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.

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

One conscious breath in is a meditation*… and why you might need it.

“I hate my body. I’m really uncomfortable in my skin. My whole adult life has been spent thinking about it. I think about it all day long. I’ve done a thousand diets. I’ve really ruined my metabolism. I’ve got not self confidence. In order to fix that, how many carbs do you think I should be eating?”

Sound familiar? It does to me – I’ve heard versions of this conversation literally hundreds, if not thousands of times in my clinical practice over the years and was reminded of it in a recent Robb Wolf podcast. The internal dialogue that accompanies these conversations is often one of self-loathing, disappointment and a sense of failure that they’ve not “managed” to successfully reach a weight or body shape that they deem ideal. These thoughts come from these deep inner workings of the brain that have been ingrained for years. Decades in many cases.* Is a 12-week diet and exercise programme able to suddenly change this? You probably don’t need me to tell you that it’s a tough ask, no matter how many carbs are being prescribed, or how much protein is on your plate.

It’s important to note, though, that adopting a minimally processed approach to eating and stripping away most aspects of the diet that drive cravings and an insatiable appetite is certainly part of the process. These hyper-palatable foods drive blood sugar up and then sends it plummeting, causing a physiological stress response that can create panic and anxiety around food. In addition, when we eat these foods we are at the mercy of the food industry, who spend billions of dollars researching the exact ingredients required to create a product that hits the pleasure centre of our brain and makes us want to continue to eat them long after we’ve satisfied our caloric requirements. Not only does a diet that by default is higher in fat, protein and vegetable fibre help stabilise blood sugar and prevents the inevitable crash, the additional nutrients that a real food diet provides in bioavailable forms (such as B vitamins, zinc, b vitamins, magnesium) are all cofactors in the production and breakdown of neurotransmitters – both processes that are important to optimising brain chemistry and mood, and our ability to think clearly and respond in a calm and measured manner to the situation at hand.

So, while diet plays a role, it’s not the only place we go and not the important one. As I see it, being dependent on a programme can leave you vulnerable and exposed when life intervenes and for whatever reason you can’t follow it. Don’t get me wrong – I love structure and I know that many people rely on that to help remove the decision making around food – that’s why I’ve developed my online system after all! However, most people in my position also dig deeper and provide education, support and guidance for lifestyle and not just diet, recognising that you can’t just prescribe food choices in isolation of sleep, stress and activity guidelines. The outcome being, our job is complete when people no longer need us. For people embarking on a weight loss programme when the underlying problems aren’t acknowledged or addressed – physical and psychological – or other lifestyle factors aren’t considered, then patterns of behaviour built up around these will always supersede any effort to change food intake. If I had a dollar for the number of times I talk to people who share that they ‘slipped up’, ate a biscuit, decide they were a complete failure and then demolished an entire packet, well I’d be able to buy a Vitamix instead of collecting true reward points on my Visa card. I think mindfulness and meditative practice of some description is required to turn the more favourable eating pattern, which is almost a surface layer (though necessary) and turn it into something concrete and foundational.

Meditation rewires the brain. For real. And while the word “meditation” might scare you, this changing myelination in the brain improves connectivity and eventually can help change thought patterns. However, you’ve got to know you’re thinking these things in the first place. So much of what goes on in between our ears is below the level that we are even aware of. Do you know we make 250 food decisions in a day? I counted the ones I was aware of and came up with roughly 28 of them. That leaves close to 90% of the decisions made that outside of my consciousness – yikes! And I’m no different from anyone else. I know that doesn’t sound possible, but take riding a bike for example. It is something that as an adult, we can just do even after years of not going near one. We may wobble a bit, feel a little unsure as we push off, but once we settle in and feel balanced enough, we are off as if we’d never had a 20-year hiatus, despite not thinking about every pedal turn, body lean or turn of the handlebar.  Imagine being this guy though, attempting to ride a bike that, when the handlebars turn left, the wheel goes right, and vice versa. Despite his obvious confidence that he could master it in an afternoon, it took 8 months for it to feel like it was a natural thing to do. Changing our thought processes and behaviours around food, how we eat and our self-perception are no different to this – both the conscious ones (“I can’t fit my pants! I’m a whale!”) and those we are unaware of, such as automatically heading to the pantry and grabbing a handful of nuts when arriving home from work.

