What’s the best exercise for longevity?

Well, that’s a bit of a loaded question, really. As any is better than none, and there will be different points of views by different experts (of which I am not one of them). However, the older I get, the more I am interested in the effects of ageing on our overall health span. Ageing is unavoidable; it happens to the best of us. Listed below are some of the physiological and biological changes that can occur the older we become:

  1. Insulin resistance – this is in healthy weight older adults also, with research showingthere is more peripheral insulin resistance compared to a younger population (an inability to dispose of glucose into the tissue).
  2. Decreased availability of anabolic hormones, and increased frailty with lower levels of hormones
  3. Increased anabolic resistance, so not only is there a decrease in the hormones that signal tissue growth, the muscle tissue is less responsive to the stimulus of amino acids (protein) and exercise, and there is less muscle protein synthesis in comparison to breakdown.
  4. Greater protein requirementsfor the same relative gains in muscle, strength and function compared to a younger population
  5. Decreased motor neuron function, therefore less neural signalling to muscle tissues and reduced motor function.
  6. Increased intracellular oxidative stress, causing inflammation and reduced cell functioning
  7. Reduction in satellite (stem) cellsnumbers and regenerative capacity – these cells are essential for the maintenance and repair tissues in normal physiological processes or in response to muscle damage/trauma.
  8. Elevated myostatin signalling, a protein that blocks our ability to build muscle
  9. Increased chronic inflammation (also known as inflamm-aging)
  10. Changes in autophagy, where ageing reduces our ability to clear out damaged DNA
  11. Mitochondrial functioning abnormalities, where we can’t utilise energy metabolites as effectively to fuel mitochondria
  12. Reduced ability to be physically active (due to many of the reasons listed above)

This is a long, daunting and rather depressing list of what can occur as we age – and we are an ageing population. There is no doubt that if we don’t look after the body we have got, then we really are staring down the barrel of a loaded gun. The list above describes many of the mechanisms to explain the loss of muscle mass and function. It’s not about being ripped or having gainz, it’s about having proper functioning of the muscle so it can work effectively in our older years. This is what is shown to have the most positive impact on our cardiovascular, neurological and musculoskeletal systems.

Inactivity is the broader environmental issue that we need to address any (and all) of the physiological issues I have mentioned above. We need to be active – in everyday life, and with some structured activity too. Hanging out washing and housework isn’t going to cut it, I’m afraid. I see a lot of people who have this idea that you don’t need to exercise in order to lose weight, and you can do it solely on diet alone. This is true, of course, but when you embark on any weight loss plan that restricts calories (i.e. any weight loss plan that is out there), then you will lose both fat weight and muscle mass – lowering your overall metabolic rate along with it. This is one of the reasons why weight regain is so prevalent, however the powerful combination of diet plus exercise helps sustainable weight loss. As I alluded to above, exercise isn’t just moving around the house, doing chores – this should just be part of everyday living. Data looking at the effects of exercise show that resistance training confers benefits over and above what we would see if we were just doing 30 minutes exercise per day.

The right type and duration of exercise:

The challenge is to get people exercising. And this is especially so for those who read what I have said above, and think that – on top of 30 minutes of aerobic training they don’t have time to do, they then need to put some resistance (or weight) training in.

I’m not writing this to encourage you to find an additional 3 hours in your week, though.

In fact, a study that is yet to be published (I heard about it on STEM talk) suggests that just 72 minutes a week in total is enough to help many of the conditions associated with ageing and poor health that I’ve mentioned above. Egan and colleagues found a combination of both resistance and cardiovascular exercise in a circuit-type setting for adults over 65 years just three times a week for 24 minutes increased walking speed, leg strength and reduced trunk fat. These measures speak to better muscular function, obviously increased strength, and will help reduce metabolic health risk. The improvements were more potent in this combined group than either resistance training or aerobic training for the same duration.

