on what others are doing may well be too low carb for you. LCHF is a spectrum, and what is low carb for one person may well be higher carb for someone else – generally speaking, anything up to 200g of carbohydrate/day could be low carb. It all depends on context. I see a lot of people who are trying to stay strictly below 25g of carbohydrate a day – too strict (and unnecessary) for most people. Even Prof Tim Noakes, staunch advocate of a LCHF approach to eating (“banting”) has loosened up on this. The people who really benefit from a diet this low would be those embarking on it for therapeutic reasons: diabetes (both types), epilepsy, cognitive health (Alzheimer’s, for example). That’s not to say that others out there can’t make this level of carbohydrate work for them. But if you’ve noticed fat gain (especially around the middle), irritability, hormone imbalances (such as a missed menstrual period), lack of energy (past the initial phases of the LCHF approach), irregularity of bowel motions, sleeplessness – to name a few symptoms, then you may have gone too low. What to do?
   1. Track your diet for 4-5 days to get an average of the grams of carbohydrate you eat per day. If it’s on the very low end of the scale (less than 50g*, for example), then try adding back in some good quality starch to see if any of your symptoms improve. Don’t be pedantic about vegetables. Really. That includes carrots and tomatoes. To be honest, you don’t have to track your carbs if you’re not a numbers person – but it can be a good way to assess if this really is the problem. Use My Fitness Pal, Cron-o-meter, My Net Diary or Easy Diet Diary as nutritional tracking tools. (If you’re embarking on a lower carb diet, this is a good first step regardless, so you don’t make the jump from 400g a day to 60g a day).
   2. If your carbohydrate intake is in the realm of 80-100g carbohydrate, you may not be too low, it might be more of a timing problem – ensuring you have carbohydrate in the meal after a high intensity (i.e. CrossFit or F45) or long duration exercise session can help improve recovery and alleviate a lot of fatigue/irritability. If you’re struggling with insomnia, then adding in some kumara or potato into your evening meal increases production of precursors to melatonin.
   3. Is it more protein you need? Protein can help keep you fuller for longer, stabilise blood sugars (therefore has implications for focus/energy/concentration), promote recovery and help with sleep. Many people fear protein because of the potential for it to be converted to glucose in the body (via gluconeogenesis). For someone following a LCHF diet this isn’t an issue. Try upping your protein portions by 1/3 – ½ at each meal.
   4. If it’s in the initial phases, then up your intake of sodium – to levels more than you think you need. When we drop the carbohydrate content of the diet, we drop a lot of water stores too (hence a rapid loss on the scales) – this is because for every gram of carbohydrates stored, we store an additional 3g of water. Add salt to your meals, a pinch in your water bottle, make a miso drink or drink bone broth.
2. Not low carb enough. I see this a lot. People equate carbohydrate to bread, pasta, rice and cereal and don’t think about other foods that are predominantly carbohydrate –fruit, dried fruit, ‘green smoothies’ with a fruit base, bliss balls, natural fruit and nut bars… In addition, many products are promoted as ‘sugar free’ when they contain dried fruit, maple sugar, rice malt syrup or some other type of natural sweetener. This may seem elementary to you, but I know many people are confused by this point. Regardless of what you hear, sugar IS just sugar – that one sugar is lower in fructose doesn’t mean it’s not going to influence your blood sugar levels, it’s likely to affect them more. This has to be my biggest bugbear of the ‘real food’ movement; not that these products contain sugar – but that they are marketed as not. This is no better than being told that Nutrigrain is healthy. We all know that’s not true.
   1. Again, track your numbers (as per above) via a tracking tool. A lower carbohydrate approach is not a fixed number, it’s a spectrum. But if you’re still consuming over 200g a day and not engaging in regular physical activity, then something might need to be tweaked (especially if you’re not seeing the results you’re after).
   2. Get rid of the bliss balls, the dried fruit, the paleo muffin or the smoothie from your favourite juice bar that you thought tasted suspiciously sweet for something ‘green’.
   3. Read the ingredient lists on the packages you buy. Sugar has over 56 different names. You probably don’t need to know them all, but it would be good to have an idea, right?
3. Too many processed foods or snacks. Even if you’ve found a sweet spot with your macronutrient intake, having too many processed ‘low carb’ snacks can continue to drive your appetite hormones in a way that favours eating more than you need. Leptin is a hormone produced by fat cells that tells the body when we’ve had enough to eat, and is involved in the regulation of calories we burn and body fat that we store. A consequence of being over-fat is high circulating leptin levels in the bloodstream, and the brain stops reading signals sent by leptin that we’ve consumed enough food. Instead, it incorrectly believes that we are starving, thus we feel hungrier. Excess body fat increases Inflammation in the body, and is one of the drivers of leptin resistance, and processed food can drive inflammatory pathways in the body – even low carb processed food. And if you’re not over-fat? Well, vegetable oils and certain additives and preservatives found in these foods can drive inflammatory pathways in the body. In addition, an overabundance of processed flours may cause disruptions to our gut microbiome as they are easily digested, perhaps not even making it to the gut bacteria in our lower digestive tract. This can mean we are starving our good bacteria and instead feeding bacteria that release endotoxins, causing increasing inflammation. This can have a secondary effect of increasing your cholesterol level (see this post here). These foods are created in such a way to send signals to your brain’s pleasure centre and drive your appetite for more food that you just don’t need. One of the benefits of a real food approach (which naturally lowers your carbohydrate intake) is that inflammation reduces, insulin drops, gut bacteria can rebalance and the signalling pathways in the brain that regulate your appetite hormones can begin to normalise.
   1. Get rid of most foods or snacks that come in a package with ingredients you don’t recognise.
   2. Eat real food. Base your snacks around hardboiled eggs, cheese (for the dairy tolerant), vegetables, leftover meat, macadamia nuts, egg muffins.
   3. Drop the nut flours. Just because they’re low carb does not mean it’s a free for all with these processed flours.
   4. Increase foods that help balance out your fatty acid profile: more fatty fish (such as salmon, mackerel, sardines) and (grass fed) meat for omega 3 fats. Consider taking a fish oil or algae omega for those who don’t eat fish – and be picky about the supplement!
   5. Take care of your gut: consider a probiotic for 30-60 days (such as Lifestream Advanced, Inner Health Plus, Syntol or Prescript Assist) to help populate the gut with the good guys, but also keep them fed with fermented foods such as sauerkraut, raw apple cider vinegar, water kefir and an abundance of vegetable fibres.