Meditation can help change both thought and behaviour patterns around food, body image and self-perception. Getting people to do it though is so hard. Give them a meal plan or exercise schedule and they will follow that to the letter. However, when I suggest they spend 10 minutes a day with Headspace, it’s a different story. It makes people uncomfortable as I’m asking them to change how they interact with their environment and the people in it. It’s also not an immediate tangible outcome. It can’t be measured on a scale, or by a measuring tape – so the results are less obvious, and not as swift as a 1200 Calorie diet over 6 weeks. And I am asking them to find 10 minutes each day where they feel they are already squeezing 27 hours into the 24 available. It’s one more thing that must be scheduled on top of an overwhelming calendar. Have I sold you on it yet? However, we want positive thoughts around yourself and good decision making around food to be as automatic as brushing your teeth. Of course, it won’t happen overnight, and meditation doesn’t solve the problem by itself, but doing a meditative practice that helps you figure out when you’re thinking (and why you’re thinking it) is a necessary first step. From here, you begin addressing the factors that are preventing you from making progress long term – rather than focusing solely on the food, which is merely a symptom of the problem.

So where to? There are several practices that can help, and everyone is individual as to which would suit them best. However, an app is an accessible place to start and can be done wherever you are. In addition, it’s just a few minutes a day rather than 90 minutes three times a week. I think frequency could be as important (if not more important) than duration, especially as you’re creating the habit. Like anything, giving it a good go (rather than just a cursory 2 or 3 times) is necessary to evaluate whether something is having an effect. The important thing is to prioritise it as you would brushing your teeth. A few of my favourite are Headspace, Calm or Brainwave App – commit to these for 30 days, and keep a journal to describe changes to how you feel with regards to the meditation – it doesn’t have to be detailed, perhaps a few key words so you can reflect back on your experience and determine if it has had any effect. These 10 or so minutes you spend now could free up so much of the clutter in your head, it will make you feel like you’ve brought yourself at least three times as much. Now, this isn’t going to happen within that 30-day timeframe, but it will begin the process – habits are built up over a lifetime, so it can take months, if not a year or two, to really change. But if you’re like anyone I’ve met, you will notice benefits after that first month if it’s going to be your thing – and hopefully in such a way that will motivate you to continue.

*Eckhart Tolle

*Imagine all the things that could have been done if the mind wasn’t occupied by ‘does my bum look big in this?’ or time wasn’t spent googling ‘get rid of cellulite.’

Trying out Deepak Chopra's meditation app

PC:www.slate.com

Injury-prone? Read this.

Nothing derails an athlete like an injury. We all know that consistency is one of the most important aspects to perform at your best, but getting to the start line in one piece is one of the biggest challenges that athletes face – particularly endurance athletes. For me, I have a long standing battle with my calves, and many people I talk to are similar: an old achillies injury, a hamstring problem, a niggly hip. However, this is hope! I listened to this great podcast where one of the leading researchers (Keith Baar) talked about his research that is helping athletes avoid injury and (when injured) recover more quickly. It is so practical and easy to apply that I had to share it. And whilst this is related specifically to athletes, I can’t think of any reason this couldn’t apply to anyone who may not think of themselves as an ‘athlete’ but struggles with an ongoing muscle or bone ailment.

A bit of background: Collagen, the most abundant protein form in the body, is made up of two amino acids, glycine and proline. It is found in bones, muscles, tendons and ligaments and has an almost scaffolding effect, to provide form and structure. Modern diets don’t contain a lot of glycine – it is found in the cartilage, bones and gelatinous part of animals and most people prefer the leaner cuts of meat (such as a steak, or a chicken breast). Most athletes I talk to would fall into this category; traditional sports nutrition guidelines would encourage them to fill up on carbohydrate, eat a moderate amount of lean protein and choose those leaner cuts of meat to ensure fat intake is kept low. Another easy source of glycine is found in gelatine – the wide, grainy powder found in the baking aisle used as a gelling agent in cooking. It is made predominantly of left over parts of the animal (bone, skin etc) that would otherwise not be used and has become more popular recently for its health promoting properties. Gelatine has also garnered the attention of sport scientists for its potential role in healing from injury and injury prevention.

While mere mortals wouldn’t typically think of tendon stiffness as a good thing, sport scientists have shown that the higher degree of stiffness you have in your muscle tendons, the better efficiency you’re going to have when using them. For a runner this would mean you’d expend less energy overall at a higher given intensity. And who doesn’t want that?

Tendon stiffness is determined largely by the amount of collagen AND the crosslinking of it. the collagen (tissue). Cross linking is determined by enzymatic processes that occur in the body, the expression and the activity of these enzymes increases when we are active. Baar’s research found that when they combined vitamin C (important for collagen synthesis) with glycine (one of the most common amino acids in collagen) there was an increase in strength of ligaments the engineered in the laboratory. They then conducted clinical trials in athletes to determine if this could be translated to a real world situation.

They conducted a randomised clinical trial, whereby they gave the group either a placebo, 5g or 15g of gelatine and measured the amino acids present in the blood stream over the following three hours. They found that the glycine peaked within the blood an hour after consuming the supplement. When they took the blood samples from the athletes and put it into their engineered ligament, they found an increase in the amount of collagen present in the ligament – a slight increase with 5g and a substantial increase with 15g of gelatine. Importantly, they found improved strength and stiffness in the ligaments that had the increase in collagen formation.