So this was a very long preamble to the main message: if you are currently NOT exercising, then please start. While there are modalities that are better than others, seriously, anything will be better than nothing. The study I talked about is in older adults, you likely don’t need me to tell you that any age you start is obviously better than not starting at all. AND the earlier you start, the better the overall health outcomes.

Exercise-1

Seriously. Those pink dumbbells. Because obviously an older female couldn’t possibly lift anything heavier, right?! (PC:www.fabafterfifty.co.uk).

 

Exercise for longevity – is there a best approach?

The older I get, the more I am interested in the effects of ageing on our overall health span. Ageing is unavoidable, it happens to the best of us. Listed below are some of the physiological and biological changes that can occur the older we become:

  1. Insulin resistance – this is in healthy weight older adults also, with research showing there is more peripheral insulin resistance compared to a younger population (an inability to dispose of glucose into the tissue).
  2. Decreased availability of anabolic hormones, and increased frailty with lower levels of hormones
  3. Increased anabolic resistance, so not only is there a decrease in the hormones that signal tissue growth, the muscle tissue is less responsive to the stimulus of amino acids (protein) and exercise, and there is less muscle protein synthesis in comparison to breakdown.
  4. Greater protein requirements for the same relative gains in muscle, strength and function compared to a younger population
  5. Decreased motor neuron function, therefore less neural signalling to muscle tissues and reduced motor function.
  6. Increased intracellular oxidative stress, causing inflammation and reduced cell functioning
  7. Reduction in satellite (stem) cells numbers and regenerative capacity – these cells are essential for the maintenance and repair tissues in normal physiological processes or in response to muscle damage/trauma.
  8. Elevated myostatin signalling, a protein that blocks our ability to build muscle
  9. Increased chronic inflammation (also known as inflamm-aging)
  10. Changes in autophagy, where ageing reduces our ability to clear out damaged DNA
  11. Mitochondrial functioning abnormalities, where we can’t utilise energy metabolites as effectively to fuel mitochondria
  12. Reduced ability to be physically active (due to many of the reasons listed above)

Clearly, these are not all inevitable. However, it is a long, daunting, and rather depressing list of what can occur as we age – and we are an ageing population. There is no doubt that if we don’t look after this body we have got, then we really are staring down the barrel of a loaded gun.

The list above describes many of the mechanisms to explain the loss of muscle mass and function. It’s not about being ripped or having gainz, it’s about having proper functioning of the muscle so it can work effectively in our older years – this is what is shown to have the most positive impact on our cardiovascular, neurological and musculoskeletal systems.

Inactivity is the broader environmental issue that contributes substantially to the physiological issues I have mentioned above. We need to be active – in everyday life, and with some structured activity too. Hanging out washing and housework isn’t going to cut it, I’m afraid. I see a lot of people who have this idea that you don’t need to exercise in order to lose weight, and you can do it solely on diet alone. This is true, of course, but when you embark on any weight loss plan that restricts calories (i.e. any weight loss plan that is out there), then you will lose both fat weight and muscle mass – lowering your overall metabolic rate along with it. This is one of the reasons why weight regain is so prevalent. However the powerful combination of diet plus exercise helps sustainable weight loss. And exercise isn’t just moving around the house, doing chores – this should just be part of everyday living. Data looking at the effects of exercise show that resistance training confers benefits over and above what we would see if we were just doing 30 minutes of cardio-based exercise per day, something that many of us maintain, but it doesn’t offer the same benefits.

The right type and duration of exercise:

The challenge is to get people exercising. And this is especially so for those who read what I have said above, and think that – on top of 30 minutes of aerobic training they don’t have time to do, they need to then put some resistance (or weight) training in.

This is not a call to encourage you to find an additional 3 hours in your week, though. In fact, a study that is about to be published (I heard about it on STEM talk) suggests that just 72 minutes a week in total is enough to help many of the conditions associated with ageing and poor health that I’ve mentioned above. Egan and colleagues found a combination of both resistance and cardiovascular exercise in a circuit-type setting for adults over 65 years just three times a week for 24 minutes increased walking speed, leg strength and reduced trunk fat. These measures speak to better muscular function, obviously increased strength, and will help reduce metabolic health risk. The improvements were more potent in this combined group than either resistance training or aerobic training for the same duration. It wasn’t olymic lifting from the sounds of it,  but it also wasn’t lifting pink dumbbells, either.