I’ve got more – quite a bit more actually! – but will post that in Part 2 so as not to risk losing your attention ;-). These are three of the basics that people can get wrong (particularly in the initial phases), and the next post will cover some of the more nuanced reasons, and what you can do to correct them. If you’re not sure whether your LCHF diet is working for you, why not jump on and book a consultation with me? An expert eye can help take the thinking out of it for you and save a lot of stress long term.

*50g still pretty low actually! Again, it’s all context 😉

Are you in the zone? (PC: http://www.tripfitness.com)

Constant cravings? Here’s 18 evidence-backed (or anecdotal) tips that will curb them.

Are you back into the swing of things but your taste buds aren’t?  It happens! Especially around this time of year where intake of sugar, alcohol and processed carbohydrates tends to be higher for most people, and while going cold turkey can be the best move, it’s sometimes easier said than done. The good news is that by reducing these foods, you’ll begin to lose the taste for them, and they’ll no longer hold the appeal that they had. For some though, completely removing them is a better idea – even small amounts can continue to drive the appetite for them. Regardless of which camp you fall into, here are some proven, some anecdotal, and some interesting ways to combat those cravings.

1. The basics: build your plate based around protein and fibre, with fat for satiety. Protein is well known to be the most satisfying nutrient, and along with fibre (also key for adding bulk and feeling full) will keep most people satisfied longer than either carbohydrate or fat. Any starchy or carbohydrate-based foods are best if they are minimally processed (such as potatoes, kumara, legumes, fruit) as these will provide more nutrient bang for your buck). How much of each? Protein-type foods (meat, fish, eggs, poultry) aim for 1-2 palm-sized portions. Starchy carbs (if included) at around a fist-sized amount.  Fat? 1-2 thumb-sized amounts, depending on the type of protein portion you’re eating: a fattier cut might be satisfying enough, however a lean chicken breast will likely require some added fat to help satisfy you. And vegetables? Go for gold – other than the starchier varieties (mentioned above) you could fill your boots with these. For some people, having a full plate is essential to feeling satisfied and if you can do that by adding more volume, it is going to have a positive effect on the satiety from a meal (that’s definitely me). For some ideas, check out my recipe e-book or my online coaching service.
2. Get rid of anything that is ‘your poison’- if you are the person that hears the icecream calling you from the freezer, it is much better off out of the house. Out of sight, out of mind.
3. Put all the ‘treat’ type food in one place in your house, preferably above eye level. This will save you seeing the Christmas cake when you are grabbing the eggs, and the chocolate almonds when you are searching for the bottle of olive oil. Constant reminders of all the things you are trying not to eat will NOT help your cause.
4. Chew your food properly at each meal. Aim for 30 times per mouthful. That way you’ll digest your nutrients effectively, feel more nourished and less likely to be hungry an hour after eating because you wolfed that meal down.
5. Do not substitute those refined sugars for ‘natural’ sugars. That dried fruit is pretty much just sugar – and (a few nutrients and fibre aside) no better than sugar and will continue to drive your sugar cravings. You shouldn’t rely on dried fruit (or any sweet food that is marketed as ‘refined sugar free’) as a substantial nutrient source . Any additional fibre or nutrients they provide in the diet is negligible compared to the whack of goodness you’ll get when you follow #1 above. When health bloggers or food producers market something based on the healthfulness of the ‘natural’ sugar, it is pure embellishment. 6 meedjol dates and a banana does not make a smoothie sugar free.