They then had the athletes jump-rope for six minutes (the length of time required to get a response from tissue cells in the bones, tendons and cartilage), rest for six hours, take the supplement again, wait an hour (for the peak amino acid expression) and jump-rope again. They did this three times a day for three days. The researchers found a doubling in the athletes’ collagen synthesis for those supplementing with 15g of gelatine, mostly from the bone.

What this shows us is if we want to improve the collagen response to an exercise bout, we can easily do this by adding gelatine as a supplement. Baar felt the initial study can be looked at as a bone recovery protocol. If we have an athlete who breaks a bone –  in the foot, a bone in the leg, bone in the back, what you can do is you can have them take the 15g gelatine alongside 50mg of vitamin C and then do five minutes of exercise an hour later. Now clearly this isn’t weighted activity – if you have access to an AlterG at your local university sports science lab that would be brilliant – something that is going to just direct those nutrients to where they need to go. Repeat this every 6h because it takes that long to get the cells to return to a state that they will then be responsive. The researchers suggest this is going to speed recovery time, something all athletes are interested in.

The above study can also be used as an injury prevention protocol, as the overall goal is to improve the mechanics of the connective tissue, reduce fatigue-related damage and optimise its strength and resilience. The protocol is the same; consume the 15g gelatine and 50mg of vitamin C then perform 5 min of activity that is going to load the area they are most concerned with. Long distance runners, for example, could supplement and then an hour later do 5-6 minutes of jump roping as this is going to load the hips, Achilles tendon, calves, tibia and femur – all areas of concern. For our long distance runners, they do five to six minutes of jump rope because if you have a history of tibial stress fractures or hip stress fractures or Achilles problems or plantar fasciitis, all of those structures are going to be loaded by the jump rope. They’re going to get just enough of a stimulus in that six minutes to have a response. Unlike muscle, bones and connective tissue don’t have a great blood supply – therefore providing nutrients then doing the exercise is like wringing out a sponge – suck the water out and it will suck up what’s left in the environment. The exercise impact is like wringing out the sponge, therefore the tissue will be responsive to up taking the nutrients.

Currently they’ve just tested the 5g and the 15g of gelatine – and while anecdotally the 5g has received favourable responses, the 15g amount was significantly more effective. The researchers don’t know for now if this is better scaled to body weight, but studies are underway to determine this. The study that is discussed here is in review and is about to be published.

In summary:

Bone healing / injury prevention protocol

  1. 15g gelatine + 50 mg vitamin C* (either added to smoothies, glass of water etc)
  2. Wait an hour for peak amino acid presentation in the bloodstream
  3. Undertake 5-6 minutes of activity that loads the area of interest (can be non-weighted) to direct nutrients to that area. For an ankle injury, this can be simply (carefully) tracing the alphabet with your ankle
  4. Do this every 6h
  5. (for injury prevention) – can do this anytime – or take the gelatine + vitamin C an hour before training if the training is including drills/warm up that targets area of interest.

*a little bit less than the amount of vitamin C found in a kiwifruit, most vitamin C tablets are over 250 mg, but you could easily have this instead.

Gelatine: I use the Great Lakes Gelatin, this is definitely pricier than what you’d find in the supermarket. This (and the I Quit Sugar brand or Vital Proteins brand) are marketed as being derived from either pig or beef that have been sustainably farmed and pasture raised. They are also free from additives and preservatives. You can purchase either the gelatine that will gel, or the collagen peptides which is the collagen broken down into smaller amino acid peptides. I haven’t seen any New Zealand gelatine – our cattle industry is one of the best. The brand in the supermarket I’ve seen (Mckenzie’s) includes a preservative which wouldn’t make it ideal for anyone wanting to use it for gut healing purposes (it’s 220, sulphite dioxide – many people are sensitive to this) and they don’t make the same animal and environmentally friendly claims. Further, if you do have an injury then the levels of inflammation in your tissues will likely be higher, and while the inflammation may not stem from your gut, it can affect your sensitivity to constituents in food such as preservatives and additives you would otherwise be fine with. In terms of the injury prevention effect though, I’ve seen nothing to suggest they wouldn’t be on par – so choose the one you can afford.

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!

snack

PC: www. revive.ca

Does your doctor value nutrition? These 3 questions might help you find out.

How much does your doctor value nutrition? This has been a rather hot topic of late, with the recent gagging of Gary Fetke in Australia, an orthopaedic surgeon who co-owns a nutrition clinic that employees dietitians to help clients. He has recently been ‘gagged’ by the Australian Health Practitioner Regulation Agency (AHPRA) and is not able to talk about the role of nutrition in preventative health, nor in the management of chronic illness on any social media platform.