So this was a very long preamble to the main message: if you are currently NOT exercising, then please start. While there are modalities that are better than others, seriously, anything will be better than nothing. The study I talked about is in older adults, you likely don’t need me to tell you that any age you start is obviously better than not starting at all. AND the earlier you start, the better the overall health outcomes.

There is often an argument as to which is best; exercise or diet for improving health. That’s a weird argument to my mind. Both are important and should be prioritised if you want more life in the years you’ve got left.

stronger-effect-of-resistance-training-when-combined-with-protein-supplementation

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

Holiday weight gain?

Who doesn’t love a holiday? A break away from early alarm clocks, work and household chores. When out of your own space you’re forced to leave behind the normal routines that are well established in everyday life, which is obviously why we come back feeling refreshed and ready to get back into it. The problem, though, is that many people panic about getting out of routine with their food and exercise – what if that 10 days in Fiji goes and undoes the last three months of hard work and they end up gaining weight?

Well, it might not. Why?

1. You are a LOT more active on holiday compared to real life: driving to work and sitting in an office does not afford the same opportunity to be as active as sight-seeing does. I clocked up almost double the number of steps as I normally would when I was away. Even on days we didn’t run, relying on both public transport and my feet to see a city racked up enough steps so I was regularly doing 23,000 or more each day. However, if you’re a lounge-around-the-pool kind of vacationer, if you had a hit out in the hotel gym, you can avoid weight gain for a short term holiday in the face of a calorie excess.

2. You sleep more: lack of sleep will drive up insulin and cortisol levels and create a hormonal environment that is unfavourable for fat loss. Even if you have the perfect diet (if there is such a thing), no amount of calorie counting, carb watching, or protein eating will make up for the string of 5-6 hours a night you manage during the week when work, exercise and home duties take up so much time, you stay up later than you know you should just to enjoy a little time out.

3. You’re generally more relaxed. The everyday stress created by school pick-ups, work deadlines and weekend sport might be ‘normal’ life, but don’t underestimate the effect this can have on your ability to lose weight. While we may not know the underlying mechanisms, like the effects of sleep deprivation, a chronic overload of stress will increase hormones responsible for fat gain regardless of what you eat or how much exercise you do. In fact, for some, their normal stress relief of going for a run or doing an F45 class will only add to the stress bucket, further exacerbating a weight loss stall. And, when stressed, we often reach for food that is high in calories, low in nutrients.

What if it does?

If you were maintaining or losing weight prior to going away on holiday, then that tells me you’ve got the tools necessary to help you refocus on an eating style and exercise routine that will easily shed any fat gain that is the result of too many cocktails by the pool.

Actual fat gain will be quite minimal, and pretty easy to shift – potentially easier than what you were finding before your holiday. The additional calories eaten on holiday aren’t all stored as fat (at all!) We restock depleted glycogen, and for some, short term overfeeding  increases resting metabolic rate in response to increased food (as many of the overfeeding studies conducted under laboratory conditions have found). Even if you have a predisposition for weight gain, the amount of weight you can is usually far less than the excess calories eaten would predict.

However, for those panicking about the additional fat gain (if any):

1. Up the protein intake. This will help reduce any carb-related cravings from too many pancakes/baked goods/fat chips. Aim for foods that will provide 30g of protein per meal (as an example, a 150g beef steak has about 37g of protein, 3 large eggs around 24g of protein). This will help fill you up and regulate blood sugar, preventing any dip in energy that might be exacerbated by lack of sleep or jetlag. Combined with strategies listed below, it’s a recipe for fat loss.