6. Coconut oil – this is a favourite of Sarah Wilson’s: a teaspoon of extra virgin coconut oil can kill a craving in its tracks. If we head to the literature to find any peer reviewed papers on the topic (for what it’s worth, there is a LOT of research published by the Coconut Research Center), there isn’t a lot to definitively tell us that it will cut cravings. That said, there is some research has found that people who include more coconut oil in their diet (compared to other types of fat) have reduced food intake overall, particularly in the subsequent meals. Like most things, you have nothing to lose by trying it.
7. Cocoa – chocolate is long associated with cravings, though right now, consumption of chocolate may well increase the cravings rather than stamp them out. It’s also not exactly useful if you’re trying to focus on reducing your intake of junk food! That said, chocolate is known for its cognitive and mood enhancing benefits. So how about some unsweetened cocoa (or cacao) in hot water with some milk to deliver the chocolate taste you are after. Add a touch of stevia if you wish. You could also do this cold with almond milk and ice – and add 1 tablespoon of psyllium husk or gelatin in there for some additional fibre or protein. If chocolate is what you’re after – go for the darkest that you can stand. Many people find they stop at 1-2 pieces of 90% chocolate instead of the 1-2 rows consumed of the 70%.
8. Anything that lowers your blood sugar response to a meal is going to positively impact your cravings. The steep rise and fall of your blood sugar in response to a meal causes alarm bells to start going off in your brain. The body runs a tight ship and prefers when all systems are in homeostasis. Low blood sugar causes a release in stress hormones which tell your liver to dump glucose into the bloodstream, and create cravings so you can re-establish blood sugar to within a normal range. Including cinnamon can reduces glucose response after a meal (in amounts of 6g) and affects insulin response. Stabilising blood sugar is going to help reduce cravings. Sprinkle this gold dust on your breakfast, with your teaspoon of coconut oil, in your cocoa drink etc.
9. Glutamine – can enhance secretion of GLP-1, a hormone which promotes insulin release that helps increase satiety and dampen appetite – this is only seen in some people however, suggesting there is individual variation of its effects. The flipside of this is that the insulin-releasing effects may override any satiety benefits, increasing hunger (and subsequent meal size) at the next meal. However, in practice this is a tool that many clinicians (myself included) have found useful for some (but not all) clients. The presence of glutamine in the bloodstream is associated with improved insulin sensitivity in healthy people. In addition to this, glutamine has been found to be beneficial for improving intestinal permeability and tight junction protein expression in the gut, being one of the most abundant amino acids in the body. If your cravings are related to gut dysbiosis then it could be useful from this perspective. In addition, it functions as part of neurotransmitter production. Taking L Glutamine by putting it under the tongue as a craving hits (1-3,000mg) may just work for you.
10. Magnesium is a nutrient that is involved in over 250 processes in our body, and particularly when we are under stress, it is put under the pump. Sugar (or specifically) chocolate craving is often linked to a deficiency to magnesium, but that isn’t conclusive. At any rate, magnesium is perfectly safe to take, and as our food supply is relatively low in magnesium, looking for a supplement that is a magnesium glycinate, citrate or chelated with amino acids may be useful, at amounts of around 300-400mg elemental magnesium.
11. Chromium is another supplement that some people have found useful for stopping cravings – research has found a reduction in carbohydrate cravings, food intake and an increase in satiety when supplementing with chromium…however this is in the laboratory using mice. There’s nothing definitive in the research to support using it for people who already have adequate amounts of this mineral. That said (as with anything), it’s individual – I know many clients who swear by using Chromium supplements when a craving hits. The only way to know if it works for you is to try it, by taking 1000mg chromium in two doses in meals that contain carbohydrate (due to its suggested benefits at reducing blood sugar response to carbohydrate meals)..