That’s troubling to say the least. Nutrition and talking about nutrition is certainly a contested field, and perhaps there is some protection of the patch when it comes to nutrition advice. I’m not going to lie to you – I can get a little scratchy myself when I read prescriptive advice from people who aren’t qualified in nutrition that push the boundaries in terms of scope of practice. Mainly because of the potential fall out if they aren’t equipped with the knowledge to either resolve and issue or refer it on. But to prevent a doctor talking about nutrition is just madness.  Doctors SHOULD be talking about nutrition – especially given that some of the most common reasons people go to their general practitioner (GP) can be improved (if not resolved) by diet. Thank goodness similar shenanigans have not been taking place this side of the ditch.

To what degree GPs should have the authority to discuss nutrition with their patients is a bit of a ridiculous question if you ask me. I know many brilliant GPs that use a holistic approach to their practice, who know a LOT about nutrition, give guidelines when that is all that is required and also who refer their patients on to more in-depth nutrition help if necessary. More important is asking your GP to what degree do they value nutrition. If you feel nutrition is an important part of your overall health, I think that having a GP who feels the same is rather important, and these three questions I heard on a podcast could be a good start to give you confidence that your needs will be met by their services.

  1. What affect does nutrition have on my health?

This may seem like a weird question to be asking your GP. I mean, surely everyone knows that diet and health are intricately linked, and doctors – well, it’s their job to know this stuff, right? Given the number of clients I have who leave their doctor’s clinic rooms feeling stupid for even mentioning diet, I don’t think we can take it for granted that your GP is going to be open to the idea of diet being a reasonable therapy (or adjunct therapy) to any condition. Sure, the diet-health connection isn’t foreign to them – there is the lipid hypothesis after all. And if you’ve ever stepped on the scales and been told your body mass index (BMI) is too high, so you need to eat less and exercise more to lose a little weight and reduce your overall health risk, then clearly your GP didn’t sleep through their three nutrition lectures provided in the medical school curriculum. However I wouldn’t be surprised if you know more about diet being able to prevent or manage conditions such as auto-immune disease (including type 1 diabetes), mood disorders, inflammatory bowel disease or irritable bowel syndrome, metabolic conditions (such as type 2 diabetes), asthma and allergies and the like. Now I’m not saying your GP is an idiot – at all! But time is a resource many health professionals don’t have, and while your GP might be open to exploring alternative or adjunct nutrition therapy, they may not have had the time to research this avenue. That (in my opinion) isn’t so much of an issue. It’s not as important (in my mind) that your GP may not know as much as you; being open to you exploring it speaks volumes, though. If your GP isn’t interested, then that is a problem. Given some of the reactions that clients have reported when mentioning to their GPs they use diet as a way to manage their health condition, there are clearly GPs who choose to remain ignorant. If you are dismissed, laughed at, or told in no uncertain terms that diet will not help, alarm bells should ring in your head. My advice would be to look for another GP.

  1. What do you think about the difference between normal lab ranges and optimal ranges for nutrient status?

There’s a difference? There appears to be, or at least, some doctors argue that there is. Vitamin D is a great example of this. In New Zealand, the adequate vitamin D level starts from 50nmol/L but a published review determined that looking at endpoints on a broader scale than just bone health (including  bone mineral density (BMD), lower-extremity function, dental health, and risk of falls, fractures, and colorectal cancer) determined it best to have serum concentrations of 25(OH)D begin at 75 nmol/L (30 ng/mL), and the best are between 90 and 100 nmol/L.

Low to low normal levels of serum folate are related to increased risk of depression and increased severity of depressions and affective disorders. Our ‘normal’ starts at above 7 nmol/L and research has shown that people with chronic mood disorders have lower morbidity when their nutrient status is above 18nmol/L, and symptoms began to alleviate when supplementation brought the levels up to above 13nmol/L. Low folate is also associated with higher homocysteine levels in the blood which is an independent risk factor for atherosclerosis.

While B12 levels in the blood are actually a poor indicator of B12 activity (as only 5-20% of the is bound to transports and able to be metabolically active), research has found a relationship between levels of B12 of 258pmol/L and lower in the bloodstream and depression. The ‘normal’ range starts at 170pmol/L, with borderline low from 110-169pmol/L. I know GPs who look for levels of 400pmol/L as being optimal for cognitive functioning and health. A sports doctor I am aware of uses higher cut-offs when it comes to haemoglobin and ferritin (both markers of iron deficiency) for athletes and will supplement to determine if a boost in iron intake helps address fatigue-related complaints or not, even if the athlete is within ‘normal’ range (see here).