2. Lay off the alcohol. We definitely had more wine and beer on holiday, and in the space of 15 days I had 2 days where I didn’t consume any during the holiday. Despite that I’m not drinking any more than 1-2 glasses (3 on a couple of occasions), it is more than what I’d normally drink. Post-holiday I went for a week without any – not a long time, but enough to help me get over my post-holiday tiredness and to ‘break the habit’ as it were. And I have to say, feel quite virtuous.

3. Drop back the fat intake – if you’ve gained excess body fat, then we want your body to tap into this (potentially) accessible fuel source – this obviously requires a calorie deficit. There is no need to seek out ‘low fat’ foods or avoid foods that naturally contain fat (i.e. egg yolks), however reducing down the amount of added fat to meals (via sauces, dressings, cooking oils, nut butters etc) will help reduce the calorie content of your diet with minimal effort.

4. Drop back the carbohydrate intake – some people benefit from doing a 21 day low (er than normal) carbohydrate diet. I know what you’re thinking – if I drop the fat AND the carbs, what do I eat? I’m talking short-term here – you base your meals around protein and titrate fat and carbohydrate according to that. If you know you feel better with a bit of carbohydrate in your diet, that’s no issue – just make it good quality (i.e. kumara) and make it a moderate serving. However, ample amounts of even low sugar carbohydrate (like rice, pasta, bread etc) will make it more difficult to shift.

5. Include plenty of vegetables – base your meals around these. The prebiotic fibre can help improve the gut environment after a week or more of too much fried foods (though that cheese hoagie was delicious) and too much alcohol. Splashing raw apple cider vinegar (ACV) on steamed vegetables ups the taste factor and helps reduce post-prandial (post-meal) blood sugar, making you less likely to search for something sweet. In addition, you can go for gold on most non-starchy vegetables, so fill your plate to help fill you up.

6. Lift weights. Heavy ones. If you don’t have access to a gym then even body weight exercises (such as press-ups, squats, lunges) if not doing them, will create stress to help you build muscle. I’m not suggesting you avoid lacing up for your long run – I’m a long-distance runner after all! –  resistance training, though, is metabolically demanding in the short term, and in the long term will preserve your resting metabolic rate to allow you to burn fat in everyday life. Plus, you’ll improve strength. Bonus.

7. Consider fasting. Be it the 5:2 protocol that I utilise in my fat-loss plans, a 16:8 protocol that is popular (i.e. fast from 8pm to 12pm the next day, or Super-fasting as per the Schofield/Zinn protocol outlined in What the Fast, it’s consistently found to improve metabolic health markers and can reduce calorie intake to elicit a fat-loss response.

8. Get plenty of sleep – try to get back into a 7-8h per night habit with this one and be disciplined about it, for reasons I outlined above.

And, finally (and most importantly), does it matter? I mean, does it truly matter that you come back from an awesome time away with a couple of additional kilograms? Part of the beauty of a holiday is leaving behind all of the routines of your day-to-day life, including exercise and your normal foods for breakfast, lunch and dinner. Many of us need a mental break almost as much as a physical one, and this includes a break from your usual diet and exercise regime. You will come back feeling refreshed and ready to embrace these with renewed energy (or being in a mindset of change for the better, if that is more appropriate).

escape

Get away from the routine of being in routine… (PC locokerala.com)

Food rules.

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

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

The types of rules I’m thinking about include:

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

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

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

One Simple Health Rule copy

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

Coffee: your friend or foe?

Coffee. It’s like the world’s favourite elixir. Mine included. For an athlete, there are many studies supporting its use as an ergogenic aid for athletes – helping reduce rates of perceived pain and effort, improving muscle fibre recruitment and enhancing glycogen repletion post-workout. These benefits are individual, however, and while research suggests that genetic differences in our ability to detoxify caffeine could account for this, it is not a universal finding. This is something true for athletes and non-athletes alike.