12. Branched chain amino acids (BCAAs) are three amino acids that act as nutrient signallers which may help reduce food intake . Leucine (one of the BCAAs) activates mammalian target of rapamycin (mTOR) which is required for our brain to respond to leptin (a hormone that tells our body when we have had enough food). BCAAs are involved with hormone release in both the gastrointestinal tract and in fat deposits. BCAAs and dietary protein enhanced glucagon like peptide-1 (GLP-1) release and reduced the expression of genes required for synthesis and adsorption of fatty acids in a human intestinal cell line (NCI-H716), suggesting an intestinal mechanism for the beneficial effect of BCAAs. Those that have successfully used BCAAs suggest 5g in the AM and every few hours while you’re adjusting your diet back to baseline awesomeness.
13. 5htp: 300-500mg taken with a meal to increase satiety of the meal – studies have found a reduced food intake (particularly carbohydrate). Studies conducted have focused on people who have reduced availability of tryptophan in the brain (a precursor to 5htp). Increasing 5htp increases tryptophan and therefore serotonin production, reducing cravings and overall food intake. (Don’t use if you are currently on antidepressants without clearance from your doctor.)
14. Exercise. A no brainer, really, but research has found this to be super effective for reducing cravings. In fact, any activity done while in the midst of a craving will take your mind off it. So when a craving hits, doing something active for 10-15 minutes can reduce your desire for something sweet. Go for a powerwalk, shoot some hoops, do some hill sprints…
15. Make sure you’re getting enough sleep! It’s hard this time of year with longer days and opportunities to take advantage of summer (when it shows up…) Sleep restriction enhances activity in brain regions involved in reward in response to energy dense, nutrient-void food (think: lollies, chips, chocolate), suggesting heightened sensitivity to rewarding properties of food. This can lead to increased cravings. If you are burning the candle at both ends and not yet back to your regular 7-8 hours sleep per night, then nailing this will go a long way to helping curb that sugar demon.
16. Meditation: decentring – viewing your thoughts as separate from yourself – has been found to help reduce food cravings and want for unhealthy food items. Mindfulness practice is also useful for not only reduced cravings, but for reduced emotional eating, body image concerns. It doesn’t require a 90 minute class three times a week (though there’s nothing wrong with that!) Headspace, Calm or Buddhify are three smart phone applications which may help you get going and provide guided sessions of between 2-20 minutes long. It’s consistency and frequency that makes a difference (like any habit).
17. Clay modelling to reduce cravings: yep. Researchers found that visual imagery plays a key role in reducing craving. Participants who worked for 10 minutes constructing shapes from plastacine had reduced cravings for chocolate compared to people who were left to their own thoughts or who were given a written task.
18. Your gut bacteria can influence your cravings. There is indirect evidence for a connection between cravings and the type of bacteria lurking in your gut. For example, people who enjoy and crave chocolate have different microbial metabolites (i.e. bacteria by-products) in their urine than “chocolate indifferent” individuals, despite eating identical diets. In addition, gut bacteria can influence the production of our ‘feel good’ and motivation hormones (serotonin and dopamine), thereby influence food decision-making based on our mood. Finally treating mice with a probiotic reduced hunger-inducing hormones and food intake. Action points here? Yes, you could start with a probiotic, particularly when you’re in the thick of it all, as this will help ensure there are beneficial bacterial strains present in your gut. However, for ongoing gut health, the regular addition of probiotic and prebiotics through food will help you maintain a healthy gut microbiome. Therefore:

• Include fermented vegetables into 1-2 meals daily, working up to 1-2 tablespoons at a time.
• The addition of unsweetened yoghurt (dairy or coconut) as part of your everyday diet (as it contains beneficial bacteria).
• Kombucha, at around 100-150ml per day (check the back of the label to ensure a lower sugar variety).
• Water, milk or coconut kefir, start with around 100ml per day.
• Raw apple cider vinegar in water – start with 1 tsp in a small amount of water, working up to 1 tablespoon. This will help stimulate stomach acid when taken prior to meals, helping you digest your food properly, and delaying gastric emptying, so your glucose response to the meal will be slower too.
• Vegetables, in abundance, to include fibres that feed your gut bacteria.

(As a side note, any change to your gut environment can result in unintended (and unwanted) changes to your digestive tract! If you’re new to the fermented foods and/or probiotics, then start small and work your way up. If you end up spending way more time in the bathroom than you wanted, reduce back further. Consider yourself warned.)

You won’t need to do all of these – but I think #1-5, #14, #15, #16 and #18 would completely diminish that sugar demon so you can get back to feeling awesome.

Grab that cupcake and bin it immediately. Underneath something that will stop you from retrieving it later on. (PC: SamadiMD.com)

 

 

 

 

 

 

 

 

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

The Gout: what you need to know and 7 things you can do about it.

1. Gout is an auto-inflammatory disease caused by a disorder in purine metabolism and the resulted chronic elevation of blood (serum) uric acid (i.e., hyperuricemia)
2. Men have a higher risk of gout at a lower given blood level of uric acid, and at a lower age than women – generally 10 years earlier.
3. Women who go through early menopause, or have estrogen deficiency are at higher risk than women who progress through menopause at a normal age, due to oestrogen’s role in increasing uric acid excretion.
4. Insulin resistance increases risk of gout, as insulin reduces uric acid secretion. The relationship between insulin resistance and gout is more pronounced in women than in men.
5. There is a bi-directional relationship between high blood pressure and gout: ie if you have high blood pressure, your risk of gout goes up (independent of diuretic medication that is taken), and if you have gout, your risk of developing high blood pressure also increases. High blood pressure can result in damage to kidney and a reduction in uric acid excretion, and the inflammation associated with gout can stiffen and damage arterial walls, and reduces production of nitric oxide – which helps widen arteries.
6. Genetics play a role in determining risk associated with gout – and people with a particular genetic profile (such as those of European descent with the SNP sequence SLC2A9 as an example) have an increased risk, as do those with ABCG2 rs2231142. However, as with any genetic risk factor, lifestyle determines if these genes are switched on or off, so while this information could be useful (and more people are starting to find out their genetic profile and determine what it means for their health), it is your lifestyle habits predominately regulate overall risk
7. Triglycerides increase in the bloodstream when people overeat refined carbohydrate foods, and recent research suggests a reduction in serum uric acid occurs when triglycerides decrease.
8. Alcohol intake is associated with an increased risk of gout – beer more so than wine.
9. Overall fructose load in the diet is the only type of carbohydrate that is known to increase uric acid levels, potentially because when metabolised, it depletes phosphate and therefore doesn’t help produce ATP (energy) in the body and instead increases uric acid production. Fructose from processed food (and particularly sugary sweetened beverages) can elevate insulin levels and increase risk of insulin resistance. There may be a genetic element to this also, with people who have polymorphisms in SLCA9 and ABCG2 genes responding unfavourably to a load of fructose.
10. A large cross sectional survey found that people following a vegan diet had the highest serum uric acid concentrations compared to fish eaters, meat eaters and vegetarians, independent of smoking status or alcohol intake.
11. While seafood is often cautioned against for people who experience gout due to its purine content, a number of studies have failed to find a relationship between seafood intake and serum uric acid levels. Those that have found a relationship may not have adjusted for body mass index (BMI), which can confound the relationship as it did in this study. Indeed, those populations who are at greater risk today (such as Maori and Pacific among New Zealand population) enjoyed a traditional diet of predominantly seafood, vegetation, tubers and gout was non-existent.