Thyroid stimulating hormone, a commonly measured marker of thyroid function has a reference range between 0.5-4.0mIU/L. However, TSH is considered to be a poor indicator of thyroid function and the ‘normal range’ included people that had underactive thyroid or thyroid disease. The recommendation from the American Association of Clinical Endocrinologists association was to lower the range to 3, with a view of it lowering further to 2.5mIU/L because data from the National Academy of Clinical Biochemistry found more than 95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L. Though this was recommended in 2003, it was contested by other governing bodies, potentially as it meant that the number of people in the US with subclinical thyroid function increased from 3 to 20% of the population, thus (as concluded in this paper) many more would require thyroxine medication as treatment.

These are just a few examples where you may fall into the ‘normal’ range, but may not be optimal according to the opinion of some doctors. At the very least, it may explain why you may be experiencing physical symptoms but these aren’t recognised by your lab test results.

  1. What will you do if my test results don’t marry up with what I’m telling you my symptoms are?

Important question, don’t you think? Let’s hope that your GP doesn’t respond with ‘perhaps you need to see a psychologist’ – as one of my clients reported. To be honest, I actually think there is a degree of psychosomatic issues that occur when someone is struggling with a health problem – most of us are familiar with the gut-brain axis and relationship between stress and digestive problems. This is partly driven by the return of seemingly ‘normal’ test results that don’t explain their ongoing concerns. However, to dismiss your symptoms as being unimportant because the results don’t reflect what you are reporting should (to me) set off alarm bells.

I think one problem could lie in the funding for lab tests. My GP is brilliant and will order me any test I want, but at my cost. I don’t blame her for this as there is pushback with GPs ordering tests. However I know that not all GPs are like this, and not all people can afford testing to get to the bottom of the issues. I think if more GPs appreciated the role nutrition can play in preventing, managing or reversing many of the chronic conditions people are dealing with today, then, then there would be more referrals to nutritionists or dietitians on the basis of reported symptoms or test results that may fit into the ‘normal’ range, but aren’t what is considered optimal.  From here, nutritionists, naturopaths and dietitians can order tests that delve further into hormonal issues, gut problems and even cholesterol levels if required. But this might not be necessary as they may pick up from your initial test results that certain nutritional strategies can help you optimise your nutrient levels without the need for further testing.

At the end of the day, you should feel confident that your GP values nutrition as much as you do.These questions may help you determine that and, if you suspect they do not, perhaps it’s time to find another GP.

Nutritionist

Obligatory doctor and fruit shot. I couldn’t find one with a steak.(PC: http://www.healthtrap.com)

 

Nutrigrain does not build Iron Men (or Women) + an Up and Go isn’t breakfast

(But I’m picking you know that).

By default, I’ve been in the sports nutrition world more than usual over the last couple of weeks. The Eat Well Live Well topic at New World (where I’m on hand to give nutrition advice and share good choices for foods), a sports nutrition talk during the week to a bunch of athletes and my first experience of Saturday morning kids winter sport this weekend. Well, first adult experience, as being your typical kiwi girl I was an enthusiastic netball player when I was in my early teens, and remember 9am starts at Kettle Park, playing on an ice-white netball court that had been frosted over the night before.

These experiences have reminded me that the ‘real food’ nutrition choices are not mainstream yet. And have a way to go before they will be. It’s still common for athletes to smash food straight after training (to make the most of the ’30 min window of opportunity’, to base their meals around processed carbohydrates (cereals, breads, pasta, rice) and to follow an eating style that didn’t allow for adequate delivery of fat and protein across the course of the day, so they are left irritable, tired, and hungry. The problem isn’t carbohydrates per se. It’s that processed carbohydrate has pervaded the diet to the extent that we now view it as an essential part of every meal at the expense of fat and protein which provide essential fatty acids and amino acids for healthy growth, development and recovery. This is especially true for children. It can get confusing though when cereal companies spend the big bucks persuading the consumer that products such as Nutrigrain or Special K are a nutritious, substantial start to the day. Such examples include:

  1. They fortify their cereals with micronutrients and can then sell them as a substantial source of vitamins and minerals, whereas we don’t know how effectively these are absorbed in the body. Nature is really smart at packaging nutrients in the correct ratios for maximum absorption when we eat, say, an apple. There’s so much about nutrition we don’t know, I doubt that Kellogg’s has cracked that nut yet.
  2. They pump their products with additional gluten and soy and can then promote them as being ‘high protein’ and ‘plant based’. A lot of people are sensitive to gluten and processed soy is far removed from the soy which is attributed to the many health benefits of a traditional Asian diet. And ‘plant based’ is bandied around so much these days, as if to insinuate it is nutritionally superior to a diet that contains animal protein. The opposite is true, given that many minerals and vitamins aren’t able to be as readily absorbed because of the phytic acid and other anti-nutrients which bind them.
  3. They put dried fruit and ‘ancient grains’ in their products, call them ‘Nourish’ and then sell it as real food. All this does is load them up with additional sugar.
  4. They pay sports stars and other influential people good money to front their ad campaigns. Even if you can do 12 Weet-bix in one hit, I’m picking that you’re not going to be able to do much else for the rest of the day if you make a habit of it.
  5. They compare a product to something else that we perceive as being  healthy or nutritious – for example, Up and Go being marketed as having as much ‘fibre, energy and protein as 2 Weet-bix and milk’. For the record, 2 Weet-bix and milk doesn’t have much fibre, protein or energy – but you wouldn’t know that from this claim which is what Sanitarium is counting on. There is 4.3g of fibre in a 250ml serve of Up and Go, and 19.3g of sugar. And a bunch of other additives, preservatives and vegetable oils to go with it.

    upandgo

    How many ways can you say sugar? There’s 5 right here.

The cereals I’ve mentioned above are as good (or bad) as junk food. But, do any of my points really matter if your kid is super active? They can’t just eat more of it, right? Hmm.  I’ve recently been reminded that there is a real culture in sports that suggest people who are active can ‘get away’ with eating high sugar junk food, and kids especially can eat sugar (I’ve heard some suggest they NEED sugar) as they can ‘burn it off.’ Nothing is further from the truth. Despite what the sports nutrition resources tell you, or what you might learn in a nutrition talk at the sports club, or see advertised on television, they don’t need additional sugar to make up for energy burnt during their practices or games. Sports drinks, white bread jam sandwiches, 2-3 jet planes aren’t necessary straight after exercise and are best left out of a young athletes menu. The ‘window’ of  opportunity of replenishing carbohydrate stores has been a convenient theory for sports nutrition products to justify their use, but we have since discovered the body can adequately restore carbohydrate up to 48 hours after a match or training. Unless, of course, there is a multi-day or multiple events on one day that requires a quick refuel, but even then there are options that allow for quick refuelling that are real food options.

A calorie is not a calorie, and active kids need more attention paid to their diet because of the heavier demands placed on their growing bodies. This expands their micronutrient and energy requirements. However, because we use body size as the main marker (or for some, the only marker) of health, we look at kids who are active and thin as ‘healthy’ without giving consideration to other equally (if not more) important indicators. I’ve worked with a number of adults who are prediabetic, yet have been fit and active their whole life, and a blood sugar screening reveals their metabolic state is probably worse than if they didn’t do any activity at all. A contributing factor to this is the carbohydrate-dominant diet that has fuelled them through the preceding years, and not just the additional treats they may have eaten because they could ‘eat what they liked.’ To the body, a high carbohydrate load is a high sugar load, regardless of where those carbs come from, because it’s broken down to the same single glucose unit.

So to save your active kids from the same fate, we need to set them up right from the get go.

Now I got a bad rap last year when I suggested that the new Weet-bix campaign that provided a ‘better brekkie’ was anything but. Weet-bix have long been the staple kiwi breakfast and growing up in winter, I had mine with hot water, warm milk, raw sugar, (because it was healthier*) and the aroma of a Gregg’s instant coffee with a freshly lit cigarette (it was the 80s, after all). Even now that combo conjures up that warm snuggly feeling of familiarity in me. The problem is that Weet-bix, or any cereal, isn’t typically a great vehicle for a nutrient dense, energy filling breakfast. Even with the campaign to make them a ‘better brekkie’. Most of the recipes on Sanitarium’s website sound amazing, but better breakfasts they are not.

So I offer a few suggestions**.

  1. Better breakfast shake: swap out the dates for an egg and add a tablespoon of peanut butter or tahini ( for a nut-free variety). We’ve lowered the sugar content and upped the fat, protein and calories. This will at least keep them awake for a little longer.
  2. Power porridge: swap the apple juice for grated apple. Use actual coconut milk (and not coconut flavoured milk), up the amount of rolled oats to a cup and add ¼ cup sunflower and pumpkin seeds. We’ve added more fibre, protein and lowered the sugar content.
  3. Weet-bix winter warmer: swap the trim milk for full fat (so much better for growing kids and adults alike actually) – or coconut milk, up the oats, add a few tablespoons of sunflower or pumpkin seeds and ditch the dried fruit. Stir through an egg before taking off the heat.
  4. Hot Weet-bix apple crumble: add ¼ cup shredded coconut, ½ cup roughly chopped mixed raw nuts – which you microwave with 1 Tbsp butter or coconut oil to make a crumble-type mixture.