Other features of coffee are also salient for all individuals. Caffeine is ketogenic; not only can it help mobilise fatty acids to be used for energy, it increases the presence of ketones in the bloodstream – hence it is a good pre-workout fuel to help elicit fatty acid oxidation pathways and provide fuel for the workout in the absence of glucose. This doesn’t necessarily translate in additional body fat loss (more important lifestyle strategies are required for that, such as a caloric deficit, resistance training, reduction in stress etc), but can encourage these energy pathways to be upregulated, helping in the process of becoming adapted to a lower carb dietary approach.

Coffee improves insulin sensitivity and glucose tolerance (potentially related to the polyphenols present, though the mechanism is currently unclear), therefore enhancing the effects of both a lower carb approach, or a plan that includes fasting (either intermittent fasting, super-fasting, or a 5:2 approach such as the one in my fat-loss plans). Further, anyone doing my accelerated fat loss plans who have that 16h intermittent fast on the ‘fasting mimicking’ days could experience a more potent effect from the fast by including black coffee alongside water as their beverages of choice.

Autophagy, where our body starts to clear out damaged cells from the liver, heart and muscle tissue, is one of the benefits of fasting as you know. In mice models it might take just 16 hours for this to occur, in humans it is likely to take a lot longer given the differences in our metabolic rate (a mouse has a faster metabolism). Consuming caffeine on an empty stomach (or as part of a fast) promotes autophagy, which theoretically would shorten the time that is required to fast to stimulate this process. It also triggers AMPK, an enzyme that inhibits fat storage, promotes fat burning and activates antioxidant networks. These properties are thought to underpin much of the purported health benefits of drinking coffee.

It IS a balance though – if you’re following a fasting protocol, working out, and reading this at 3.30am in the morning, it’s a good sign that your brain is wired – raising cortisol to the extent that it’s (quite obviously) disrupting sleep. When we fast, like exercise, it places a stress on the body – this is where many benefits come from, as your body responds and adapts, becoming more resilient. However, too much of anything is too much! If coffee on top of your fasting regime or exercise program (or, life in general) is causing this stress response, then it is worth dialling it back a bit (or go 1/2 and 1/2 with decaf) to see if this changes your stress response.

Caffeine (or coffee), though, may not be good for anyone with gut issues. As it can stimulate the stomach cells to release more gastric juices, aiding in digestion, we often hear that too much coffee promotes a highly acidic environment and as such, could increase the risk of damage to the cells and subsequent gut issues. The literature, though, reports that caffeine does not negatively impact gastric or duodenal ulcers, and in fact when administered in vitro, could help repair cells damaged by inflammatory bowel conditions such as ulcerative colitis, and is also protective for the mucosal layer of the gut. Research suggests this is because caffeine increases blood flow to the gastrointestinal tract. Conversely, caffeine can lower the tone of the oesophageal sphincter – the valve that controls the release of stomach acid into the oesophagus, thus may promote heartburn and reflux.

With all research studies, it’s important to remember you are your own best investigator when it comes to how coffee affects you. I’ve said this before, but a good point to reiterate. The best advice, then, is to pay attention to how you feel when you drink coffee. Does drinking coffee make you more wired, especially when you fast, indicating it stimulates your stress (or cortisol) response? Does it give you reflux or heartburn? Does it upset your digestive tract more than settle it? Everyone has a different tolerance level to coffee, and further, our ability to detoxify it may also be different. If you feel great when you have coffee, and you don’t have any gut-related issues, then it is likely absolutely fine for you. If you notice an irritated gut, or you feel a bit wired, then it isn’t worth persevering with coffee for the purported health benefits – in your case, it might be making things worse.

coffee2

Ahhh… coffee 🙂

Does HIIT take a hit on a ketogenic diet?

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

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

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

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

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

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

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

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

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

hiit-for-cyclists01c52

Hungry?

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

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

Why do you fear being hungry?