What to do?

1. Look after your gut. Bacteroides caccae and Bacteroides xylanisolvens are increased, and Faecalibacterium prausnitzii and Bifidobacterium pseudocatenulatum depleted in the gut of people who experience gout, suggesting a strong correlation with the presence of gout. F prausnitzii is one of the most abundant bacterium in the gut of a healthy individual, helping produce short chain fatty acids butyrate, which is fuel for our gut bacteria, and the provision of B pseudocatenulatum improves markers of gut wall integrity. So these are pretty important! While this doesn’t necessarily mean that the provision of certain bacteria through probiotics will reduce gout attacks, it does suggest that inflammatory processes of the gut play a role in the presentation of gout and provides further evidence of the importance of a diverse population of bacteria in the gut for overall health.
2. Supplementing with 1500mg vitamin C reduces serum uric acid and its antioxidant functions may also help kidney function by reducing inflammation.
3. Like your coffee? You don’t have to go without if you have gout and in fact, 4-5 cups per day have found to decrease serum uric acid that isn’t seen with green or black tea, or total caffeine intake. Decaffeinated coffee has afforded similar benefits, leading investigators to suggest the phenol content (phytochemicals) might increase insulin sensitivity and decrease serum insulin, as discussed above insulin levels have a positive correlation with uric acid due to decreased renal excretion. Furthermore, xanthines, either in caffeine or in coffee itself, could inhibit xanthine oxidase – an enzyme that increases reactive oxygen species (and inflammation).
4. Magnesium intake is associated with a decreased serum uric acid level in males, and marginal intakes is associated with higher levels of markers in the body indicative of inflammation. Magnesium is low in soil which makes dietary sources of the micronutrient not as high as they once were, therefore supplementing with magnesium of 300-600mg/day (depending on bowel tolerance) is likely a good idea. (To be honest, I’m a big fan of magnesium supplementation for pretty much anyone male or female, given it’s a co-factor in over 300 processes in the body).
5. Tart cherry extract – not just useful for sleep – is found to reduce the prevalence of gout flare ups in cross sectional studies, potentially due to the presence of polyphenols including anthocyanins, and vitamin C found in the fruit, which have anti-inflammatory and antioxidant affects.
6. The consumption of low fat dairy products is linked to a lower risk of gout in larger population studies.*
7. Anecdotally (as in, I didn’t find any study on pubmed to support this), baking soda is used to increase pH level of the blood (¼ teaspoon in water), thus making uric acid in the blood able to be excreted. If you know of any studies around this that I’ve missed, let me know!)

The take-home?