Any of these would be okay if your kid feels a bit nervous before an early weekend sports game and just wanted something small. Otherwise, they will probably need some more food to go alongside the ideas above. Some good examples would be:

  1. Leftover cooked sausages or other meat leftover from dinner
  2. Scrambled eggs
  3. Hardboiled eggs (you’ve boiled these the night before)
  4. This tahini chia loaf with some nut butter spread on it
  5. Kumara ‘toast’ – slice and toast as you would your bread and top accordingly (mine took a couple of goes on high to get it to a cooked but still firm stage. So easy!)
  6. Three ingredient pancakes made with banana and eggs
  7. Peanut butter or tahini with chopped fruit
  8. Baked kumara or potato with butter
  9. Chicken drumsticks
  10. Glass of full milk and a banana

For more awesome ideas, click here for individualised nutrition advice or sign up for online nutrition coaching.

image1 (35)

Kumara toast spread with fennel pesto and topped with tasty cheese.

*it’s not healthier, but it the 80s we thought it was. Sugar is sugar is sugar. Including dried fruit, rice malt syrup, fruit juice and coconut sugar or coconut nectar.

** Weet-bix optional

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

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

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

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

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

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

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

PC www.gazetteinterviews.com

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

 

Like what you read? For more, check out mikkiwilliden.com for individualised nutrition plans, or sign up now for online nutrition coaching and meal plans.

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.

 

10 ways to naturally reduce your cholesterol-related risk and save yourself $8.00

I was at the supermarket yesterday and just happened to be taking a picture of an iced coffee drink when someone came beside me to grab a couple for themselves and put them in their trolley alongside a pottle of Flora ProActiv margarine.

Heinous drink containing 75g sugar on the left, and overpriced margarine on the right. JICYWW.

Heinous drink containing 75g sugar on the left, and overpriced margarine on the right. JICYWW.

There’s a disconnect right there.

These margarines are not only ridiculously expensive and taste terrible (I suppose that’s the nature of margarine anyway), but consuming this spread in an effort to reduce cholesterol levels is totally misguided. Don’t get me wrong. They work. In fact, a good friend of mine did her Master’s project at the same time as I did to show their effect at lowering LDL cholesterol in a clinical trial. There have been more than a handful of randomised controlled trials that show plant sterols can inhibit cholesterol absorption and reduce LDL cholesterol.

The end goal, however, shouldn’t be about reducing your LDL cholesterol levels. You’re probably down with that anyway given you’re reading my blog. The end goal is about reducing your overall health risk, and these margarines have not been shown to do this, despite the Heart Foundation tick and the Health Star Rating. In fact, for a substantial proportion of the population, a lower cholesterol level increases the risk of heart disease (for more information, read this excellent blog post by Zoe Harcombe)

Interestingly, even the American Heart Association released a statement saying the use of sterol and stanol esters should be reserved for adults requiring LDL cholesterol lowering because of hypercholesterolemia, or as secondary prevention after an atherosclerotic event – and these have yet to be updated.

If you want the real benefits of cholesterol lowering foods, eat your plant sterols in the form that nature intended (i.e. plants), not a pharmaceutical company

Anyways.

Here are 10 ways to naturally reduce your risk related to cholesterol and save yourself $8.00