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

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

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

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

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

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

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

 

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

The non-food reasons you’re constantly craving…

Cravings. We all have them at one time or another, and while a lot of it can largely be mitigated by building your diet around a foundation of good quality protein, fat and fibre, with the addition of some unrefined carbohydrates, for whatever reason sometimes even this is not enough to withstand the temptation to snack on something you wouldn’t otherwise grab. Not only is it distracting to be thinking about food, cravings do in fact reduce cognitive ability– affecting our ability to recall information.

Why is it that sometimes your energy and appetite is well supported by your diet, and other times they are not? Well, first – it’s not all about the food (obviously!) Here are other reasons for an increase in cravings that are often overlooked.

  1. Lack of sleep: this is one that we can all attest to: a bad night’s sleep makes it more difficult to resist the call of that raw vegan cake in the local café. That’s because even one night of sleep restriction (less than 6 hours of sleep) will affect the feedback-reward loop in your brain that makes you crave sweet (or salty, fatty) processed food. Lack of sleep will enhance the reward factor, leading to a more intense craving AND you’ll gain even more pleasure from eating it. Like anything that feeds into this pathway, though, the amount needed to satisfy the craving will increase the more you have it. One night’s rubbish sleep will also increase the body’s cortisol response – sending signals to your liver to dump glucose into the blood stream – this shift in blood sugar levels causes other hormones to kick into gear (such as insulin) and in no time at all, blood sugar levels drop -causing you to crave foods that are high in carbohydrate to bring them back up to within normal range. This fluctuation in blood sugar creates highs and lows in your energy levels, but ultimately leaves you feeling far worse than you would have otherwise.
  2. Stress – see above for why a situation that leaves you feeling overwhelmed causes you to crave sweet or fatty, salty food and the effects of this. The situation itself, though, can also drive you to the vending machine outside of any blood sugar changes. Eating in response to stress is a distraction technique that will take your mind off what is going on around you, and many find themselves eating food they don’t want to eat, in amounts they don’t want to be consuming, as a way to avoid the stressor.
  3. Coffee – as a stimulant, coffee may affect the food choices of people who are sensitive to its effect. If you are sensitive to its stimulant effects, then the changes in stress hormones may cause the same blood sugar management issues that I’ve discussed earlier. However, it coffee can affect food choices in another way too – recent researchhas found that caffeine can dull our perception of a sweet taste by blocking the adenosine receptors in our brain. The same mechanism that increases our alertness may drive a preference for sugary foods as we don’t get the expected level of sweetness.
  4. Alcohol – another blood sugar disruptor, alcohol also causes a disinhibition of behaviour. While people can easily forgo a platter of food with no alcohol onboard, 1-2 drinks later and suddenly we don’t really care if we eat 1 cracker or 10. Alcohol increases the release of dopamine in the brain, much like eating sugar does. Over time we become less sensitive to the effects of dopamine and require more of a substance to help us get the same effect. This is another reason why we may have sugar cravings after drinking alcohol. Finally, to point out the obvious, alcohol disrupts sleep patterns and there is a disinhibition of the different sleep phases. We don’t get the type of sleep that is most restorative and therefore wake up feeling unrefreshed and lacking in sleep. I’ve explained above the effects that this has on our food cravings, and alcohol will further compound the issue.
  5. Hormones. When oestrogen levels drop, serotonin levels also drop (as serotonin requires oestrogen for its production). For some women, then, shifts in hormones across the month, and heading into menopause can trigger cravings where they would otherwise not have any. So that sugar/chocolate thing? It’s a physiological drive that can be super hard to ignore.

What to do about your cravings?

Obviously, the first thing I’m going to mention address the situations or triggers above. The more you prioritise good sleep hygiene and stress management, the better you are able to manage your diet, it is that simple. I’ve talked about both of these in more detail here and here, with tips to help you nail both. Further, consider your eating habits around the consumption of coffee and alcohol. If your intake is increasing, or at a level that you think might be too high for you, cutting down on both of these could help. If you’re unsure then ask a good friend their opinion, as it can help to have objective advice from someone you trust.