While a low purine diet is often recommended as a dietary prescription for people with gout, many purine-containing foods (such as seafood and vegetables) do not contribute to hyperuricemia or gout and may in fact be protective. The effects of red meat consumption on serum acid levels are arguably hard to disentangle from other elements of the modern dietary pattern, and are often in conjunction with higher alcohol intake, lower fruit and vegetable consumption and higher fast-food intake – all contributors to inflammation in the body. In addition, the agricultural practices of the cattle industry in countries such as the US where many of the epidemiological studies that associate red meat with poor health (including higher serum uric acid levels) include the use of antibiotics, poor farming practices and animals that are grain and not grass fed, altering the fatty acid profile of the meat to be higher in omega 6, pro-inflammatory fats. Furthermore, processed and fresh meat is often grouped together – thus a steak is viewed the same as a hamburger from a fast-food outlet – the latter often being in the company of a bun, fries, mayonnaise made with industrial seed oils and a sugar sweetened beverage – the adverse effects which many, myself included, argue cannot be adjusted away by a statistician when determining risk.

*I don’t think you need to start consuming low fat dairy if right now you’re enjoying the benefits of full-fat dairy in the context of an awesome diet. I think this could well be indicative of overall lifestyle patterns. I’d be surprised if there were studies showing that risk of gout is increased in a diet that is whole food, minimally processed, an abundance of vegetables that also incorporated full-fat dairy products.

The GOUT. (PC: https://en.wikipedia.org/wiki/Gout#/media/File:The_gout_james_gillray.jpg)

 

14 reasons to ditch the toast and jam (and 7 key tips to help you do this).

After feeling like I’d taken a trip back to 2003 with some of the sports nutrition posts and articles I’d been reading lately, I got tagged in a cool picture from a listener of our Fitter Radio podcast  – a triathlete who has switched from the traditional higher carb, lower fat diet approach to eating lower carb, higher fat, real food whilst training and commented she ‘didn’t know her 41 year old body could be the best body I have ever had’ (Woot! high fives all around!!) This coincided with finishing Mark Sisson’s Primal Endurance book.

Mark outlines 115 reasons why athletes should train and eat the Primal Endurance way. I concurred with pretty much all of them. I have added my own 2c worth, added some literature below (and cut it down to 21 for brevity’s sake). While geared towards athletes, hands down this is applicable to everyone. Everyone.

So if you’re currently eating toast and jam pre OR post training (or in general), I’ve outlined the 14 reasons why you need to ditch that junk and become a fat burning beast, and 7 key tips to help you get there.