  1. Eat more vegetable fibre. Fibre is the ‘f’ word that is super important but doesn’t receive nearly as much press as the other ‘f’ word (fat). Current recommendations are 28g for females, and 34g for males and we are currently consuming an average of 20g per day. Fibre comes in a few different forms and while soluble fibre has been found to lower cholesterol absorption – this is not the most important aspect to my mind. A few people (who may have a genetic defect that makes them hyperabsorb fibre, or have a defect on their LDL cholesterol recpetors which limits their cholesterol uptake and removal) would benefit from this in particular. Moreso, eating more plant based fibre shifts us back to an eating pattern that, as Eaton & Cordain point out, we consumed for over 99% of human evolution. And while estimations of fibre intake of Hunter Gatherers vary (as pointed out by Steve in this excellent blog post), the point is: we don’t eat enough of these plant-based foods and we need to eat more AND more from the sources of foods which are as close to their natural form as they can be. You’ve heard of the 5 a day campaign? I say we should aim for 9 – and mostly vegetables. This is particularly true if you do have underlying inflammation that is driving up your cholesterol level. There different types of fibre and soluble fibre is known to absorb cholesterol and remove it from food you eat and your bloodstream. This level of detail is certainly useful if you have a genetic predisposition towards a high cholesterol level which places you at risk (i.e. familial hypercholesterolemia). However, to keep it brief: if you’re currently barely managing three serves of vegetables a day – work on increasing vegetables in general. Natural sources of fibre from plants will deliver soluble and insoluble fibre, along with resistant starch. This is a good place to start.
  2. Ditch processed food. Sounds dramatic I know – and it’s not realistic to ‘never eat anything in a packet’. However if most of your daily calories come with a nutrient information panel and an ingredient list, then you seriously need to reconsider what you are putting into your body. Processed food is devoid of nutrients in the forms your body requires, contains additives and preservatives, some of which have a dubious health profile and takes very little energy to digest. This leads to peaks and troughs in your blood sugar levels, poor appetite control and the potential to overeat.
  3. Ditch sugar. No surprises here. Sugar not only increases your risk of metabolic syndrome that can result in type 2 diabetes and increased cardiovascular disease risk, it drives almost all inflammatory pathways in the body. Thankfully though, if you try hard to stick to #2 above, you’ll do this by default. Do note though, minimising sugar includes all forms of sugar – including the ‘natural’ forms. If you’re unsure of what a sugar is, print out this PDF which tells you the 56 different names to burn into your brain for your supermarket shop.
  4. Lose weight. Or, more specifically, lose body fat. Being obese is an independent risk factor for cardiovascular disease, type 2 diabetes, neurological conditions and some cancers. Yes there are certainly limitations with how we define ‘overweight’ or ‘obese’, but you don’t have to rely on tools to establish whether or not you need to lose some additional fat around the middle. You know this yourself.
  5. Increase your intake of omega 3 fatty acid rich foods (think salmon, mackerel, herring and sardines) and consider an omega 3 supplement if you don’t eat fish. I know – you’re thinking ‘what about plant-based sources’? truth is, these don’t contain the type of long chain fatty acids that are most beneficial for reducing risk of chronic disease, and their conversion rate into those forms is quite poor. Eicosapentanoic acid (EPA) is the omega 3 that is involved in reducing inflammation, and if you do have high cholesterol and inflammation, then a supplement such as this Nordic Naturals could be worthwhile taking. While a very recent clinical trial failed to show improvements in total cholesterol with the addition of an omega 3 supplementation, it did show a reduction in fasting blood sugar, triglyceride levels and c-reactive protein (a marker of inflammation in the body). And as I said, your cholesterol level might not be the most important metabolic marker to focus on anyway. Vegetarians especially would benefit from supplementation, and an algae supplement would provide a similar benefit.
  6. Get out in the sun…. and get your vitamin D levels checked. There is an association between low vitamin D and poor metabolic health – studies have shown a link between high sunlight hours and lower cholesterol levels at a population levels. This is due to the exposure of skin to the UVB rays that uses cholesterol to create vitamin D. However, a large percentage of New Zealander’s are below adequate levels. For best and safe practice, sun exposure, minus the burning, for 10-15 minutes where parts of your skin not often seen by the sun (for maximum absorption) are exposed (think: armpits, abdomen – unless you’re young and gorgeous) is best. The thing is, though, the sun doesn’t hit the earth at the right latitude to get any of those rays to produce vitamin D in winter, so we can be lagging even more coming into spring. So supplementation could well be required. In addition to the mechanism above, studies (like this one) have shown that higher dose vitamin D supplementation can lower cholesterol and inflammatory markers in women. If supplementing, choose a supplement that also includes vitamin K2 to help vitamin D’s absorption such as this Clinicians one.
  7. Alpha-lipoic acid (along with other antioxidants vitamin C or E) can provide antioxidant support to help reduce your overall health risk associated with cholesterol levels (i.e. reduce inflammation and oxidative species) by increasing the activity of your body’s antioxidant defences. If you’re wanting to spend your money on actively lowering your cholesterol, these relatively safe supplement options are a better idea than margarine.
  8. Your thyroid, your gut, your genetic profile can all influence your cholesterol profile. If your cholesterol is more than a bit elevated, consider investigating other reasons for this. FYI it’s now easier to get your LDL cholesterol tested, rather than calculated, including those which are more atherogenic, such as VLDL, oxidised LDL if you do have concerns. You can work with a practitioner to do this.
  9. Exercise. Free and long known to improve metabolic health. The arguments for or against the benefit of exercise for losing weight are irrelevant. Mood, lean muscle mass, cardiovascular fitness and general all around awesomeness will increase. It doesn’t mean you have to slog it out in the gym. Body weight exercises and some short, sharp, intense exercise a couple of times a week – combined with walking and general movement as much as you can – is most effective for health and wellbeing. If you like to track your details then get a Fitbit or a Garmin or similar. If you obsess over numbers then don’t.
  10. Stress less. Sleep more. And if you are losing weight, and doing all of the above, wait for your weight to stabilise before worrying too much about your cholesterol levels, which can be elevated during this time.

 

Body weight exercises from the 7min workout - not a bad place to start. (http://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/)

Body weight exercises from the 7min workout – not a bad place to start. (http://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/)