The second thing? Read this article I wrote last year, detailing some helpful food strategies and supplements which may support blood sugar and cravings, including chromium, 5Htp, magnesium and cinnamon.

The third thing? Use a distraction technique. Sometimes cravings are associated with a time of day, with boredom or (as mentioned) stress. Put some strategies in place to help offset the craving. Too often, the psychology around eating foods we crave is about ‘giving in’ – this brings about a sense of failure and people berate themselves for a lack of willpower. The food that we’re eating in this scenario is often eaten standing up, in front of the fridge or the pantry, is eaten quickly (for fear of being caught) and then brings about a sense of shame that we couldn’t ‘control ourselves’. Often, too, the mindset of ‘I’ve blown it’ leads to further unhelpful thought patterns – such as ‘I’ve had one biscuit, I might as well consume the entire packet as it’s the last time I’ll ever eat biscuits.’ Let’s be real: this won’t be the last time you’ll eat biscuits. And you haven’t ruined anything.

A distraction strategy might include (as it does for some clients of mine): having two glasses of water, brushing your teeth and getting outside for a brisk walk (of even 2 minutes). Then, if you are still craving something (or feeling like eating something), make the decision to have it. BUT you must eat it in a way that allows you to engage fully in the process. Get a plate or bowl, serve yourself some of whatever it is, then sit down and (where possible) using cutlery to eat it slowly, savouring the flavours. And really enjoy it. Then move on.

If you need a good food strategy to help mitigate your cravings, check out my real food meal plans – providing a 28 day meal plan each month along with personalised nutrition coaching to help meet your goals.

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Junk food that’s not off the hook.

Six things I think you should know about LDL cholesterol

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

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

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

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

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

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

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

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

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

 

Diet and body composition: 11 key take home points

The International Society of Sports Nutrition just released a position stand that reviewed the literature available regarding diet and body composition. You can read it here.  For those who want it broken down into more simple terms, I’ve distilled it somewhat into 11 key take home points. While much of this draws on literature from strength and power athletes, it is definitely applicable to the general audience too, given that resistance-based training is one of the best things you can do to support your health and body composition goals.