1. Western diet is based on excess grains and sugars (and low fibre) which stimulates excess insulin production, leading to lifelong insidious weight gain, chronic inflammation and elevated disease risk factors.
2. A high carb, grain-based diet can leave endurance athletes nutrient deficient (due to phytic acid effects on minerals), inflamed and more susceptible to the oxidative damage of the stress of training, general life and poor nutrition.
3. The way that most people consume modern grains (cereals, breads, pasta) ends up being a cheap source of calories which are immediately turned into glucose upon ingestion and offer minimal nutritional value. There are no good reasons to consume these types of grains and many good reasons not to, especially for those who are sensitive to gluten and other anti-nutrients found in wheat.
4. Everyone is sensitive to the health compromising effects of grains at some level, especially the pro-inflammatory effects of gluten and the propensity for the lectins in grains to cause leaky gut syndrome.
5. Even lean people suffer from the consequences of carbohydrate dependency, such as chronic inflammation, oxidative damage, and accelerated ageing and disease risk factors.
6. Carrying excess body fat despite careful attention to diet and a high training load is largely due to carbohydrate dependency caused by a grain-based diet and chronic training patterns.
7. Carbohydrate dependency cycle looks like this: consume a high carbohydrate meal – elevate bloods sugar – stimulate an insulin response – shut off fat metabolism and promote fat storage – experience fatigue and sugar cravings – low blood sugar elicits stress response and we consume more carbohydrates – stimulate the fight or flight response to regulate blood sugar – dysregulate and exhaust assorted hormonal processes, and end up in burnout and weight gain (potentially lifelong)
8. Weight loss through portion control, low fat foods and calorie burning is ineffective long term. And while we think calories burned through exercise stimulate a corresponding increase in appetite – research might not back this up. I tend to think that people are more likely to eat more because they ‘reward’ themselves OR the long slow training allows increased opportunity to eat sports ‘junk food’ and the amount of calories burnt through training is far less than you think – and overestimated more so in females in certain instances. At any rate, the secret to weight loss is hormone optimisation, primarily through moderating excess insulin production.
9. Endurance athletes can begin to dial in to their optimal carbohydrate intake by asking themselves the question ‘do I carry excess body fat?’ Any excess body fat calls for a reduction in dietary carbohydrate intake to accelerate fat burning.
10. Endurance athletes who already have an optimal body composition but are looking to optimise training and recovery should choose high nutrient value carbohydrates. These include a high volume of vegetables, a moderate fruit intake, kumara/potatoes and other starchy tubers, dairy for those that tolerate, wild rice, quinoa and small amounts of dark chocolate.
11. Endurance athletes with high calorie needs who also have an optimal body composition can enjoy occasional treats, but the habit of unbridled intake of nutrient-deficient carbohydrates should be eliminated in the interest of health and performance.
12. Primal style eating (or eating minimally processed foods) is fractal and intuitive, and when escaping carbohydrate dependency and becoming fat adapted, you don’t have to rely on ingested carbs for energy. Eating patterns can be driven by hunger, pleasure and maximal nutritional benefit.
13. Escaping sugar dependency and becoming fat adapted gives you a cleaner burning engine, since glucose burning promotes inflammation and increased oxidative stress
14. Ketones are an internally generated, energy rich by-product of fat metabolism in the liver when blood glucose and insulin levels are low due to carbohydrate restriction in the diet. Ketones are burned efficiently by the brain, heart and skeletal tissue in the same manner as glucose. You do not need to be on a ketogenic diet to upregulate your ability to produce ketones – you can do this via a lower carbohydrate approach.

HOW TO DO THIS: 7 KEY TIPS

15. Step one: omit sugars, grains, industrial seed oils for 21 days. Step two: emphasis highly nutritious foods such as meat, poultry, vegetables, eggs, nuts, fish, fruits, some full fat dairy, seeds, and kumara/potato.
16. 100g or less of carbohydrate promotes fat loss, 150g is around maintenance level and over this could promote lifelong weight gain and over 300g could promote disease patterns.
17. While transitioning to primal there are some struggles initially due to lifelong carbohydrate dependency and the addictive (for some) properties of sugar and excess grains and wheat. Headaches, dehydration, lower blood pressure and ‘dead legs’ are all initial side effects when removing processed food. Trust me – this too will pass.
18. To minimise side effects, start the transition in a base-training phase of your training where training occurs at an easy pace. The transition phase can take anywhere from 2-12 weeks initially.
19. Consume salt. Don’t underestimate the importance of this! Lower circulating insulin affects your body’s ability to retain sodium (and other electrolytes) – so we need more, particularly as processed food (of which you are no longer basing your diet around) is where you got around 70% of your sodium from.
20. You can accelerate the process of fat adaptation by instigating some of the tactics used by athletes who opt to ‘train low’ – i.e. in a low glycogen training state. Some of these are naturally undertaken if you train without eating in the morning, or work out after dinner in the evening and don’t consume anything post-workout. If you’re new to this, have a read through to establish which might suit you best, and start instigating 1-2 x per week. Don’t undertake all of them as this aggressive approach could cause too much additional stress, derailing your plans to become a fat-burning beast.
21. The FASTER study and Peter Attia, Sami Inkinen suggests any endurance athlete can become fat adapted and deliver performances that may be superior to carb-fuelled efforts all of the way up to anaerobic intensity. This is a new and growing research space, one AUT is testing, among other Universities around the globe.

Strong, lean and awesome at 41y.

 

PS What the Fat Sports Performance – currently an ebook, about to be published is one I can’t WAIT to read as well – sure to be a goody.