  1. There is a vast multitude of diets and within these, several subtypes of diet. Low fat, low carb, higher protein, Mediterranean, low calorie… and these will all work work to reduce body fat given the right conditions. As a practitioner, we need to be familiar of the evidence supporting each diet type to make informed recommendations to the people we interact with, both at an individual and population level. As someone who is interested in losing body fat, know that no ONE diet is going to suit everyone, and if you’re trying to follow something because your mate is too, but you’re not seeing the results, then potentially it’s not the right plan for you. Seems simple when I write it down – but I think important to remind you.
  2. All body composition assessment methods have strengths and limitations. It’s good to bear in mind the limitations of using just scales as the only indicator, as this doesn’t account for fat mass loss. I’ve had numerous clients basically freak out that they have gained a kilogram overnight because they’ve eaten something high in carbs (causing your body to hold water) or they have done a hard training session (inflamed tissue). It is impossible to gain kilo of fat over a week, let alone a night, but the obsession with scales can make even the most rational person a little … less rational. Thus, if you use the scales, then think about how this makes you feel. And do it at the same time each week, on waking, after you go to the bathroom – etc. IE try to make it consistent. Ditto re: skinfolds – choose a practitioner who is skilled and stick to the same person so any errors are at least consistent errors.
  3. While it’s not about ‘calories in, calories out’, as that is far too simplistic, we do need to create a deficit in calories to drop body fat. Don’t freak out by the next bit of (evidence-backed, science-informed) information: The more fat you’ve got stored, the quicker you can lose this body fat without losing too much muscle mass by creating a large calorie deficit. The leaner an individual is, it is better if the caloric deficit isn’t as dramatic, to help preserve muscle mass. We can use calorie cycling to do this (ie higher calories for some days, lower for others across the course of 7-14 days, such as the 5:2 approach), or a consistently lower calorie approach, whatever fits in with the individual and their adherence. This study found that working on a weekly reduction of 0.7% of body weight better than 1.4% for preservation of lean muscle tissue.
  4. A wide range of dietary approaches (low-fat to low-carbohydrate/ketogenic, and all points between) can be similarly effective for improving body composition, and this allows flexibility with programme design, which is great – again, there is no one right approach for everyone. AND there is no one approach that will suit the same individual all the time – context, physical activity, stress, budget etc will all affect the suitability of an eating style that will improve body composition. This in part could explain why Weight Watchers, which helped you drop weight in the past, is not working now – regardless of how many points you are under at the end of the day/week. Being flexible rather than dogmatic will go a long way to finding a plan that suits you. I will also add, however, that something based on minimally processed food contains more nutrients – this will nourish your body and provide nutrients to ensure metabolism, brain and gut health are optimised while shifting excess body fat.
  5. When protein amounts are matched in the diet, there doesn’t appear to be an approach that reports a meaningful reduction of fat when we look at different macronutrient composition. All are as effective as each other – it’s sustainability which is the factor to consider. If an individual is insulin sensitive, research shows they are going to be able to lose weight on a moderate carbohydrate diet and potentially perform better on that than a lower carbohydrate diet. The reverse is also true. In addition, when adding resistance training to the mix, in some instances insulin sensitivity is improved. Therefore, knowing your metabolic health markers initially can help you determine what dietary approach might work for you.
  6. However, a ketogenic diet has been shown to have appetite-suppressing potential in part due to its effects on our appetite hormones (as explained in this review), resulting in a spontaneous caloric restriction. That said, for some this may only happen initially and clinically I have seen that this affect appears to wear off. (Note, this is my clinical observation).
  7. Increasing dietary protein to levels significantly beyond current recommendations for athletic populations (up to 2g/kg body weight) may improve body composition as in line with the ISSN’s position stand. It is also much more satiating for those of us who aren’t athletes, particularly in a restricted calorie state (as I’ve discussed here). There is also evidence that increasing protein in the diet beyond 3g/kg body weight and creating a calorie surplus can increase muscle mass and decrease fat mass simultaneously- I know! It’s like magic! Except very difficult to eat that much protein for a lot of people.
  8. Time-restricted feeding (which I’ve written about here) combined with resistance training is an emerging area of research that has thus far shown mixed results with respect to body composition (ie see here and here, however eating within that restricted window does allow for improvements in metabolic health. Much like cycling calories, the window of time that people choose to eat should be based on individual preference in a way that is easy to be sustained in everyday life. There is more to gain from having a good resistance-based training programme and adequate protein (in the context of an awesome diet) than worrying if your eating window is 8 hours a day or 9 hours a day.
  9. Do we starve our metabolism, thus slow it down and lead to fat gain if we restrict calories too much? Only in the context of a restrictive caloric diet and in the absence of resistance training where muscle mass has reduced, and energy expenditure has reduced. This can be mitigated when these are accounted for (see here and here).
  10. In addition to this, clinically what seems to work well is having a metabolic reset meal, where more fat/carb calories are consumed (which some might call a ‘treat’ or ‘cheat’ meal, particularly in the fitness industry) – this might be 1-2 meals every 7-14 days depending on the individual and their goals.
  11. There needs to be more research on women, older adults
  12. There needs to be more research on meal frequency and timing combined with different caloric loads, and with different training regimes.

Despite all of the above, a member of my online nutrition coaching system shared with me her experience with improving overall health (and metabolic markers – prior to embarking on her regime her HbA1c was in ‘pre-diabetic’ range). She found focusing on a higher fat approach, coupled with water fasting helps her control her insulin resistance and overall health much more than focusing on protein intake. While a few years ago this would have set alarm bells ringing in my head, the longer I’m in the game the more I understand that it is so individual as to how someone will respond to a dietary approach. Being willing to experiment with different protocols will help you figure out what works best for you regardless of the research papers.